益气养阴活血汤治疗气血两虚证糖尿病肾病临床研究

Clinical Study on Yiqi Yangyin Huoxue Tang for Diabetic Nephropathy with Qi-blood Deficiency Syndrome

目的:探讨益气养阴活血汤治疗气血两虚证糖尿病肾病(DN)的疗效及对肾小管氧化损伤、肾小球硬化情况的影响。方法:将气血两虚证DN患者162例随机分为观察组和对照组,每组81例;对照组给予常规控制血糖、血压、降脂等基础治疗,观察组在对照组基础上辅以益气养阴活血汤治疗;2组连续治疗6个月;观察比较2组治疗前后空腹血糖(FBG)、糖化血红蛋白(HbA1c),肾功能[血尿素氮(BUN)、尿蛋白排泄率(UPER)、尿微量白蛋白/肌酐比值(ACR)],肾小管损伤指标[胱抑素-C(Cys-C)、β2-微球蛋白(β2-MG)、N-乙酰-β-D-葡萄糖苷酶(NAG)]水平,并进行肾穿刺活检,分析肾小球硬化情况,采用KM风险图比较2组患者疾病进展。结果:治疗后,2组患者FBG、HbA1c水平较治疗前明显降低(P <0.05),但组间比较差异无统计学意义(P> 0.05)。治疗后,2组患者BUN、UPER、ACR值均较治疗前降低(P <0.05),且观察组BUN、UAER、ACR值低于对照组(P <0.05)。治疗后,2组患者Cys-C、β2-MG、NAG水平均较治疗前降低(P <0.05),且观察组Cys-C、β2-MG、NAG水平低于对照组(P <0.05)。治疗6个月,2组肾脏病理分级比较,经秩和检验,差异有统计学意义(P <0.05),观察组病理改善优于对照组。在疾病进展风险方面,观察组DN进展风险低于对照组(P <0.05)。结论:在西药治疗的基础上,加用益气养阴活血汤治疗气血两虚证DN能够有效改善肾功能,减轻肾小管损伤,延缓疾病进展。

Objective:To study the efficacy of Yiqi Yangyin Huoxue tang for diabetic nephropathy(DN)with qi-blood deficiency syndrome and its effect on renal tubular injury and glomerular sclerosis.Methods:Divided 162 cases of DN patients with qi-blood deficiency syndrome into the observation group and the control group randomly,with 81 cases in each group.Both groups were given basic treatment with routine control of blood glucose,blood pressure and lipid lowering,while the observation group was additionally given Yiqi Yangyin Huoxue tang;the two groups received continuous treatment for 6 months.Observed and compared the levels of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c),kidney functions[blood urea nitrogen(BUN),urinary protein excretion rate(UPER),urinary albumin/creatinine ratio(ACR)],renal tubular damage indexes[(cystatin-C(Cys-C),β2-microglobulin(β2-MG),N-acetyl-β-D-glycosidase(NAG)]in the two groups before and after treatment,performed the renal biopsy,analyzed the glomerular sclerosis and compared the disease development of patients in the two groups by K-M risk map.Results:After treatment,the levels of FBG and HbA1 c in the two groups were significantly lower than those before treatment(P<0.05),but there was no significant difference being found in comparison between the two groups(P>0.05).After treatment,the BUN,UPER and ACR values of patients in the two groups were lower than those before treatment(P<0.05)and the BUN,UAER,ACR values in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of Cys-C,β2-MG and NAG in the two groups were lower than those before treatment(P<0.05)and the levels of Cys-C,β2-MG and NAG in the observation group were lower than those in the control group(P<0.05).After 6 months of treatment,there was significant difference in pathological grading between the two groups by rank sum test(P<0.05),The pathological improvement of the observation group was better than that of the control group.In terms of the risk of disease development,the risk of DN progression in the observation group was lower than that in the control group(P<0.05).Conclusion:On the basis of western medicine treatment,the additional application of Yiqi Yangyin Huoxue tang for DN with qi-blood deficiency syndrome can effectively improve the kidney functions,reduce the renal tubular injury and delay the disease development.