摘要
目的评价益气地黄汤辅助西医常规疗法治疗早期DN气阴两虚证患者的临床疗效。方法将符合入选标准的2018年6月-2020年12月北京中医医院顺义医院117例早期DN患者按随机数字表法分为对照组58例与治疗组59例。对照组给予西医常规疗法治疗,治疗组在对照组基础上加服益气地黄汤治疗。2组均治疗1个月。分别于治疗前后采用ELISA法检测血清IL-1、巨噬细胞清道夫受体A(SR-A)、TNF-α、C-C基序趋化因子2(CCL2)及GSH-Px、SOD水平;采用全自动生化分析仪检测胱抑素C(Cys C)、SCr;采用放射免疫法测定尿白蛋白,速率法测定尿肌酐,计算尿白蛋白/肌酐比值(UACR)及肾小球滤过率(eGFR);观察治疗期间的不良反应,评价临床疗效。结果治疗组总有效率为94.92%(56/59)、对照组为81.03%(47/58),2组比较差异有统计学意义(χ^(2)=5.35,P=0.021)。治疗后,治疗组UACR[(92.28±15.42)mg/g比(108.42±20.76)mg/g,t=4.78]、eGFR[(91.42±13.18)m·min^(-1)·1.73m^(-2)比(97.30±17.94)m·min^(-1)·1.73m^(-2),t=2.02]、SCr[(65.30±9.54)μmol/L比(72.18±12.53)μmol/L,t=5.42]、Cys C[(0.65±0.12)mg/L比(1.07±0.26)mg/L,t=11.25]水平均低于对照组(P<0.05);血清SR-A[(37.18±6.10)μg/L比(51.51±7.12)μg/L,t=11.70]、CCL2[(13.12±1.63)μg/L比(19.68±2.90)μg/L,t=15.12]、TNF-α[(20.57±3.50)ng/L比(29.68±4.17)ng/L,t=12.81]、IL-1[(8.47±0.97)ng/L比(13.12±1.57)ng/L,t=19.31]水平均低于对照组(P<0.01);血清SOD[(24.09±3.12)mg/L比(18.72±2.76)mg/L,t=9.85]活性及GSH-Px[(231.57±25.38)mg/L比(174.58±22.96)mg/L,t=12.73]水平均高于对照组(P<0.01)。治疗期间,对照组不良反应发生率为10.34%(6/58)、治疗组为6.78%(4/59)。2组比较差异无统计学意义(χ^(2)=0.48,P=0.490)。结论益气地黄汤辅助西医常规疗法可有效改善早期DN气阴两虚证患者的肾功能,抑制机体炎症反应与氧化应激反应,提高临床疗效。
Objective To investigate the effect of Yiqi Dihuang Decoction assisting conventional western medicine therapy in the treatment of early diabetic nephropathy(DN)with deficiency of qi and yin.Methods A total of 117 patients with early DN who met the inclusion criteria from June 2018 to December 2020 in Beijing Hospital of Traditional Chinese Medicine Shunyi Branch were divided into a control group of 58 patients and a treatment group of 59 patients according to the random number table method.The control group was treated with conventional western medicine therapy,and the treatment group was additionally treated with Yiqi Dihuang Decoction on the basis of the control group.Both groups were treated for 1 month.Serum levels of IL-1,macrophage scavenger receptor A(SR-A),TNF-α,C-C motif chemokine 2(CCL2),GSH-Px and SOD were detected by ELISA before and after treatment.Cystatin C(Cys C)and SCr levels were detected by automatic biochemical analyzer.The urinary albumin was determined by radioimmunoassay,urinary creatinine determined by rate method,and urinary albumin/creatinine ratio(UACR)and glomerular filtration rate(eGFR)were calculated.The adverse events during treatment and clinical efficacy were evaluated.Results The total effective rate was 94.92%(56/59)in the treatment group and 81.03%(47/58)in the control group,and the difference between the two groups was statistically significant(χ^(2)=5.35,P=0.021).After treatment,UACR[(92.28±15.42)mg/g vs.(108.42±20.76)mg/g,t=4.78],eGFR[(91.42±13.18)m·min^(-1)·1.73m^(-2)vs.(95.30±15.94)m·min^(-1)·1.73m^(-2),t=2.02],SCr[(65.30±9.54)μmol/L vs.(70.18±12.53)μmol/L,t=5.42],Cys C[(0.65±0.12)mg/L vs.(1.07±0.26)mg/L,t=11.25]in the treatment group were significantly lower than those in the control group(P<0.05).Serum SR-A[(37.18±6.10)μg/L vs.(51.51±7.12)μg/L,t=11.70],CCL2[(13.12±1.63)μg/L vs.(19.68±2.90)μg/L,t=15.12],TNF-α[(20.57±3.50)ng/L vs.(29.68±4.17)ng/L,t=12.81],IL-1[(8.47±0.97)ng/L vs.(13.12±1.57)ng/L,t=19.31]levels in the treatment group were signif
作者
胡华杰
张秀媛
Hu Huajie;Zhang Xiuyuan(Department of Endocrinology,Beijing Hospital of Traditional Chinese Medicine Shunyi Branch,Beijing 101300,China)
出处
《国际中医中药杂志》
2022年第6期631-635,共5页
International Journal of Traditional Chinese Medicine
基金
首都卫生发展科研专项项目(重点攻关)(2016-1-4151)。
关键词
糖尿病肾病
气阴两虚
益气地黄汤
微量白蛋白尿
尿肌酐
肾小球滤过率
炎症反应
氧化应激
中西医结合疗法
Diabetic nephropathies
Qi Yin deficiency
Yiqi Dihuang Decoction
Microalbuminuria
Urine creatinine
Glomerular filtration rate
Inflammatory reaction
Oxidative stress
Integrated Chinese traditional and western medicine therapy
