【作者】 颜秀芸；

【导师】 汪悦；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的：在新加坡(仁康中医诊疗中心)门诊按照一般临床设计研究,观察以清热利湿通络法治疗早期糖尿病肾病湿瘀阻络证患者中医临床症状、蛋白尿、肾功能、血糖、血脂、血红蛋白及血桨白蛋白的改善,探讨清热利湿通络法治疗早期糖尿病肾病的机理。评价在西医降糖、控制血压等基础治疗的基础上清热利湿通络中药对糖尿病肾病(DN)患者尿蛋白和肾功能的影响。方法：将符合西医诊断标准和中医辨证标准的48例患者分为治疗组26例和对照组22例。治疗组在原有西药不变的基础上,加用清热利湿通络中成药(处方是均以《台湾港香兰》生产“浓缩科学细粒剂Granules")和《台湾顺天堂》生产的特浓缩细粒,处方：黄芩1.5g、茯苓2g、泽泻1g、怀牛膝1g、丝瓜络2g、玉米须2g、丹参1g、益母草1g,生大黄1.5g。注(每1克浓缩科学细粒剂相等于原药生药3.5克。每日两次,早晚口服,治疗10周后评价其疗效。对照组,则维持原有的西药治疗。连续观察10周。结果：研究显示,中医药的疗效机理是通过多靶点多器官系统的整体调节而实现的,因此其治疗效果通常在症状体征和实验室指标两个方面都有反映。本研究中疾病治疗总有效率为92.3%,与对照组(总有效率为54.54%)有非常显著的差异。说明以清热利湿通络方在西药治疗的基础上,既可进一步改善早期糖尿病肾病湿瘀阻络证病患者的血糖及血脂代谢,又能明显改善患者的湿瘀阻络的症状和体征,使患者的疾病状态得到较全面地改观治疗前后的组内比较显示,治疗组在糖化血红蛋白(HbAIC)、空腹血糖(FBG)和餐后2小时血糖(PBG)方面均有极其显著性差异(P<0.001),总胆固醇(TC)和低密度脂蛋白(LDL)有极其显著性差异(P<0.001),甘油三酯(TG)有显著性差异(P<0.05)。而对照组治疗前与治疗后没有显著性差异。分析：清热利湿通络法,从整体的角度改善身体的素质,改善气血的运行,调节新陈代谢。现代研究证实,本研究所选用的大多数中药物具有良好的降血糖、降血脂、和改善胰岛素抵抗及血液流变学等多方位的、多环节的作用。因此,在患者的西药治疗表现出进展停顿时,中医药的介入不仅使血糖进一步降低,而且明显改善临床症状,说明清热利湿通络法不仅能增强体质,提升能量,还能促进机体的能量物质代谢。结论：清热利湿通络法对早期糖尿病肾病患者的中医临床症状、糖化血红蛋白,空腹血糖和餐后2小时血糖及生活质量疗效明显。更多还原

【Abstract】 In Diabetic nephropathy (Diabetic Nephropathy, DN), diabetic glomerulosclerosis is one of the most typical diabetes microvascular complications. It is the main reason leading to the death of diabetic patients. Diabetic nephropathy in about20%to40%of type1or type2diabetes patients with some progressing to End Stage Renal Disease (ESRD) Without special intervention, approximately80%of people with persistent microalbuminuria in type1diabetes in10to15years, develop clinical nephropathy accompanied with hypertension. Once clinical nephropathy occurs, and lack of effective intervention, glomerular filtration rate can gradually deteriorate within a few years, gradually decreased to50%after10years, and20years later, more than75%of patients will develop ESRD.Objective:The clinical research, made observations of the effects of expulsion of heat dampness through collaterals in the treatment of early diabetic nephropathy patients, understands the impact of the TCM clinical symptoms, proteinuria, kidney function, blood sugar, blood lipids, hemoglobin and plasma albumin mechanism for the above treatment of early diabetic nephropathy.Methods:48patients were in line with Western diagnostic criteria and standards of TCM is divided into22cases of26cases of the treatment group and control group. Treatment group maintain the same in the original Western medicine, with added clearing away heat and Tongluo Chinese medicine treatment, twice daily, morning and evening oral. Evaluation was carried out after10weeks of treatment. Control group, maintain the original western medicine. Continuous observation for made for10weeks.Results:After treatment, Chinese medicine clinical symptoms total score than before treatment there are significant differences in the control group, P<0.05, treatment group, P<0.001, between groups after treatment, the contrast is extremely significant difference (P<0.001), treatment group efficiency of92.3%.Conclusion:clearing away heat and collaterals of TCM clinical symptoms in patients with early diabetic nephropathy, glycated hemoglobin, fasting plasma glucose and2-hour postprandial blood glucose and quality of life were significantly improved.更多还原