叶氏糖肾方对临床期糖尿病肾病炎症因子及血液动力学的影响

Ye Tang Shen Decoction on the Study of Inflammatory Factors and Hemodynamic Changes in Early Stage of Diabetic Nephropathy

目的:从肾脏血流动力学和炎性细胞因子的角度观察叶氏糖肾方治疗脾肾气虚、湿浊瘀阻型临床期糖尿病肾病患者的临床效果。方法:入组患者被随机分为西药对照组、中西药治疗组和综合治疗组,每组各50例,分别使用西药、中西药和中西药加脐疗,进行为期6个月的临床治疗观察,之后随访2个月,共8个月。结果:(1)三组治疗前一般情况和有关实验室检查无明显差异。(2)治疗6个月后西药组、中西医组、综合组中医临床症状总积分(分别为26.8±6.3,21.9±5.8和16.3±4.8),临床有效率(分别为60.0%,84.0%和88.0%),24 h尿蛋白定量和肾脏血流动力学指标均较治疗前有明显好转,其中,综合组最明显,其次为中西医组,最后为西药组,三组比较差别有统计学意义(P<0.05)。(3)治疗6个月后中西医组和综合组血尿素氮、肌酐和炎性细胞因子(TGF-β1、MCP-1、TNF-α)较治疗前明显降低,肾小球滤过率明显升高,均有统计学差异(P<0.05),而西药组治疗前后变化不明显。(4)在停用中药继续西药治疗随访2个月后,中西医组和综合组的上述各项指标虽较治疗6个月时有一定程度的恶化,但仍好于西药组。结论:叶氏糖肾方加脐疗能明显改善临床期糖尿病肾病患者的临床症状,降低蛋白尿,延缓肾功能衰竭。其作用机理可能与改善肾脏血流动力学,下调血液相关炎症因子水平有关。

Objective： To observe the clinical effect of Ye Tang Shen Decoction in treating patients with diabetic nephropathy with spleen and kidney qi deficiency and dampness and stasis syndrome from the perspective of renal hemodynamics and inflammatory cytokines. Methods： The patients were randomly divided into western medicine control group,Chinese and western medicine treatment group and comprehensive treatment group. There were 50 cases in each group,respectively,the use of Western medicine,Chinese and western medicine,Combined therapy of Chinese and Western Medicine with umbilical therapy,for a period of 6 months of clinical observation. Followed by 2 months,a total of 8 months. Results：（1） There was no significant difference in the relevant laboratory examination before treatment in the three groups.（2） The clinical efficacy（26. 8 ± 6. 3,21. 29 ± 5. 8 and 16. 3 ± 4. 8）,the clinical effective rate（60. 0%,84. 0% and 88. 0%,respectively） were significantly higher than those in the control group（P〈0. 05）,24 hour urinary protein and renal hemodynamics,the treatment group were significantly improved compared with the total score of clinical symptoms before treatment,which,the most obvious group,followed by the Chinese and Western medicine group,and finally for the Western medicine group（P〈0. 01）. There was significant difference between the two groups（P〈0. 01）,the difference was statistically significant（P〈0. 05）.（3） The levels of serum urea nitrogen,creatinine and inflammatory cytokines（TGF-β1,MCP-1,TNF-α） were significantly lower than those before treatment,and the rate of glomerular filtration was significantly increased（P〈0. 05）,but there was no obvious change in the western medicine group before and after treatment.（4） After discontinuation of traditional Chinese medicine for 6 months follow-up,Chinese and Western medicine group and the three groups of these indicators although the treatment of 6 months when a certain degree of deterioration,but still better than the Western medicine group. Conclusion： Ye Tang Shen Decoction plus umbilical therapy can significantly improve the clinical symptoms of patients with diabetic nephropathy,reduce proteinuria,delay renal failure. Its mechanism may be related to improving renal hemodynamics,down-regulation of blood-related inflammatory factors.