参芪地黄汤加减结合西医常规疗法治疗Ⅲ期糖尿病肾病气阴两虚证临床研究

Clinical research on Shenqi Dihuang Decoction combined with conventional western medicine in the treatment of stageⅢdiabetic nephropathy

目的评价参芪地黄汤加减结合西医常规疗法治疗Ⅲ期DN气阴两虚证的临床疗效。方法将符合入选标准的2019年1月-2021年1月本院患者96例,按随机数字表法分为2组,每组48例。对照组采用西医常规疗法治疗,观察组在对照组基础上结合参芪地黄汤加减治疗。2组均连续治疗3个月。分别于治疗前后进行中医证候评分,采用双抗体夹心ELISA法检测可溶性细胞间黏附分子-1(soluble intercellular adhesion molecular-1,sICAM-1)、单核细胞趋化性蛋白-1(monocyte chemoattractant protein-1,MCP-1)水平,全自动生化分析仪检测BUN、SCr、SOD、同型半胱氨酸(homocysteine,Hcy);安静状态下测量3次血压,取平均值;收集24 h尿液,采用免疫比浊法检测24 h尿蛋白定量(24-hour urine total protein quantity,24 hUTP),计算肾小球滤过率(estimated glomerular filtration rate,eGFR),评价疗效。结果观察组总有效率为83.3%(40/48)、对照组为66.7%(32/48),2组比较差异有统计学意义(χ^(2)=3.56,P=0.049)。观察组治疗后中医证候积分低于对照组(t=4.05,P<0.01),收缩压低于对照组(t=4.29,P<0.01)。治疗后,观察组24hUTP[(1.43±0.54)g比(1.86±0.50)g,t=4.05]、血清sICAM-1[(396.07±50.61)μg/L比(480.11±63.01)μg/L,t=7.20]、Hcy[(27.41±3.42)μmol/L比(29.76±5.80)μmol/L,t=2.42]水平低于对照组(P<0.05),SOD[(168.32±41.26)U/ml比(143.11±37.02)U/ml,t=3.15]水平高于对照组(P<0.01)。结论参芪地黄汤加减联合西医常规疗法治疗可有效改善Ⅲ期DN患者的临床症状,有效控制血压,降低尿蛋白,延缓DN进展,提高疗效。

Objective To observe the clinical efficacy of Shenqi Dihuang Decoction combined with conventional western medicine in the treatment of stageⅢDiabetic Nephropathy(DN).Methods A total of 96 patients with stageⅢdiabetic nephropathy with syndrome of deficiency of qi and yin in our hospital,from January 2019 to January 2021,who met the inclusion criteria,were divided into 2 groups by random number table method,48 in each group.The control group was given the conventional western treatment.The observation group was given Shenqi Dihuang Decoction on the basic of the control group treatment.Both groups treatment lasted for 3 months.Before and after the treatment,the changes of TCM Syndrome Scores were observed.The levels of soluble intercellular adhesion molecular-1(sICAM-1)and monocyte chemoattractant protein-1(MCP-1)were detected by double antibody sandwich ELISA.The levels of BUN,SCr,SOD and Hcy were detected by automatic biochemical analyzer,collect 24-hour urine,24-hour urine total protein quantity(24 UTP)was detected by immunoturbidimetry,and eGFR was calculated by CKD-EPI formula to evaluate the clinical efficacy.Results After the treatment,the total effective rate in the observation group was 83.3%(40/48),and the control group was 66.7%(32/40)and the difference was statistically significant(χ2=3.56,P=0.049).After the treatment,TCM Syndrome Scores in the observation group was significantly better than that of the control group(t=4.05,P<0.01).After treatment,the systolic blood pressure in the observation group was significantly lower than that of the control group(t=4.29,P<0.01).After treatment,the levels of 24 hUTP[(1.43±0.54)g vs.(1.86±0.50)g,t=4.05],serum sICAM-1[(396.07±50.61)μg/L vs.(480.11±63.01)μg/L,t=7.20],Hcy[(27.41±3.42)μmol/L vs.(29.76±5.80)μmol/L,t=2.42]in the observation group were significantly lower than those in the control group(P<0.05),and the levels of SOD[(168.32±41.26)U/ml vs.(143.11±37.02)U/ml,t=3.15]was significantly higher than that of the control group(P<0.01).Conclusions Shenqi Dihuang Decoction combined with conventional western medicine can reduce 24 hUTP quantity and kidney damage,delay the development ofⅢDN,improve clinical effect and protect the kidney function,and sICAM-1 for theⅢDN patients with the syndrome of qi and yin deficiency combined with blood stasis.