达格列净联合六味地黄汤加减治疗气阴两虚型糖尿病肾病的临床效果研究

Study on clinical effect of dapagliflozin combined with modified Liuwei Dihuang Decoction in the treatment of diabetic kidney disease with Qi-Yin deficiency syndrome

目的 研究达格列净联合六味地黄汤加减治疗气阴两虚型糖尿病肾病(DKD)的临床效果。方法 60例气阴两虚型DKD患者,根据入院时间分为常规组和联合组,每组30例。常规组给予达格列净治疗,联合组采用达格列净联合六味地黄汤加减治疗。比较两组治疗前后的中医症状评分、血糖指标[糖化血红蛋白(Hb A1c)、空腹血糖(FBG)及餐后2 h血糖(2 h PG)]、炎症因子水平[超敏C反应蛋白(hs-CRP)]、肾功能指标[尿白蛋白排泄率(UAER)、24 h尿微量白蛋白(24 h MALB)、血肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)]及不良反应发生情况。结果 治疗后,两组的中医症状评分均较本组治疗前降低,且联合组的中医症状评分(9.04±1.18)分低于常规组的(14.61±2.31)分,差异有统计学意义(P<0.05)。治疗后,两组的Hb A1c、FBG及2 h PG水平均较本组治疗前降低,且联合组的Hb A1c、FBG及2 h PG分别为(5.23±1.02)%、(5.58±1.22)mmol/L、(6.52±1.36)mmol/L,低于常规组的(6.45±0.97)%、(7.48±1.06)mmol/L、(8.14±1.71)mmol/L,差异有统计学意义(P<0.05)。治疗后,两组的hs-CRP水平均较本组治疗前降低,且联合组的hs-CRP(4.38±0.82)mg/L低于常规组的(6.27±1.16)mg/L,差异有统计学意义(P<0.05)。治疗后,两组的UAER、24 h MALB、Scr、β_(2)-MG水平均较本组治疗前降低,且联合组的UAER、24 h MALB、Scr、β_(2)-MG水平分别为(6.34±1.98)μg/min、(62.11±12.31)mg/24 h、(82.76±9.89)μmol/L、(0.23±0.01)mg/L,低于常规组的(8.07±2.25)μg/min、(85.74±12.19)mg/24 h、(88.49±10.62)μmol/L、(0.25±0.01)mg/L,差异有统计学意义(P<0.05)。两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论 达格列净联合六味地黄汤加减治疗气阴两虚型DKD患者的疗效确切,能有效改善中医症状,稳定血糖水平,消除机体炎症,恢复肾功能。

Objective To study the clinical effect of dapagliflozin combined with modified Liuwei Dihuang Decoction in the treatment of diabetic kidney disease(DKD)with Qi-Yin deficiency syndrome.Methods A total of 60 cases of DKD patients with Qi-Yin deficiency syndrome were divided into conventional group and combined group according to the time of admission,with 30 cases in each group.The conventional group was treated with dapagliflozin,and the combined group was treated with dapagliflozin and modified Liuwei Dihuang Decoction.Both groups were compared in terms of traditional Chinese medicine symptom score,blood glucose index[glycated hemoglobin(HbA1c),fasting blood glucose(FBG)and 2 h postprandial glucose(2 h PG)],inflammatory factor[hypersensitive C-reactive protein(hs-CRP)]level,renal function index[urinary albumin excretion rate(UAER),24 h urinary microalbumin(MALB),serum creatinine(Scr),β_(2)-microglobulin(β_(2)-MG)]before and after treatment,and adverse reactions.Results After treatment,the traditional Chinese medicine symptom score in both groups was lower than that before treatment in this group,and the traditional Chinese medicine symptom score of(9.04±1.18)points in the combined group was lower than that of(14.61±2.31)points in the conventional group.The differences were statistically significant(P<0.05).After treatment,the levels of HbA1c,FBG and 2 h PG in both groups were lower than those before treatment in this group;the levels of HbA1c,FBG and 2 h PG in the combined group were(5.23±1.02)%,(5.58±1.22)mmol/L and(6.52±1.36)mmol/L,which were lower than those of(6.45±0.97)%,(7.48±1.06)mmol/L and(8.14±1.71)mmol/L in the conventional group;the differences were statistically significant(P<0.05).After treatment,the hs-CRP level in both groups was lower than that before treatment in this group,and the hs-CRP level of(4.38±0.82)mg/L in the combined group was lower than that of(6.27±1.16)mg/L in the conventional group.The differences were statistically significant(P<0.05).After treatment,the levels of UAER,24 h MALB,Scr andβ_(2)-MG in both groups were lower than those before treatment in this group;the levels of UAER,24 h MALB,Scr andβ_(2)-MG in the combined group were(6.34±1.98)μg/min,(62.11±12.31)mg/24 h,(82.76±9.89)μmol/L and(0.23±0.01)mg/L,which were lower than those of(8.07±2.25)μg/min,(85.74±12.19)mg/24 h,(88.49±10.62)μmol/L and(0.25±0.01)mg/L in the conventional group;the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse effects between the two groups(P>0.05).Conclusion Dapagliflozin combined with modified Liuwei Dihuang Decoction is effective in the treatment of DKD patients with Qi-Yin deficiency syndrome,which can effectively improve the symptoms of traditional Chinese medicine,stabilize blood glucose level,eliminate inflammation and restore renal function.