摘要
目的:观察真武汤加味对糖尿病肾病脾肾气虚证患者血清转化生长因子-β(transforming growth factor beta,TGF-β)和谷胱甘肽过氧化物酶(glutathion peroxidase,GSH-Px)水平的影响,并观察其治疗该病的临床疗效。方法:将114例患者按随机数字表法分为对照组和观察组各57例。对照组患者给予氯沙坦钾片,每次100 mg,1次·d^(-1),口服。观察组在对照组治疗基础上加用真武汤加味,1剂·d^(-1)。两组疗程均为24周,并进行24周随访。记录治疗期间和随访期间病情进展至Ⅴ期的患者,或肌酐翻倍等终点事件发生情况;检测治疗前后糖化血红蛋白(glycosylated hemoglobin,HbAlc)、尿素氮、血肌酐、24小时尿蛋白定量检测;进行治疗前后脾肾气虚证评分;检测治疗前后TGF-β、GSH-Px水平。结果:观察组临床疗效有效率为84.21%,高于对照组的64.91%,差异有统计学意义(χ~2=5.573,P<0.05)。观察组中医证候有效率为91.23%,高于对照组的75.44%,差异有统计学意义(χ~2=5.116,P<0.05)。对照组终点事件发生率为43.86%,高于观察组的24.56%,差异有统计学意义(χ~2=4.715,P<0.05)。治疗后两组Hb Alc水平均较治疗前下降(P<0.01),两组24小时尿蛋白定量、尿素氮和肌酐水平均较治疗前升高(P<0.01);治疗后观察组HbAlc、24小时尿蛋白定量、尿素氮和肌酐水平均低于对照组(P<0.01)。治疗后观察组TGF-β水平均低于对照组,GSH-Px水平高于对照组(P<0.01)。结论:真武汤加味治疗糖尿病肾病脾肾气虚证能改善临床症状、降低蛋白尿、调节血糖,从而降低终点事件的发生率,对DN病情起到延缓作用,其作用机制可能是下调TGF-β、升高GSH-Px等细胞因子来实现的。
Objective： To observe the effect of Zhenwu decoction on diabetic nephropathy of spleen and kidney deficiency syndrome serum transforming growth factor beta（ TGF-β） and glutathione peroxidase（ GSH-Px） levels,and to observe the clinical curative effect of the treatment of the disease. Methods： 114 cases were randomly divided into control group and observation group with 57 cases in each group. The control group was treated with Losartan Potassium Tablets,100 mg per day,one time a day,oral. The observation group was treated with Zhenwu Decoction based on the control group,one dose a day. The course of treatment was 24 weeks,and 24 weeks were followed up for two weeks. During the treatment period and follow-up records of disease progression to stage patients,the incidence of creatinine or double endpoint events. Detection of glycosylated hemoglobin（ HbA lc）,blood urea ni-trogen,serum creatinine,24 hours urine protein quantitative detection; spleen and kidney deficiency syndrome score before and after treatment; detection of TGF-beta 1,GSH-Px level before and after treatment. Results： The clinical efficacy of the observation group was 84. 21%,higher than that of the control group of 64. 91%,the difference was statistically significant（ χ^2= 5. 573,P〈0. 05）. In the observation group,the effective rate was 91. 23%,higher than that of the control group（ 75. 44%）,and the difference was statistically significant（ χ^2= 5. 116,P〈0. 05）. The end points of response rate of the control group was 43. 86%,higher than 24. 56% of the observation group,the difference was statistically significant（ χ^2= 4. 715,P〈0. 05）. After treatment,the levels of HbA lc in the two groups were lower than before treatment（ P〈0. 01）,the two groups of 24 hours urine protein,urea nitrogen and creatinine levels were higher than before treatment（ P〈0. 01）; After treatment,the observation group HbA lc,24 hours urinary protein quantitation,urea nitrogen and creatinine levels were lower than the control group（ P〈0. 01）. After treatment,the average water level of TGF-beta 1 in the observation group was lower than that of the control group,and the level of GSH-Px was higher than that of the control group（ P〈0. 01）. Conclusion： Zhenwu decoction in the treatment of diabetic nephropathy of spleen and kidney Qi deficiency syndrome can improve clinical symptoms,reduce proteinuria,regulate blood sugar,thereby reducing the end points of response rate,delaying the condition of DN,the mechanism may be through down-regulation of TGF-beta 1,elevated cytokines such as GSH-Px to achieve.
出处
《中医学报》
CAS
2016年第12期1885-1888,共4页
Acta Chinese Medicine
基金
陕西省科学技术研究发展计划项目(S2016YFSF0014)
