降糖益肾方联合西药治疗2型糖尿病肾病临床疗效及对内皮功能与血液流变学的影响

Clinical Effect of Jiangtang Yishen Prescription Combined with Western Medicine on Type 2 Diabetic Nephropathy and Its Effect on Endothelial Function and Hemorheology

目的:观察降糖益肾方联合西药治疗2型糖尿病肾病的疗效及对内皮功能及血液流变学的影响。方法:将100例2型糖尿病肾病患者采用随机数字表法随机分为对照组与观察组各50例。对照组予常规治疗,观察组在对照组基础上服用降糖益肾方治疗。比较2组临床疗效,比较2组治疗前后内皮功能及血液流变学。结果:治疗前,2组空腹血糖(FBG)、餐后2小时血糖(P2hBG)及糖化血红蛋白(HbA1c)水平比较,差异无统计学意义(P>0.05);治疗后,2组FBG、P2hBG、HbA1c水平均降低(P<0.05),且观察组低于对照组(P<0.05)。治疗前,2组24小时尿蛋白定量(24hPRO)、微量蛋白尿(mAlb)、β2-微球蛋白(β2-MG)及胱抑素C(CysC)水平比较,差异无统计学意义(P>0.05);治疗后,2组24hPRO、mAlb、β2-MG、CysC水平均降低(P<0.05),且观察组低于对照组(P<0.05)。治疗前,2组血清一氧化氮(NO)及内皮素-1(ET-1)水平比较,差异无统计学意义(P>0.05);治疗后,2组血清NO水平升高(P<0.05),ET-1水平下降(P<0.05),且观察组血清NO水平高于对照组(P<0.05),ET-1水平低于对照组(P<0.05)。治疗前,2组全血高切黏度(ηbH)、全血中切黏度(ηbM)、全血低切黏度(ηbL)、血浆黏度(ηp)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05);治疗后,2组ηbH、ηbM、ηbL、ηp、FIB水平均降低(P<0.05),且观察组低于对照组(P<0.05)。结论:益肾降糖方在控制2型糖尿病肾病患者血糖水平、减少蛋白尿、保护肾功能等方面效果显著,机制可能与该方能有效调节2型糖尿病肾病患者血管内皮功能,保护血管内皮,改善患者血液流变学,降低血液高黏状态有关。

Objective:To observe the curative effect of therapy of Jiangtang Yishen Prescription combined with western medicine on type 2 diabetic nephropathy and its effect on the endothelial function and hemorheology.Methods:A total of 100 patients with type 2 diabetic nephropathy were randomly divided into the control group and the observation group according to the random number table method,with 50 cases in each group.The control group was given routine treatment,and the observation group was additionally treated with Jiangtang Yishen Prescription based on the treatment of the control group.The clinical effects,endothelial function and hemorheology were compared before and after treatment between the two groups.Results:Before treatment,there was no significant difference being found in the comparisons of levels of fasting blood glucose(FBG),2-hour postprandial blood glucose(P2hBG)and glycosylated hemoglobin(HbA1c)between the two groups(P>0.05);after treatment,the levels of FBG,P2hBG and HbA1c in both groups were decreased(P<0.05),and the above three levels in the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparisons of levels of 24-hour urinary protein content(24hPRO),microalbuminuria(mAIb),β2-microglobulin(β2-MG)and cystatin C(CysC)between the two groups(P>0.05);after treatment,the levels of 24hPRO,mAIb,β2-MG and CsyC in both groups were decreased(P<0.05),and the above four levels in the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparisons of levels of serum nitric oxide(NO)and endothelin-1(ET-1)between the two groups(P>0.05);after treatment,the serum NO levels in both groups were increased(P<0.05)and the ET-1 levels in both were decreased(P<0.05);the serum NO level in the observation group was higher than that in the control group(P<0.05)and the ET-1 level was lower than that in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparisons of levels of whole blood high-shear viscosity(ηbH),whole blood middle-shear viscosity(ηbM),whole blood low-shear viscosity(ηbL),plasma viscosity(ηp)and fibrinogen(FIB)between the two groups(P>0.05);after treatment,the levels ofηbH,ηbM,ηbL,ηp and FIB in the two groups were decreased(P<0.05),and the above five levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Jiangtang Yishen Prescription has a significant effect on controlling the glucose level,reducing proteinuria and protecting the kidney function of patients with type 2 diabetic nephropathy,whose mechanism may be related to effective regulation of the vascular endothelial function,protection of vascular endothelium,improvement of hemorheology and decrease in high blood viscosity.