加味水陆二仙汤、卡格列净、缬沙坦对脾肾两虚型2型糖尿病肾病蛋白尿的疗效比较

Comparative Study of Modified Shuilu Erxian Decoction,Canagliflozin and Valsartan in the Treatment of Type 2 Diabetic Nephropathy Proteinuria with Deficiency of Spleen and Kidney

目的:研究比较加味水陆二仙汤、卡格列净、缬沙坦对脾肾两虚型2型糖尿病肾病蛋白尿的临床疗效。方法:选取2020年8月-2022年7月在漳州市中医院就诊的脾肾两虚型2型糖尿病肾病患者90例,随机分为A组30例、B组30例和C组30例。A组采用卡格列净治疗,B组采用缬沙坦治疗,C组采用加味水陆二仙汤治疗,疗程均为3个月。比较三组治疗前后的24 h尿蛋白定量、尿白蛋白/肌酐比值(UACR)、血肌酐(Scr)、估算肾小球滤过率(eGFR),并记录不良反应。结果:与治疗前比较,三组治疗后的24 h尿蛋白定量及UACR均降低,且A组和B组均低于C组,差异均有统计学意义(P<0.05)。与治疗前比较,B组、C组治疗后Scr均降低,C组的eGFR升高,差异均有统计学意义(P<0.05)。三组治疗后的Scr、eGFR比较,差异均无统计学意义(P>0.05)。三组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在临床上使用加味水陆二仙汤、卡格列净、缬沙坦治疗脾肾两虚型2型糖尿病肾病是安全有效的,其中以卡格列净和缬沙坦的降尿蛋白作用较显著,而加味水陆二仙汤在降低尿蛋白的同时还可改善肾功能,体现了中西医治疗糖尿病肾病的不同优势。

Objective:To compare the clinical efficacy of Modified Shuilu Erxian Decoction,Canagliflozin and Valsartan in the treatment of type 2 diabetic nephropathy proteinuria with deficiency of spleen and kidney.Method:A total of 90 patients with type 2 diabetic nephropathy with deficiency of spleen and kidney in Zhangzhou Traditional Chinese Medical Hospital from August 2020 to July 2022 were selected,they were randomly divided into group A(30 cases),group B(30 cases)and group C(30 cases).Group A was treated with Canagliflozin,group B was treated with Valsartan,and group C was treated with Modified Shuilu Erxian Decoction.The course of treatment was 3 months.The 24 h urinary protein quantity,urinary albumin/creatinine ratio(UACR),serum creatinine(Scr),estimated glomerular filtration rate(eGFR)among the three group were compared before and after treatment,and adverse reactions were recorded.Result:Compared with those before treatment,24 h urinary protein quantity and UACR of three groups after treatment were decreased,those in group A and group B were lower than those in group C,the differences were statistically significant(P<0.05).Compared with those before treatment,Scr in group B and group C were decreased after treatment,eGFR in group C was increased,the differences were statistically significant(P<0.05).There were no significant differences in Scr and eGFR between the three groups after treatment(P>0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:Clinically,it is safe and effective to treat type 2 diabetic nephropathy with deficiency of spleen and kidney with Modified Shuilu Erxian Decoction,Canagliflozin and Valsartan.Among them,Canagliflozin and Valsartan have significant effects on reducing urinary protein,while the Modified Shuilu Erxian Decoction can reduce urinary protein and improve renal function,reflecting the different advantages of traditional Chinese and western medicine in treating diabetic nephropathy.