消渴方加减对气阴两虚夹瘀型糖尿病肾病的内皮损伤、氧化应激及生化指标的影响

Effect of Modified Xiaokefang on Endothelial Injury,Oxidative Stress and Biochemical Indices of Diabetic Nephropathy Patients of Qi-Yin Deficiency with Blood-stasis Syndrome

目的:探究消渴方加减对气阴两虚夹瘀型糖尿病肾病(DN)的内皮损伤、氧化应激及生化指标的影响。方法:随机将2017年9月至2018年6月河南省中医院收治的94例DN患者分为两组,各47例,对照组采用静脉滴注还原型谷胱甘肽注射液进行治疗,在对照组的基础上,观察组给予消渴方加减进行治疗。于治疗前后,观察两组的症状评分、空腹血糖(FBG),餐后2 h血糖(2 h PG),谷胱甘肽过氧化物酶(GSH-Px),超氧化物歧化酶(SOD),丙二醛(MDA),白细胞介素-1β(IL-1β),IL-6,超敏C反应蛋白(hs-CRP),肿瘤坏死因子-α(TNF-α),组织型血纤维蛋白溶酶原激活物(t-PA),1型组织纤溶酶原激活物抑制物(PAI-1),血肌酐(SCr),血尿素氮(BUN),一氧化氮(NO),内皮素-1(ET-1),24 h尿总蛋白水平,并观察两组的疗效。结果:治疗后,观察组治疗总有效率为89.36%,高于对照组的74.47%(Z=3.949,P<0.05);观察组治疗后的口渴喜饮、倦怠乏力、气短、心悸、心烦、失眠、头晕耳鸣等中医症状评分低于对照组(P<0.05);观察组治疗后的FBG,2 h PG,SCr,BUN,24 h尿总蛋白,ET-1,MDA,IL-1β,IL-6,hs-CRP,TNF-α,PAI-1水平低于对照组(P<0.05),NO,SOD,GSP-Px,t-PA水平升高(P<0.05)。结论:消渴方加减治疗气阴两虚夹瘀型DN效果显著,促进临床症状的改善,促进机体凝血纤溶系统平衡的恢复,抑制炎症反应及氧化应激反应,保护内皮功能及肾功能。

Objective: To explore the effect of modified Xiaokefang on endothelial injury,oxidative stress and biochemical indices of diabetic nephropathy( DN) patients of Qi-Yin deficiency with blood-stasis syndrome.Method: Ninety-four patients with DN admitted to our hospital from September 2017 to June 2018 were randomly divided into two groups. The control group( 47 cases) was injected with reduced glutathione by intravenous drip.In addition to the therapy of the control group,the observation group( 47 cases) was treated with modified Xiaokefang. Before and after treatment,the symptom scores,fasting blood glucose( FBG),2 hpostprandial blood glucose( 2 h PG),glutathione peroxidase( GSH-Px) and superoxide dismutase( SOD),malondialdehyde( MDA)and interleukin-1 beta( IL-1β),IL-6,hypersensitive C-reactive protein( hs-CRP),tumor necrosis factor-α( TNF-α),tissue blood fibrin dissolve enzyme activation( t-PA),type 1 original organization fibrin lytic enzyme activators inhibitor( PAI-1),serum creatinine( SCr),blood urea nitrogen( BUN),nitric oxide( NO),endothelin-1( ET-1),24 h total urinary protein levels were observed,and the efficacy of the two groups were observed. Result:After treatment,the total effective rate of the observation group was 89. 36%,which was higher than 74. 47% of the control group( Z = 3. 949,P< 0. 05). The scores of symptoms in the observation group after treatment were lower than those in the control group( P< 0. 05). After treatment,FBG,2 h PG,SCr,BUN,24 h total urine protein,ET-1,MDA,IL-1β,IL-6,hs-CRP,TNF-α,and PAI-1 levels in the observation group were lower than those in the control group( P <0. 05),while NO,SOD,GSH-Px,and t-PA levels were increased( P <0. 05).Conclusion: Modified Xiaokefang has a remarkable effect in treatment of diabetic nephropathy patients of Qi-Yin deficiency with blood-stasis syndrome by alleviating clinical symptoms,promoting the recovery of balance of coagulation and fibrinolysis system,inhibiting inflammation and oxidative stress,and protecting endothelial function and renal function.