糖肾地黄汤联合氯沙坦钾片治疗早中期糖尿病肾病的临床疗效及对患者肾素-血管紧张素系统的影响

Tangshen Dihuang Decoction Combined with Losartan Potassium Tablets in Early and Middle Stage Diabetic Nephropathy: Clinical Efficacy and Influence on RAS

目的观察糖肾地黄汤联合氯沙坦钾片治疗早中期糖尿病肾病(DN)的临床疗效及对患者肾素-血管紧张素系统(RAS)的影响。方法随机双盲法将98例早中期DN患者分为3组,均予基础治疗。西药组33例应用氯沙坦钾片治疗;中药组32例应用糖肾地黄汤治疗;中西药组33例应用糖肾地黄汤联合氯沙坦钾治疗。3组疗程均为3个月。比较3组治疗前后中医证候疗效、临床疗效、尿微量白蛋白(尿m ALB)、血肌酐(SCR)、尿素氮(BUN)、空腹血糖(FPG)、餐后2 h血糖(2 h-PG)、糖化血红蛋白(Hb A1c)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、血视黄醇结合蛋白(RBP)、血清胱抑素C(CYS-C)、同型半胱氨酸(HCY)变化。结果中药组、中西药组的中医证候有效率明显优于西药组(P <0.05);中西药组的临床疗效有效率明显优于西药组和中药组(P <0.05);3组患者的SCR、BUN、尿m ALB治疗后均出现降低(P <0.05),且中西药组改善情况明显优于西药组和中药组(P <0.05);3组患者的FPG、2 h-PG、Hb A1c治疗后均明显下降(P <0.05),且中药组、中西药组治疗后2 h-PG、Hb A1c较西药组降低更明显(P <0.05);3组患者PRA、AngⅡ治疗后均明显下降(P <0.05);且中西药组治疗后PRA、AngⅡ较西药组降低更明显(P <0.05);3组患者RBP、CYS-C、HCY治疗后均明显下降(P <0.05),且中西药组治疗后较西药组降低更明显(P <0.05)。结论糖肾地黄汤联合氯沙坦钾片治疗早中期DN能明显改善患者的临床症状,减少蛋白尿,降低餐后血糖,拮抗RAS,降低血清RBP、CYS-C、HCY,改善肾功能。

Objective To observe the clinical efficacy of Tangshen Dihuang Decoction combined with Losartan Potassium Tablets in the treatment of early and middle stage diabetic nephropathy( DN) and its effect on patients with RAS.Methods Ninety-eight patients with DN in the early and mid-term were randomly divided into three groups.All patients were treated with basic therapy.Thirty-three patients of western medicine group were treated with Losartan Potassium Tablets and thirty-two patients of traditional Chinese medicine group were treated with Tangshen Dihuang Decoction.Thirty-three patients of Chinese and Western medicine group were treated with Tangshen Dihuang Decoction combined with losartan potassium.The three groups’ treatments were all three months.The changes in the efficacy of TCM syndromes before and after treatment,clinical efficacy,urinary microalbumin( urine m ALB),serum creatinine( SCR),urea nitrogen( BUN),fasting blood glucose( FPG),postprandial 2 h blood glucose( 2 h-PG),Glycated hemoglobin( Hb A1 c),renin( PRA),angiotensin II( Ang II),blood retinol binding protein( RBP),serum cystatin C( CYS-C) and homocysteine( HCY) were compared.Results The TCM syndromes of the Chinese medicine group and Chinese and Western medicine group were significantly better than those of the Western medicine group( P < 0.05).The clinical efficacy of the Chinese and Western medicine group was significantly better than that of the Western medicine group and Chinese medicine group( P < 0.05).SCR,BUN and urine m ALB decreased after treatment( P < 0.05),and the improvement of the Chinese and Western medicine group was significantly better than that of the Western medicine group and Chinese medicine group( P < 0.05).After treatment,the levels of FPG,2 h-PG and Hb A1 c in 3 groups were significantly decreased( P < 0.05),and the levels of 2 h-PG and Hb A1 c in the Chinese medicine group and the Chinese and Western medicine group were significantly lower than those in the Western medicine group( P < 0.05).The patients in the 3 groups were significantly decreased after treatment with PRA and Ang II( P < 0.05).PRA and Ang II were significantly lower in the Western medicine group than those in the western medicine group( P < 0.05).The levels of RBP,CYS-C and HCY in the three groups were significantly decreased after treatment( P < 0.05),and those of the Chinese and Western medicine group obviously decreased after treatment compared with those of the Western medicine group( P < 0.05).Conclusion Tangshen Dihuang Decoction combined with Losartan Potassium Tablets can significantly improve the clinical symptoms,reduce proteinuria,postprandial blood glucose,antagonize RAS and serum levels of RBP,CYS-C and HCY and improve renal function.