印荻 章旭 曹娟 赵艳茹

[摘要] 目的 研究早期糖尿病腎病患者应用健脾固肾活血汤联合厄贝沙坦治疗的临床疗效。方法 选择2015年1月—2017年12月在该院就诊的67例早期糖尿病肾病患者作为该次研究对象，按照计算机表法将其分为治疗组与对照组，治疗组36例，对照组31例，对照组在降糖基础上仅给予厄贝沙坦口服，治疗组在对照组基础上加用健脾固肾活血汤，比较两组临床效果，并观察两组治疗前后的尿微量白蛋白、24 h尿蛋白定量、血液流变学指标、肾功能、肝功能及糖化血红蛋白。结果 ①治疗组患者临床总有效率是91.67%，对照组患者临床总有效率是70.96%，治疗组临床总有效率高于对照组，差异有统计学意义（P<0.05）。②两组治疗后尿微量白蛋白、尿蛋白定量、红细胞压积、血浆黏度和纤维蛋白原均低于治疗前，差异有统计学意义（P<0.05）；治疗后，治疗组尿微量白蛋白、红细胞压积、血浆黏度与纤维蛋白原水平低于对照组（P<0.05）。③两组治疗后β2-MG、CysC水平均低于治疗前，差异有统计学意义（P<0.05），两组治疗后BUN、Scr、ALT、Alb、AST、HbA1c水平和治疗前比较，差异无统计学意义（P>0.05）；治疗组治疗后β2-MG、CysC水平显著低于对照组，差异有统计学意义（P<0.05），治疗组治疗后BUN、Scr、ALT、Alb、AST、HbA1c水平和对照组比较，差异无统计学意义（P>0.05）。结论 健脾固肾活血汤与厄贝沙坦联合治疗早期糖尿病肾病的效果明显，能够有效提高患者的治疗总有效率，减轻尿微量白蛋白，改善血液流变学指标，安全性较好，值得临床应用。

[关键词] 健脾固肾活血汤；厄贝沙坦；早期糖尿病肾病

[中图分类号] R587.1 [文献标识码] A [文章编号] 1672-4062（2018）08（b）-0189-04

Clinical Analysis of Jianpi Gushen Huoxue Decoction Combined with Irbesartan in the Treatment of Early Diabetic Nephropathy

YIN Di， ZHANG Xu， CAO Juan， ZHAO Yan-ru

Department of Nephrology， Taixing People's Hospital， Taixing， Jiangsu Province， 225400 China

[Abstract] Objective To study the clinical efficacy of Jianpi Gushen Huoxue Decoction combined with irbesartan in patients with early diabetic nephropathy. Methods Sixty-seven patients with early diabetic nephropathy who were admitted to the hospital from January 2015 to December 2017 were enrolled in this study. They were divided into a treatment group and a control group according to the computer table method， and 36 patients in the treatment group and 31 cases in the control group. The control group was given only irbesartan orally on the basis of hypoglycemic effect. The treatment group was treated with Jianpi Gushen Huoxue Decoction on the basis of the control group. The clinical effects of the two groups were compared， and the urine micro whites protein， 24-hour urine protein quantitation， hemorheology， renal function， liver function， and glycated hemoglobin before and after treatment were observed. Results 1.The total effective rate of the treatment group was 91.67%， and the total effective rate of the control group was 70.96%. The total effective rate of the treatment group was higher than that of the control group， and the difference was statistically significant（P<0.05）. 2.After treatment， urine microalbumin， urine protein quantitation， hematocrit， plasma viscosity and fibrinogen were lower than before treatment， the difference was statistically significant（P<0.05）； after treatment， the treatment group of white urine protein， hematocrit， plasma viscosity and fibrinogen levels were lower than the control group（P<0.05）. 3.The levels of β2-MG and CysC in the two groups were lower than those before treatment， and the difference was statistically significant（P<0.05）. The levels of BUN， Scr， ALT， Alb， AST and HbA1c were compared with those before treatment. The difference was not statistically significant（P>0.05）. The levels of β2-MG and CysC in the treatment group were significantly lower than those in the control group， the difference was statistically significant （P<0.05）. The BUN， Scr， ALT and Alb， AST and HbA1c levels between the control group and the treatment group were not statistically significant （P>0.05）. Conclusion Jianpi Gushen Huoxue Decoction combined with irbesartan is effective in treating early diabetic nephropathy， which can effectively improve the total effective rate of treatment， reduce microalbuminuria， improve blood rheology， with better safety， which is worth clinical application.

[Key words] Jianpi Gushen Huoxue Decoction； Irbesartan； Early diabetic nephropathy

糖尿病肾病是糖尿病危害最大的慢性并发症，发病率较高，对该病症的发病机制进行分析，早期出现肾小球滤过率增高，后逐渐出现微量白蛋白尿、蛋白尿及进行性肾功能减退，严重时造成患者死亡[1]。因此，给予行之有效的治疗，尽可能延缓病情的发展，对患者的预后尤为重要。当前临床中主要通过降糖、降压、调脂、抗凝等方法治疗糖尿病肾病，无其他有效治疗手段。……