加味真武汤联合督灸治疗脾肾阳虚型消渴病癃闭的临床观察

Clinical Observation on the Modified Zhenwu Decoction Combined with Du-Moxibustion in the Treatment of Yang Dificiency of the Spleen and Kidney Type of Diabetic Mellitus with Uroschesis

【目的】观察加味真武汤联合督灸治疗脾肾阳虚型消渴病癃闭(糖尿病神经源性膀胱排尿障碍)的临床疗效。【方法】将72例脾肾阳虚型消渴病癃闭患者随机分为观察组和对照组,每组各36例。2组患者均给予常规降糖方案治疗,在此基础上,观察组给予加味真武汤联合督灸治疗,对照组给予甲钴胺片治疗,连续治疗8周。治疗8周后,评价2组临床疗效,观察2组患者治疗前后膀胱残余尿量的变化情况,以及美国泌尿协会症状指数(AUA-SI)评分和中医证候积分的情况,比较2组患者治疗前后空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)的变化情况。【结果】(1)研究过程中,观察组失访7例,对照组失访7例。最终观察组29例、对照组29例纳入疗效统计。(2)观察组临床疗效总有效率为89.66%(26/29),对照组为44.83%(13/29),组间比较,观察组的临床疗效优于对照组,差异有统计学意义(P<0.01)。(3)观察组中医疗效总有效率为86.21%(25/29),对照组为44.83%(13/29),组间比较,观察组的中医疗效优于对照组,差异有统计学意义(P<0.01)。(4)治疗后,2组患者的AUA-SI评分均明显改善(P<0.01),且观察组在改善AUA-SI评分方面明显优于对照组,组间治疗后及治疗前后差值比较,差异均有统计学意义(P<0.01)。(5)治疗后,2组患者的膀胱残余尿量均明显改善(P<0.01),且观察组在改善膀胱残余尿量方面明显优于对照组,组间治疗后及治疗前后差值比较,差异均有统计学意义(P<0.01)。(6)治疗后,2组患者的中医证候积分均明显改善(P<0.01),且观察组在改善中医证候积分方面明显优于对照组,组间治疗后及治疗前后差值比较,差异均有统计学意义(P<0.01)。(7)治疗后,2组患者的FPG、2hPG、HbA1c水平均明显改善(P<0.01),且观察组在改善FPG、2hPG、Hb A1c水平方面稍优于对照组,但组间治疗后及治疗前后差值比较,差异均无统计学意义(P>0.05)。【结论】加味真武汤联合督灸治疗脾肾阳虚型消渴病癃闭,能有效缓解患者的临床症状,从而提高患者生活质量,疗效显著。

Objective To observe the clinical efficacy of modified Zhenwu Decoction combined with Dumoxibustion in treating yang deficiency of the spleen and kidney type of diabetic mellitus with uroschesis. Methods Seventy-two patients with yang deficiency of the spleen and kidney type of diabetic mellitus with uroschesis were randomly divided into the observation group and the control group,with 36 patients in each group. Both groups were given conventional hypoglycemic regimen. The observation group was treated with modified Zhenwu Decoction combined with Du-moxibustion,while the control group was treated with Mecobalamine Tablets. Both groups of patients were treated for 8 weeks. After 8 weeks of treatment,the clinical efficacy of the 2 groups was evaluated,and the changes in residual bladder urine volume,as well as the American Urological Association Symptom Index(AUA-SI)score and traditional Chinese medicine(TCM)syndrome score were observed before and after treatment in the two groups. The changes in fasting plasma glucose(FPG),2-hour postprandial plasma glucose(2hPG)and glycated haemoglobin(HbA1c)before and after treatment in the two groups. Results(1)During the study,7 cases were dropped in the observation group and 7 cases were dropped in the control group. Finally,29 cases in the observation group and 29 cases in the control group were included in the efficacy statistics.(2)The total effective rate of the observation group was 89.66%(26/29), while that of the control group was 44.83%(13/29). The efficacy of the observation group was superior to that of the control group, the difference being statistically significant(P<0.01).(3)The total effective rate of Chinese medicine treatment in the observation group was86.21%(25/29),compared with 44.83%(13/29)in the control group. The efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.01).(4)After treatment,the AUA-SI scores of the two groups were significantly improved(P<0.01), and the observation group was significantly superior to the control group in improving the AUA-SI scores, the difference being statistically significant(P<0.01). The difference of AUA-SI score before and after treatment between the two groups was statistically significant(P<0.01).(5)After treatment,the residual bladder urine volume in the two groups was significantly improved(P<0.01), and the observation group was significantly superior to the control group in improving the residual bladder urine volume,the difference being statistically significant(P<0.01). There was statistical significance in the difference of residual urinary volume before and after treatment between two groups(P<0.01).(6)After treatment,TCM syndrome scores of the two groups were significantly improved(P<0.01),and the observation group was significantly superior to the control group in improving TCM syndrome scores,the difference being statistically significant(P<0.01). The difference of TCM syndrome score before and after treatment between the two groups was statistically significant(P<0.01).(7)After treatment,the levels of FPG,2hPG and HbA1c in two groups were significantly improved(P<0.01),the observation group was slightly superior to the control group in improving the levels of FPG,2hPG and HbA1c,but the difference being not statistically significant(P>0.05). There was no statistical significance in the difference of FPG, 2hPG and HbA1c levels between two groups before and after treatment(P>0.05). Conclusion The combination of modified Zhenwu Decoction combined with Du-moxibustion in treating yang deficiency of the spleen and kidney type of diabetic mellitus with uroschesis has significant effects in relieving the clinical symptoms of the patients, thererby improving their quality of life,with remarkable efficacy.