脉络学说指导下津力达联合通心络治疗2型糖尿病肾病的临床观察
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摘要
目的:观察脉络学说指导下津力达颗粒联合通心络胶囊治疗2型糖尿病肾病的临床疗效。方法:将120例2型糖尿病肾病患者随机分为对照组和治疗组,各60例,对照组予常规降糖降压等对症支持治疗,治疗组在对照组治疗基础上加津力达颗粒,1袋/次,3次/日,通心络胶囊4粒,3次/日,12周为1个疗程,治疗前后观察并比较两组患者的临床疗效、中医证候积分;糖代谢指标空腹血糖(FBG),餐后2 h血糖(2 h PG),糖化血红蛋(Hb A1c),胰岛素抵抗指数(HOMA-IR);脂代谢指标甘油三酯(TG),胆固醇(TC),低密度脂蛋白(LDL-C),高密度脂蛋白(HDL-C);肾功能血肌酐(SCr),尿白蛋白排泄率(UAER),尿β2微球蛋白(Uβ2-MG);甲襞微循环。结果:(1)对照组、治疗组临床总有效率分别为61. 67%,80. 00%,治疗组明显优于对照组(P <0. 05)。(2)中医证候积分改善比较,治疗组优于对照组(P <0. 05)。(3)治疗后治疗组在糖代谢指标FBG,2 h PG,Hb A1c上与对照组无明显差异,HOMA-IR改善优于对照组(P <0. 05);脂代谢指标TG,TC,LDL-C均明显降低(P <0. 05),HDL-C升高(P <0. 05);肾功能指标SCr,UAER,尿Uβ2-MG改善较对照组明显(P <0. 05);甲襞微循环结果显示,治疗组较对照组微循环改善明显(P <0. 05)。结论:通心络联合津力达可改善2型糖尿病肾病患者的临床症状,降低尿微量白蛋白,其机制可能与降糖、调节脂质代谢、改善微循环有关。
Objective: To observe the clinical efficacy of Jinlida(JLD) granules and Tongxinluo(TXL)capsules on type 2 diabetic kidney disease(DKD) under the guidance of vessel collateral theory. Method: A total of 120 patients with type 2 DKD,were randomly divided into 2 groups: the normal control group(60 cases) and the treatment group(60 cases). The patients in normal control group were treated with dietary control and hyperglycemia control. Based on treatment in control group,patients in treatment group were additionally treated with JLD granules(1 bag,tid),and TXL capsules(4 capsules,tid). The treatment was lasted for 12 weeks. The clinical efficacy,traditional Chinese medicine(TCM) syndrome scores were observed and compared before and after treatment. At the same time,the levels of glucose metabolism indexes including fasting blood glucose(FBG),postprandial 2 h plasma glucose(2 hPG),glycosylated hemoglobin(HbA1 c) and the insulin resistance(IR); the levels of lipid metabolism indexes including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C) and the high-density lipoprotein cholesterol(HDL-C); the levels of renal function indexes including urinary albumin excretion rate(UAER) and serum creatinine(SCr); as well as nailfold microcirculation were detected and compared. Result:(1)The total effective rate was 80. 0% in treatment group,significantly higher than 61. 67% in the normal control group(P < 0. 05).(2) The improvement in TCM syndrome scores of the treatment group was better than that of the control group,and the difference was statistically significant(P <0. 05).(3)After treatment,the treatment group showed no significant difference with the control group in glucose metabolism indexes FBG,2 hPG and HbA1 c,but HOMA-IR improvement was better than that of control group(P < 0. 05). Lipid metabolism indexes TG,TC and LDL-C were significantly decreased(P < 0. 05),and HDL-C was increased in both groups(P < 0. 05). The improvement of renal function indexes SCr,UAER and urine Uβ2-MG in treatment group was significantly obvious than that in the control group(P < 0. 05). The nailfold microcirculation results showed that the microcirculation improvement in treatment group was better than that of control group(P < 0. 05). Conclusion: Tongxinluo combined with Jinlida can improve the clinical symptoms of patients with type 2 diabetic nephropathy and reduce urinary trace albumin,and its mechanism may be related to lowering glucose,regulating lipid metabolism and improving microcirculation.
