【作者】 赵永山；

【导师】 栗德林；

【作者基本信息】 黑龙江中医药大学 ， 中医内科学， 2003， 博士

【摘要】 本文首先进行理论研究，着重从中医学对“糖尿病肾病”的认识、中医药治疗糖尿病肾病的研究进展和现代医学对糖尿病肾病（DN）的发病机理、治疗现状进行文献整理，并在最后概述了导师栗德林教授运用中医药理论辨治DN的学术思想。为本课题的临床研究奠定了理论基础。第二部分为临床研究，依据临床流行病学、循证医学等方法，对78例早期DN患者进行随机对照研究，对芪蛭肾消方的临床疗效进行了科学评价，并从治疗后对病人血清AGEs、血浆Hcy、TXB₂／6-keto-PGF_1a的影响情况揭示了芪蛭肾消方防治DN的部分机理。研究结果显示：芪蛭肾消方可显著改善早期DN患者的临床症状与体征（P＜0.01）；治疗前后的血脂、血小板、血液流变学指标显示：芪蛭肾消方有良好的调节脂代谢作用，可以明显抑制亢进的血小板粘附、聚集功能，改善血液流变学异常。血糖和糖化血红蛋白治疗前后虽无显著差异（P＞0.05），但两组降糖药增减数量统计变化可间接证明芪蛭肾消方具有一定的降糖作用。加之治疗组疗后血清AGEs显著降低，明显优于对照组（P＜0.01），说明芪蛭肾消方能够改善糖代谢紊乱及其继发的内源性AGEs产生增多。这可能是芪蛭肾消方防治早期DN的重要机理之一。芪蛭肾消方能够显著改善早期DN患者存在的高Hcy状态（P＜0.01），并可明显降低其内生肌酐清除率、尿微量白蛋白排泄率（P＜0.01），表明芪蛭肾消方还能在一定程度上调节蛋白质／氨基酸的代谢紊乱，具有改善肾小球高滤过状态、减少尿微量白蛋白排泄、保护肾功能作用，从而起到预防和减缓DN发生和发展的功效。更多还原

【Abstract】 This paper was divided into two parts. The first part is about theoretical discussion and the following contents were reported such as basic theory and treatment development of diabetic nephropathy of traditional Chinese medicine, pathology and therapeutic situation of western medicine, and sum up our teacher-professor Lee Delin’s academic ideology, which provided theoretical foundation for clinical study. In the second part, 78 patients with incipient DN were observed with random control study on the basis of clinical epidemiological survey and DME method. The result: l.Qizhi Shenxiao fomular has function of improving clinical symptoms and the effect was better than the control group treated with western medicine through statistics analysis. 2. Qizhi Shenxiao fomular has effect of reducing blood sugar, serum advanced glycation end products (AGEs), regulating sugar and lipid metabolism. 3. Qizhi Shenxiao fomular could reduce urinary albumin excretion rate in DN early stage, improve glomerular filtration rate, protect kidney function, and defer DN development. 4. Qizhi Shenxiao fomular has effect of reducing plasma homocysteine (Hey), regulating protein metabolism, decrease the hyperhomocysteinemia (Hhcy) occurremce of incipient DN. 5. Qizhi Shenxiao fomular could reducd TXB2 and increase 6-Keto-PGF1a, reduce blood viscosity, pack cell volume, RBC aggregation index, fibrinogen concentration, blood platelet adhesion and aggregation rate, all above were better than control group treated with western medicine (P<0.01). 6. Qizhi Shenxiao fomular probably has good effect on treating retina disorders and peripheral nerve diseases caused by diabetes.更多还原