【作者】 刘兴亚；

【导师】 章永红；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 博士

【摘要】 糖尿病肾病(Diabetic Nephropathy, DN)是糖尿病常见的并发症,是目前糖尿病患者的主要死因之一。其临床分期可分为Ⅰ期(肾小球高滤过期)、Ⅱ期(静息期)、Ⅲ期(隐性期)、Ⅳ期(临床显性期)、Ⅴ期(肾功能衰竭期)五个阶段。DN患病率随着现代生活水平的改善呈不断上升趋势,估计在未来的20年中糖尿病肾病将成为终末期肾衰竭的最重要原因,所以如何有效地治疗、预防DN已成为国内外学者共同关注的问题。其发病机制至今为止尚未明暸。目前西医尚缺乏理想的治疗方法,因此积极探索中医药治疗DN的有效方法将是关注的热点。本研究的主要内容有：(1)结合历代医家对消渴的论述以及DN的现代中医药治疗进展,探讨了糖尿病肾病的中医发病机理与病理因素。(2)通过对糖尿病肾病的文献和理论研究,结合本人在内分泌科病案的临床体会,我们应用扶正化瘀解毒法治疗糖尿病肾病,并藉由临床症状与各项生化指标的改善来验证扶正化瘀解毒方治疗DN的有效性.本研究共完成观察病例60例,其中治疗组30例,对照组30例。对照组采用国际通用最新的综合治疗方案,治疗组依据糖尿病肾病的基本病机特点联合使用中药汤剂,汤剂以基本方为主,同时根据患者不同阶段不同病情随症加减。研究结果表明扶正化瘀解毒方结合综合治疗的方案可以通过改善临床症状、改善生存质量、降低尿蛋白、降低血脂、降低血糖达到防治糖尿病肾病进展的疗效。论文详细谈论了扶正化瘀解毒方的方药组成及给药方法,并分析其作用机理。更多还原

【Abstract】 Diabetic nephropathy is a major complication of diabetes and responsible for the major cause of death in diabetic patients. It includes five stages:phase I(high filtration rate stage of glomerulus), phaseⅡ(quiescent stage), phaseⅢ(occult stage), phaseⅣ(dominant stage), phaseⅤ(renal failure stage).With the changing of lifestyle, the incidence of DN is rising year by year. DN is becoming the leading cause of ESRD in the next 20 years. How to treat and prevent the DN effectively will become the most concerned issue in the future. The exact cause of diabetic nephropathy is unknown, but it is believed that uncontrolled high blood sugar leads to the development of kidney damage, especially when high blood pressure is also present. Western medicine is still short of better treatment. So it is very important for searching a better strategy for DN from Traditional Chinese Medicine (TCM) field.The major content of this subject including:(1) Focus and research the traditional medical theory regarding diabetes and the medical process of DN in modern TCM. (2) Combine with the Chinese medical theory and our clinical experience to propose a new treatment protocol for DN. The effectiveness was measured by the change of clinical symptoms and biochemical index.Sixty patients with DN were divided randomly into two groups (testing group n=30, control group n=30). Thirty patients in testing group per os Chinese herbal drugs of supplementing qi, blood-activating with stasis-resolving and detoxification, accept general combined therapy at the same time. Thirty patients in control group were given general combined therapy only. All patients were treated for 12 weeks.The result of the study shows the better effect, compared with general combined therapy, only. All patients were treated for 12 weeks.The result of the study shows the better effect, compared with general combined therapy, in treating diabetic nephropathy with the method of supplementing qi, blood-activating with stasis-resolving, and detoxification. The method we proposed not only has the therapeutic effect, the most important is that it could get the goal of protection and improvement of renal function by decreasing urinary protein, blood glucose, and blood lipids.更多还原