Objective: To observe the clinical efficacy of Jinlida(JLD) granules and Tongxinluo(TXL)capsules on type 2 diabetic kidney disease(DKD) under the guidance of vessel collateral theory. Method: A total of 120 patients with type 2 DKD,were randomly divided into 2 groups: the normal control group(60 cases) and the treatment group(60 cases). The patients in normal control group were treated with dietary control and hyperglycemia control. Based on treatment in control group,patients in treatment group were additionally treated with JLD granules(1 bag,tid),and TXL capsules(4 capsules,tid). The treatment was lasted for 12 weeks. The clinical efficacy,traditional Chinese medicine(TCM) syndrome scores were observed and compared before and after treatment. At the same time,the levels of glucose metabolism indexes including fasting blood glucose(FBG),postprandial 2 h plasma glucose(2 hPG),glycosylated hemoglobin(HbA1 c) and the insulin resistance(IR); the levels of lipid metabolism indexes including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C) and the high-density lipoprotein cholesterol(HDL-C); the levels of renal function indexes including urinary albumin excretion rate(UAER) and serum creatinine(SCr); as well as nailfold microcirculation were detected and compared. Result:(1)The total effective rate was 80. 0% in treatment group,significantly higher than 61. 67% in the normal control group(P < 0. 05).(2) The improvement in TCM syndrome scores of the treatment group was better than that of the control group,and the difference was statistically significant(P <0. 05).(3)After treatment,the treatment group showed no significant difference with the control group in glucose metabolism indexes FBG,2 hPG and HbA1 c,but HOMA-IR improvement was better than that of control group(P < 0. 05). Lipid metabolism indexes TG,TC and LDL-C were significantly decreased(P < 0. 05),and HDL-C was increased in both groups(P < 0. 05). The improvement of renal function indexes SCr,UAER and urine Uβ2-MG in treatment group was significantly obvious than that in the control group(P < 0. 05). The nailfold microcirculation results showed that the microcirculation improvement in treatment group was better than that of control group(P < 0. 05). Conclusion: Tongxinluo combined with Jinlida can improve the clinical symptoms of patients with type 2 diabetic nephropathy and reduce urinary trace albumin,and its mechanism may be related to lowering glucose,regulating lipid metabolism and improving microcirculation.
引文
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[13]黄静,张继强,陈峥,等.雷公藤多苷治疗糖尿病肾病Ⅳ期患者疗效的系统评价[J].中国中药杂志,2015,40(15):3100-3109.
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[18]高彦彬,周晖,关崧,等.糖肾宁颗粒治疗糖尿病肾病多中心随机双盲对照临床试验[J].中华中医药杂志,2017,32(11):5212-5215.
[19]惠晓丹,朱虹.中医药治疗糖尿病肾病的研究进展[J].世界中医药,2016,11(10):2200-2203.
[20]吴以岭.脉络论[M].北京:中国科学技术出版社,2012:3-6,259-260.
[21]吴以岭,赵珊珊,魏聪,等.试论气络病变治疗十法[J].中国实验方剂学杂志,2018,24(9):1-8.
[22]吴以岭.以络病理论为指导从“脾”论治2型糖尿病研究—消渴病从脾论治探讨[J].北京中医药,2016,35(6):507-509.
[23]庞洁,高怀林,王宏涛,等.津力达对糖尿病大鼠血糖调节激素及胰岛细胞功能干预作用研究[J].中国中医基础医学杂志,2014,20(5):605-607,648.
[24]高怀林.张建军,吴以岭,等.津力达颗粒对2型糖尿病胰岛β细胞功能的影响[J].时珍国医国药,2010,21(5):1119-1120.
[25]孙颖,金鑫,郭勇英,等.津力达颗粒联合通心络胶囊对2型糖尿病大鼠胰腺组织自噬的影响[J].中国实验方剂学杂志,2015,21(23):92-96.
[26]刘必成,刘怡然.糖尿病肾病发病机制研究进展[J].现代实用医学,2014,26(8):921-923.
[27]王照. 2型糖尿病患者合并肥胖、高血压及微血管并发症的横断面研究[D].长沙:中南大学,2008.
[28]章峻钧. 2型糖尿病患者微血管病变的影响因素研究[D].南宁:广西医科大学,2014.
[29] Retnakaran R,Cull C A,Thorne K I,et al. Risk factors for renal dysfunction in type 2 diabetes-UK prospective diabetes study[J]. Diabetes,2006,55(6):1832-1839.
[30] Abe M,Maruyama N,Okada K,et al. Effects of lipid lowering therapy with rosuvastatin on kidney function and oxidative stress in patients with diabetic nephropathy[J]. J Atheroscler Thromb,2011,18(11):1018-1028.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013版)[J].中国医学前沿杂志:电子版,2015,7(3):26-89.
