健脾益肾泄浊活血方治疗糖尿病肾病Ⅳ期临床研究

Clinical Study on Jianpi Yishen Xiezhuo Huoxue Prescription for Diabetic Nephropathy in StageⅣ

目的:观察健脾益肾泄浊活血方对糖尿病肾病Ⅳ期尿微量白蛋白/尿肌酐、血肌酐(SCr)、血清胱抑素C(Cys-C)的临床疗效。方法:将80例2型糖尿病肾病Ⅳ期患者随机分为治疗组和对照组各40例。对照组采用西医基础治疗,治疗组在对照组治疗方案的基础上加用健脾益肾泄浊活血方治疗,2组疗程均为3个月,观察2组治疗前后中医证候评分、尿微量白蛋白/尿肌酐、血白蛋白、SCr、Cys-C的变化情况。结果:治疗后,治疗组尿微量白蛋白/尿肌酐明显低于治疗前,差异有统计学意义(P<0.01),且治疗组尿微量白蛋白/尿肌酐明显低于对照组,差异有统计学意义(P<0.01)。治疗后,2组血白蛋白治疗前后及治疗后组间比较,差异均无统计学意义(P>0.05)。治疗组40~49岁、50~59岁患者治疗后SCr及Cys-C均有下降,治疗前后比较,差异均有统计学意义(P<0.05,P<0.01);治疗组60~70岁患者SCr及Cys-C治疗前后比较,差异均无统计学意义(P>0.05)。对照组40~49岁、50~59岁、60~70岁患者SCr及Cys-C治疗前后比较,差异均无统计学意义(P>0.05)。治疗后,治疗组40~49岁、50~59岁患者SCr及Cys-C分别与对照组同年龄段比较,差异均有统计学意义(P<0.05,P<0.01);治疗组60~70岁患者SCr及Cys-C分别与对照组同年龄段比较,差异均无统计学意义(P>0.05)。治疗后,中医证候总有效率治疗组92.5%,对照组62.5%,差异有统计学意义(P<0.01)。临床疗效总有效率治疗组90.0%,对照组65.0%,差异有统计学意义(P<0.01)。结论:在西医基础治疗方案的基础上加用健脾益肾泄浊活血方可明显改善糖尿病肾病Ⅳ期的临床症状,减少蛋白尿,可以降低60岁以下患者SCr、Cys-C水平,延缓肾病进展。

Objective:To observe the clinical effect of Jianpi Yishen Xiezhuo Huoxue prescription on urinary microalbumin/urinary creatinine,serum creatinine(SCr)and serum cystatin C(Cys-C)in patients with diabetic nephropathy in stageⅣ.Methods:A total of 80 cases of patients with type 2 diabetic nephropathy in stageⅣwere randomly divided into the treatment group and the control group,with 40 cases in each group.The control group was treated with basic western medicine,and the treatment group was additionally treated with Jianpi Yishen Xiezhuo Huoxue prescription based on the treatment plan of the control group.Both groups were treated for three months.The changes of Chinese medicine syndrome scores,urinary microalbumin/urinary creatinine,blood albumin,SCr and Cys-C before and after treatment in the two groups were observed.Results:After treatment,the urinary microalbumin/urinary creatinine in the treatment group was significantly lower than that before treatment,the difference being significant(P<0.01),and the urinary microalbumin/urinary creatinine in the treatment group was significantly lower than that in the control group,the difference being significant(P<0.01).After treatment,there was no significant difference being found in the comparison of blood albumin between the two groups,and there was no significant difference being found in the comparison of blood albumin before and after treatment(P>0.05).After treatment,SCr and Cys-C of patients aged from 40 to 49 and from 50 to 59 in the treatment group were decreased,and the differences before and after treatment were significant(P<0.05,P<0.01).There was no significant difference being found in the comparison of SCr and Cys-C before and after treatment in patients aged from 60 to 70 in the treatment group(P>0.05).There was no significant difference being found in the comparison of SCr and Cys-C before and after treatment in patients aged from 40 to 49,from 50 to 59 and from 60 to 70 in the control group(P>0.05).After treatment,SCr and Cys-C in patients aged from 40 to 49 and from 50 to 59 in the treatment group were compared with those in the control group respectively,differences being significant(P<0.05,P<0.01);there was no significant difference being found in the comparison of SCr and Cys-C in patients aged from 60-70 between the treatment group and the control group(P>0.05).After treatment,the total effective rate of Chinese medicine syndromes was 92.5%in the treatment group and 62.5%in the control group,the difference being significant(P<0.01).The total effective rate was 90.0%in the treatment group and 65.0%in the control group,the difference being significant(P<0.01).Conclusion:Based on the basic treatment regimen of western medicine,the additional application of Jianpi Yishen Xiezhuo Huoxue prescription can significantly improve the clinical symptoms of diabetic nephropathy in stage IV,reduce proteinuria and the levels of SCr and Cys-C in patients under 60 years old,and delay the progression of nephropathy.