益气化瘀汤联合西药治疗早期糖尿病肾病疗效观察及对血管内皮功能的影响

Yiqi Huayu Tang Combined with Western Medicine for Early Stage Diabetic Nephropathy and Its Effect on Vascular Endothelial Function

目的:观察益气化瘀汤联合西药治疗早期糖尿病肾病的疗效及对血管内皮功能的影响。方法:将106例早期糖尿病肾病气阴两虚兼血瘀证患者随机分为西医组和观察组各53例。西医组给予控制血糖、改善生活方式、控制血压、调脂、饮食干预等综合措施,并口服缬沙坦片治疗。观察组在西医组治疗基础上加服益气化瘀汤治疗。2组疗程均为3月。检测2组患者治疗前后的空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿素氮(BUN)、血肌酐(SCr)、24 h尿蛋白定量(24h Upr)、一氧化氮(NO)和内皮素-1(ET-1)水平,比较2组的临床疗效与中医证候疗效。结果:临床疗效观察组总有效率为67.92%,高于西医组的45.28%,差异有统计学意义(P<0.05)。中医证候疗效观察组总有效率为84.91%,高于西医组的66.04%,差异有统计学意义(P<0.05)。2组FBG治疗前后比较,差异均无统计学意义(P>0.05)。治疗后,2组HbA1c、24h Upr、BUN和SCr水平均较治疗前下降(P<0.01),观察组HbA1c、24h Upr、BUN和SCr水平均低于西医组(P<0.01)。2组血清ET-1均较治疗前下降(P<0.01),NO水平均较治疗前升高(P<0.01);观察组ET-1水平低于西医组(P<0.01),NO水平高于西医组(P<0.01)。结论:在西医常规疗法基础上加用益气化瘀汤治疗早期糖尿病肾病气阴两虚兼血瘀证,能有效改善患者的临床症状,减轻蛋白尿,并能改善血管内皮功能,延缓肾功能的损害,临床疗效显著。

Objective：To observe the curative effect of Yiqi Huayu tang combined with western medicine in treating early stage diabetic nephropathy（DN） and its effect on vascular endothelial function.Methods：Divided 106 cases of patients with early stage DN of deficiency of both qi and yin and blood stasis syndrome into the western medicine group and the observation group randomly,53 cases in each group.Both groups received comprehensive measures,such as control of blood glucose,improvement of lifestyle,control of blood pressure,regulation of lipid,diet intervention and so on,and both groups also received valsartan tablets orally.The observation group additionally received Yiqi Huayu tang.Both groups received treatment for3 months.Detected levels of fasting blood glucose（FBG）,glycosylated hemoglobin（HbA1c）,urea nitrogen（BUN）,serum creatinine（SCr）,24 hours urinary protein（24h Upr）,nitric oxide（NO） and endothelin 1（ET-1） in both groups before and after treatment,and compared the clinical effect as well as Chinese Medicine（CM） symptom effect in both groups.Results：The total effective rate in the observation group was 67.92%,being higher than 45.28%in the western medicine group（P〈0.05）.The total effective rate of CM symptom effect in the observation group was 84.91%,being higher than 66.04%in the western medicine group（P〈0.05）.No significance was found in the comparison of FBG between two groups before and after treatment（P〉0.05）.After treatment,levels of HbAlc,24 h Upr,BUN and SCr in both groups were deceased,comparing with those before treatment（P〈0.01）.Levels of HbAlc,24 h Upr,BUN and SCr in the observation group were lower than those in the western medicine group（P〈0.01）.Comparing with those before treatment,levels of serum ET-1 in both groups were declined（P〈0.01）,and levels of NO in both groups were increased（P〈0.01）.Levels of serum ET-1 in the observation group were lower than those in the western medicine group（P〈0.01）,and levels of NO were higher than those in the western medicine group（P〈0.01）.Conclusion：The therapy of Yiqi Huayu tang based on routine western medicine therapy for early stage DN of deficiency of both qi and yin and blood stasis syndrome can effectively improve clinical symptoms,reduce proteinuria,improve vascular endothelial function and delay renal dysfunction,which has significant curative effect.