[3]张雨薇,童南伟.《中国成人糖尿病肾病临床诊断的专家共识》解读[J].中国实用内科杂志,2015,35(2):139-142.
[4]吴以岭.消渴病从脾论治探讨[J].中医杂志,2002,43(6):410-411.
[5]庞洁,梁俊清,王志鑫,等.津力达联合通心络对高糖诱导胰岛微血管内皮细胞损伤干预作用及机制研究[J].中国药理学通报,2015,31(3):430-435.
[6]李婷,柳洁.津力达颗粒改善2型糖尿病胰岛素抵抗和血管并发症的临床研究[J].世界中医药,2015,10(12):1883-1884,1886.
[7]中华医学糖尿病分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[8] Foundation N K. KDIGO2012 clinical practice gudeline for the evaluation and management of chronic kidney diease[J]. Kidney Ent,2013,doi:10. 1016/j.clinbiochem. 2015. 07. 030.
[9]中华医学会糖尿病学分会微血管并发症学组.糖尿病肾脏防治专家共识(2014年版)[J].中华糖尿病杂志,2014,6(11):11-12.
[10]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:243-247,361-390.
[11]中华中医药学会肾病分会.糖尿病肾病诊断、辨证分型及疗效评定标准(试行方案)[J].上海中医药杂志,2007,41(7):7-8.
[12]任妍林,王定坤,董慧,等.小檗碱治疗糖尿病肾病的研究进展[J].中国中药杂志,2017,42(3):438-442.
[13]黄静,张继强,陈峥,等.雷公藤多苷治疗糖尿病肾病Ⅳ期患者疗效的系统评价[J].中国中药杂志,2015,40(15):3100-3109.
[14] Jha V,Garcia-garcia G,Iseki K,et al. Chronic kidney disease:global dimension and perspectives[J].Lancet,2013,382(9888):260-272.
[15]于牧鑫,解汝娟.糖尿病肾病肾小球硬化的机制研究进展[J].医学综述,2016,22(18):3632-3636.
[16]汪容,曹和欣.炎症及氧化应激机制与糖尿病肾病关系[J].辽宁中医药大学学报,2016,18(5):98-101.
[17]张智龙,陈宏,吉学群,等. 2型糖尿病慢性并发症中医证候特点分析[J].中医杂志,2011,52(16):1379-1382,1386.
[18]高彦彬,周晖,关崧,等.糖肾宁颗粒治疗糖尿病肾病多中心随机双盲对照临床试验[J].中华中医药杂志,2017,32(11):5212-5215.
[19]惠晓丹,朱虹.中医药治疗糖尿病肾病的研究进展[J].世界中医药,2016,11(10):2200-2203.
[20]吴以岭.脉络论[M].北京:中国科学技术出版社,2012:3-6,259-260.
[21]吴以岭,赵珊珊,魏聪,等.试论气络病变治疗十法[J].中国实验方剂学杂志,2018,24(9):1-8.
[22]吴以岭.以络病理论为指导从“脾”论治2型糖尿病研究—消渴病从脾论治探讨[J].北京中医药,2016,35(6):507-509.
[23]庞洁,高怀林,王宏涛,等.津力达对糖尿病大鼠血糖调节激素及胰岛细胞功能干预作用研究[J].中国中医基础医学杂志,2014,20(5):605-607,648.
[24]高怀林.张建军,吴以岭,等.津力达颗粒对2型糖尿病胰岛β细胞功能的影响[J].时珍国医国药,2010,21(5):1119-1120.
[25]孙颖,金鑫,郭勇英,等.津力达颗粒联合通心络胶囊对2型糖尿病大鼠胰腺组织自噬的影响[J].中国实验方剂学杂志,2015,21(23):92-96.
[26]刘必成,刘怡然.糖尿病肾病发病机制研究进展[J].现代实用医学,2014,26(8):921-923.
[27]王照. 2型糖尿病患者合并肥胖、高血压及微血管并发症的横断面研究[D].长沙:中南大学,2008.
[28]章峻钧. 2型糖尿病患者微血管病变的影响因素研究[D].南宁:广西医科大学,2014.
[29] Retnakaran R,Cull C A,Thorne K I,et al. Risk factors for renal dysfunction in type 2 diabetes-UK prospective diabetes study[J]. Diabetes,2006,55(6):1832-1839.
[30] Abe M,Maruyama N,Okada K,et al. Effects of lipid lowering therapy with rosuvastatin on kidney function and oxidative stress in patients with diabetic nephropathy[J]. J Atheroscler Thromb,2011,18(11):1018-1028.
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