温阳通脉汤治疗2型糖尿病微血管病变气虚湿阻血瘀证

Wenyang Tongmai Decoction Treating Type 2 Diabetic MicrovascularDisease with Qi Deficiency,Dampness and Blood Stasis Syndrome

目的:观察温阳通脉汤治疗2型糖尿病微血管病变气虚湿阻血瘀证的临床疗效。方法:将128例2型糖尿病微血管并发症患者随机分为对照组63例,观察组65例。对照组给予常规西医治疗,观察组在对照组治疗基础上给予温阳通脉汤。3个月后,比较两组患者临床疗效、肾功能、氧化应激指标水平。结果:①有效率比较:治疗后观察组有效率为95.4%(62/65),高于对照组(55/63,87.3%),差异有统计学意义(P<0.05)。②中医证候评分比较:治疗后,两周患者神疲乏力、食少纳呆、水肿、尿浊、舌质评分均显著降低,且观察组以上评分均低于同期对照组(P<0.05)。③眼底微血管病变比较:治疗后,两组患者眼底微血管瘤、眼底出血量、眼底渗出量均显著改善,观察组优于同期对照组(P<0.05)。④糖化血红蛋白(glycated hemoglobin,HbA1c)、尿素氮(urea nitrogen,BUN)、肾小球滤过率(glomerular filtration rate,GFR)、24小时尿蛋白定量(24-hour urine protein quantification,24hUpor)、β2微球蛋白(β2-microglobulin,β2-MG)比较:治疗后,两组患者HbA1c、BUN、GFR、UTP、β2-MG水平均显著降低,且观察组低于同期对照组(P<0.05)。⑤血管内皮生长因子(vascular endothelial growth factor,VEGF)、转化生长因子β1(transforming growth factor beta-1,TGFβ1)、晚期氧化蛋白产物(advanced oxidation protein products,AOPP)、超氧化物歧化酶(superoxide dismutase,SOD)比较:治疗后,两组患者VEGF、TGFβ1、AOPP水平均显著降低,SOD水平显著升高;观察组VEGF、TGFβ1、AOPP水平显著低于同期对照组,SOD水平显著高于同期对照组(P<0.05)。随访18个月后,对照组有4例进入DKD 4期,6例进入重度DR期;观察组有2例进入DKD 4期,两组比较,差异有统计学意义(P<0.05)。结论:温阳通脉汤治疗2型糖尿病微血管病变气虚湿阻血瘀证临床疗效显著,能减轻患者机体氧化应激反应,改善眼底微血管病变,提高肾功能。

Objective:To observe the clinical effect of Wenyang Tongmai Decoction in the treatment of type 2 diabetic microvascular disease with Qi deficiency and Dampness obstruction and blood stasis syndrome.Methods A total of 128 patients with type 2 diabetes with microvascular complications were randomly divided into a control group of 63 cases and an observation group of 65 cases.The control group was given conventional western medicine treatment,and the observation group was given Wenyang Tongmai Decoction on the basis of the treatment of the control group.After 3 months,the clinical efficacy,renal function,and oxidative stress index levels were compared between the two groups.Results:①Comparison of effective rate:After treatment,the effective rate of the observation group was 95.4%(62/65),which was higher than that of the control group(55/63,87.3%),and the difference was statistically significant(P<0.05).②Comparison of TCM syndrome scores:After two weeks of treatment,the scores of Shenpi,fatigue,poor appetite,edema,turbid urine,and tongue quality were significantly reduced,and the above scores in the observation group were lower than those in the control group at the same period(P<0.05).③Comparison of fundus microvascular lesions:After treatment,fundus microangioma,fundus hemorrhage and fundus exudation were significantly improved in the two groups,and the observation group was better than the control group at the same period(P<0.05).④Glycated hemoglobin(HbA1c),urea nitrogen(BUN),glomerular filtration rate(GFR),24-hour urine protein quantification(24hUpor),Comparison ofβ2-microglobulin(β2-MG)comparison:After treatment,the levels of HbA1c,BUN,GFR,UTP andβ2-MG in the two groups were significantly decreased,and the observation group was lower than the control group at the same period(P<0.05).⑤Vascular endothelial growth factor(VEGF),transforming growth factor beta-1(TGFB1),advanced oxidation protein products(AOPP),superoxide dismutase(SOD))comparison:After treatment,the levels of VEGF,TGFB1,and AOPP in the two groups were significantly decreased,and the level of SOD was significantly increased;the levels of VEGF,TGFB1,and AOPP in the observation group were significantly lower than those in the control group,and the SOD levels were significantly higher than those in the control group(P<0.05).After 18 months of follow-up,4 patients in the control group entered DKD stage 4,6 patients entered severe DR stage,and 2 patients in the observation group entered DKD stage 4,the difference was statistically significant(P<0.05).Conclusion:Wenyang Tongmai Decoction has significant clinical curative effect in the treatment of type 2 diabetic microvascular disease with Qi deficiency and dampness obstruction and blood stasis syndrome.It can reduce oxidative stress,improve fundus microvascular disease and improve renal function.