益肾降糖饮对早期糖尿病肾病气阴两虚证患者尿单核细胞趋化蛋白-1、血C反应蛋白的影响

Effects of Yishen-jiangtang decoction on urinary MCP-1 and blood CRP in early diabetic kidney disease patients with qi and yin deficiency syndrome

目的观察益肾降糖饮对早期糖尿病肾脏病(DKD)气阴两虚证的疗效。方法将120例早期DKD患者随机分为2组,对照组60例(后剔除4例)给予控制血糖、血压、血脂等基础治疗,治疗组60例(后剔除4例)在基础治疗的同时予益肾降糖饮口服,治疗周期为90 d。观察患者治疗前后尿微量白蛋白/尿肌酐(ACR)、尿单核细胞趋化蛋白-1(MCP-1)、血C反应蛋白(CRP)、肾小球滤过率(GFR)、空腹血糖(FPG)、血肌酐(Cr)、血脂、糖化血红蛋白(HbA_1c)及中医证候积分等指标的变化,并统计疗效。结果治疗组DKD疗效及中医证候疗效均优于对照组,差异有统计学意义(P<0.05)。治疗组治疗后尿MCP-1、血CRP、ACR及中医证候积分较治疗前均降低,GFR升高(P<0.01,P<0.05)。对照组治疗后尿MCP-1、血CRP均降低,ACR升高(P<0.01,P<0.05);GFR、中医证候积分比较差异无统计学意义(P>0.05)。2组治疗后尿MCP-1、ACR、中医证候积分比较差异有统计学意义(P<0.01,P<0.05);血CRP、GFR比较差异无统计学意义(P>0.05)。治疗组治疗后血Cr、HbA_1c较治疗前均降低(P<0.05,P<0.01),对照组治疗后HbA_1c降低(P<0.05),血Cr较治疗前无改善(P>0.05)。2组治疗后血Cr比较差异有统计学意义(P<0.01),HbA_1c比较差异无统计学意义(P>0.05)。2组组内治疗前后FPG及血脂指标比较差异无统计学意义(P>0.05),2组治疗后FPG及血脂指标组间比较差异无统计学意义(P>0.05)。结论益肾降糖饮可改善早期DKD气阴两虚证患者的临床症状,可降低其尿MCP-1水平,延缓肾功能损害的进展。

Objective To observe the effects of Yishen-jiangtang decoction on early diabetic kidney disease（DKD） patients with qi and yin deficiency syndrome.Methods 120 early DKD patients were randomly divided into two groups.The control group（n = 60） was treated by controlling blood sugar,blood pressure,blood lipids and other basic treatment,and the treatment group（n = 60） was treated by Yishen-jiangtang decoction on the basis of the conrol group.The treatment course was 90 d.The urinary micro albumin/urine creatinine（ACR）,urinary monocyte chemoattractant protein-1（MCP-1）,blood C reactive protein（CRP）,glomerular filtration rate（GFR）,fasting plasma glucose（FPG）,blood creatinine（Cr）,blood lipid,glycosylated hemoglobin（HbA1c） and traditional Chinese medicine（TCM） syndrome scores before and after treatment were observed in two groups,the curative effects were evaluated.Results The curative effects of DKD and TCM syndrome in treatment group was superior to that in control group（P〈0.05）.The urinary MCP-1,blood CRP,ACR and TCM syndrome scores after treatment reduced in treatment group,and the GFR increased（P〈0.01,P〈0.05）.The urinary MCP-1and blood CRP after treatment reduced in control group,and the ACR increased（P〈0.01,P〈0.05）,with no statistical difference on GFR and TCM syndrome scores（P〈0.05）.There were statistical differences on urinary MCP-1,ACR and TCM syndrome scores after treatment between two groups（P〈0.01,P〈0.05）,and with no statistical differences on blood CRP and GFR（P〈0.05）.The blood Cr and Hb A1 c after treatment reduced in treatment group（P〈0.05,P〈0.01）.The Hb A1 c after treatment reduced in control group（P〈0.05）,and the blood Cr was no improvement（P〈0.05）.There were statistical differences on blood Cr after treatment between two groups（P〈0.01）,with no statistical difference on HbA1c（P〈0.05）.There was no statistical difference on FPG and blood lipid between-group（P〈0.05） and intra-group（P〈0.05）.Conclusion Yishen-jiangtang decoction can improve the clinical symptoms of DKD patients with qi and yin deficiency syndrome,reduce the urinary MCP-1,and delay the progression of renal dysfunction.