黄芪消渴方联合前列地尔治疗气阴两虚型糖尿病肾病的疗效及对血管内皮、氧化应激的影响

Effect of Huangqi Xiaoke Recipe combined with alprostadil on qi and yin deficiency type diabetic nephropathy and its effect on vascular endothelium and oxidative stress

目的:观察黄芪消渴方联合前列地尔对气阴两虚型糖尿病肾病(DN)的临床疗效及对血管内皮、氧化应激的影响。方法:选取在本院糖尿病专科病房及门诊就诊的气阴两虚型DN患者72例为研究对象,随机分为对照组与观察组,每组36例。两组均予降糖、降压、降脂、抗血小板聚集等常规治疗,对照组在常规治疗基础上给予前列地尔静推治疗,观察组在对照组基础上给予黄芪消渴方加减口服,两组均每日治疗一次,共观察4周。比较两组治疗前后的中医临床证候积分、临床疗效;空腹血糖(FPG)、糖化血红蛋白(HbA1C)、血脂(TC、TG、LDL、HDL)、血肌酐(SCr)、血尿素氮(BUN);内皮素-1(ET-1)、一氧化氮(nitric oxide,NO)、血管性血友病因子(vWF);谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、丙二醛(MDA)的水平。结果:观察组中医证候疗效总有效率高于对照组,差异具有统计学意义(P<0.05);观察组中医证候积分比对照组明显减少,差异具有统计学意义(P<0.05);与对照组比较,观察组HDL-C变化不大,差异无统计学意义(P>0.05);FBG、HbA1C、SCr、BUN、TC、TG、LDL-C、ET-1、vWF、MDA显著下降,NO、GSH-Px、SOD显著上升,差异具有统计学意义(P<0.05)。结论:黄芪消渴方联合前列地尔治疗气阴两虚型DN疗效显著,不仅能降低血糖,调节血脂,改善肾功能及中医临床症状,还能抑制机体氧化应激反应并保护血管内皮功能。

Objective: To observe the clinical efficacy of Huangqi Xiaoke Decoction combined with alprostadil on qi and yin deficiency type diabetic nephropathy (DN) and its effect on vascular endothelium and oxidative stress. Methods: A total of 72 patients with qi and yin deficiency type DN who were admitted to the diabetes specialist ward and outpatient department of Baoan District Hospital of Shenzhen from January 2017 to July 2018 were enrolled. The patients were divided into the control group and the observation group according to the random number method. 36 cases in each group. Both groups were treated with conventional treatments such as hypoglycemic, hypotensive, lipid-lowering and anti-platelet aggregation. The control group was treated with alprostadil on the basis of conventional treatment. The observation group was given orally on the basis of the control group. Both groups were treated once a day for a total of 4 weeks. Compare the clinical syndrome scores and clinical efficacy of the two groups before and after treatment;fasting blood glucose (FPG), glycosylated hemoglobin (HbA1C), blood lipids (TC, TG, LDL, HDL), serum creatinine (SCr), blood urea nitrogen (BUN Endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (vWF);glutathione peroxidase (GSH-Px), superoxide disproportionation The level of enzyme (SOD), malondialdehyde (MDA). Results: The total effective rate of TCM syndromes in observation group was 94.44%, which was significantly different from 72.22% in the control group ( P <0.05). The scores of TCM syndromes in the observation group were significantly lower than those in the control group ( P <0.05);Compared with the control group, the HDL-C of the observation group did not change much, there was no statistical difference ( P >0.05);FBG, HbA1C, SCr, BUN, TC, TG, LDL-C, ET-1, vWF, MDA Significantly decreased, NO, GSH-Px, SOD increased significantly, with significant difference ( P <0.05). Conclusion: Huangqi Xiaoke Decoction combined with alprostadil in the treatment of qi and yin deficiency type DN has significant curative effect, which can not only lower blood sugar, regulate blood lipids, improve renal function and clinical symptoms, but also inhibit oxidative stress and protect endothelial function.