世界中医药

作者	单位
王素利1，张宇1，丁凡1，陈丽玲1，刘晏汝2	1 海南省三亚市中医院，三亚，572000； 2 长春中医药大学附属医院，长春，130021

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中文摘要:

目的：探究自拟培元方对糖尿病肾病微循环障碍影响性，以期提高疗效。方法：选取2016年1月至2018年1月三亚市中医院收治符合糖尿病肾病患者108例作为研究对象，按照就诊顺序编号随机分为对照组和观察组，每组54例。对照组予以常规治疗，观察组加用自拟培元方加减治疗，均治疗8周，观察2组治疗前、治疗后肾功能指标尿素氮（BUN）、肌酐（SCr）、尿蛋白排泄率（UAER）、24 h尿蛋白定量（24 hUpro）水平变化并比较；观察治疗前、治疗后在微循环障碍指标内皮素（ET-1）、血栓素（TXB2）、6-酮-前列腺素F-1a（6-Keto-PGF-1a）、一氧化氮（NO）水平变化并比较；观察治疗前、治疗后在氧化应激指标白细胞介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平变化并比较；观察治疗前、治疗后在血流流变学指标全血黏度、全血还原黏度、血小板聚集率、血浆黏度水平变化并比较。治疗过程中进行不良反应监测，治疗后进行统计，比较不良反应发生率变化。结果：治疗前2组BUN、SCr、UAER、24 h Upro比较，差异无统计学意义（P>0.05），治疗后2组BUN、SCr、UAER、24 hUpro较治疗前均显著下降，差异有统计学意义（P<0.05），治疗后观察组患者以上指标均显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组ET-1、TXB2、6-Keto-PGF-1a、NO比较，差异无统计学意义（P>0.05），治疗后2组ET-1A意义TXB2较治疗前均显著下降，6-Keto-PGF-1a、NO较治疗前均显著升高，差异有统计学意义（P<0.05），治疗后观察组6-Keto-PGF-1a、NO显著高于对照组、ET-1、TXB2显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组IL-6、IL-8、TNF-α、CRP比较，差异无统计学意义（P>0.05），治疗后2组IL-6、IL-8、TNF-α、CRP较治疗前均显著下降，差异有统计学意义（P<0.05），治疗后观察组以上指标均显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组全血黏度、全血还原黏度、血小板聚集率、血浆黏度比较，差异无统计学意义（P>0.05），治疗后2组以上指标较治疗前均显著下降，差异有统计学意义（P<0.05），治疗后观察组以上各指标均显著低于对照组，差异有统计学意义（P<0.05）。2组在不良反应率比较，差异无统计学意义（P>0.05）。结论：自拟培元方能通过改善糖尿病肾病微循环障碍，促进血液循环，抑制应激氧化，从而改善肾功能，提高疗效，且安全性高。

English Summary:

To explore the effects of self-made Peiyuan Formula on microcirculation disturbance of diabetic nephropathy in order to improve the curative effect.Methods:A total of 108 eligible patients with diabetic nephropathy were enrolled in our hospital from January 2016 to January 2018.They were randomly divided into control group(54 cases)and observation group(54 cases)according to the order of admition.The control group was given routine treatment，while the observation group was also treated with self-made Peiyuan Formula for 8 weeks.Changes of renal function indexes such as urea nitrogen(BUN)，creatinine(SCr)，urinary protein excretion rate(UAER)and 24 h urinary protein quantification(24 h Upro)were observed and compared before and after the treatment.Changes of endothelin-1(ET-1)，thromboxane(TXB2)，6-keto-prostaglandin F-1a(6-Keto-PGF-1a)and nitric oxide(NO)in microcirculation disturbance indexes were observed and compared before and after the treatment.Levels of interleukin-6(IL-6)，interleukin-8(IL-8)，tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in oxidative stress indexes before and after the treatment were observed and compared.Changes of hemorheological parameters such as whole blood viscosity，whole blood reduction viscosity，platelet aggregation rate and plasma viscosity were observed and compared before and after the treatment.Adverse reactions were monitored in the course of treatment，and statistics was performed after the treatment to compare the incidence of adverse reactions.Results:Before the treatment，the level differences of BUN，SCr，UAER and 24 h Upro in the 2 groups were comparable(P>0.05).After the treatment，the levels of BUN，SCr，UAER and 24 h Upro in the 2 groups were significantly lower than those before the treatment(P<0.05).After the treatment，the levels of above indexes in the observation group were significantly lower than those in the control group(P<0.05). 2)There were no significant differences in the levels of ET-1，TXB2，6-Keto-PGF-1a and NO between the 2 groups before the treatment(P>0.05).After the treatment，the levels of ET-1 and TXB2 in the 2 groups were decreased significantly compared with those before the treatment，while the levels of 6-Keto-PGF-1a and NO were increased significantly compared with those before the treatment(P<0.05).After the treatment，the levels of 6-Keto-PGF-1a and NO in the observation group were significantly higher than those in the control group，while the levels of ET-1 and TXB2 were significantly lower than those in the control group(P<0.05). 3)There were significant differences in the levels of IL-6，IL-8，TNF-a and CRP between the 2 groups before the treatment(P>0.05).After the treatment，the levels of IL-6，IL-8，TNF-α and CRP in the 2 groups were significantly lower than those before the treatment(P<0.05)，and the levels of above indexes in the observation group after the treatment were significantly lower than those in the control group(P<0.05). 4)The differences of whole blood viscosity，whole blood reduction viscosity，platelet aggregation rate and plasma viscosity in the 2 groups before the treatment were comparable(P>0.05).After the treatment，the above indexes in the 2 groups were significantly lower than those before the treatment(P<0.05).After the treatment，the above indexes in the observation group were significantly lower than those in the control group(P<0.05). 5)There was no significant difference in the rate of adverse reactions between the 2 groups(P>0.05).Conclusion:Self-made Peiyuan Formula can improve renal function and improve curative effect by improving microcirculation disturbance，promoting blood circulation and inhibiting oxidation stress in diabetic nephropathy，with high safety.

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