柴珂 陈洪宇 曾佳丽

[摘要] 目的 探討复方积雪草2号组方治疗Ⅲ～Ⅳ期糖尿病肾病（DKD）的临床效果及安全性评价。 方法 选取2018年6月至2019年12月在杭州市中医院收诊的50例Ⅲ～Ⅳ期DKD患者，随机分为试验组与对照组，每组各25例，对照组采用常规西药疗法进行治疗，试验组在对照组基础上予以复方积雪草2号组方进行治疗。比较两组患者治疗前后的尿蛋白评价指标、肾功能评价指标、血糖血脂评价指标及安全性评价指标。 结果 治疗12周后，试验组的24 h尿蛋白定量、尿蛋白肌酐比（Acr）、血肌酐（Scr）低于治疗前（P<0.05），且试验组24 h尿蛋白定量、Acr低于对照组（P<0.05）。治疗后，试验组糖化血红蛋白与对照组比较，差异无统计学意义（P>0.05），试验组低密度脂蛋白与对照组比较，差异有统计学意义（P<0.05）。两组谷丙转氨酶、谷草转氨酶、血白细胞、血小板前后比较，差异无统计学意义（P>0.05）。试验组的治疗总有效率（84%）高于对照组（33%），差异有统计学意义（P<0.05）。 结论 复方积雪草2号组方可有效改善DKD患者的尿蛋白水平及肾功能指标水平，可能有助于患者血脂控制，提高患者的预后质量，且安全性较高，值得推广和应用。

[关键词] 复方积雪草2号组方;糖尿病肾病;尿蛋白水平;肾功能

[中图分类号] R587.1          [文献标识码] B          [文章编号] 1673-9701（2021）13-0139-05

Analysis on the clinical efficacy of Compound Centella Asiatica No.2 Prescription in the treatment of stage Ⅲ- V diabetic kidney disease

CHAI Ke1， 2   CHEN Hongyu1， 2   ZENG Jiali1， 2

1.Zhejiang Chinese Medical University， Hangzhou   310053， China; 2.Guangxing Hospital Affiliated to Zhejiang Chinese Medical University， Hangzhou   310000， China

[Abstract] Objective To explore the clinical efficacy and safety evaluation of Compound Centella Asiatica No.2 Prescription in the treatment of stage Ⅲ-Ⅳ diabetic kidney disease （DKD）. Methods A total of 50 patients with stage Ⅲ-Ⅳ DKD admitted to Hangzhou Hospital of Traditional Chinese Medicine from June 2018 to December 2019 were randomLy divided into the experimental group （n=25） and the control group（n=25）. The control group was treated with conventional western medicine， while the experimental group was treated with Compound Centella Asiatica No.2 Prescription on the basis of the control group. The urinary albumin evaluation index， renal function evaluation index， blood glucose and blood lipid evaluation indexes and safety evaluation index were compared between the two groups before and after treatment. Results After 12 weeks of treatment， the 24-hour urinary protein quantification， urinary albumin creatinine ratio （Acr） and serum creatinine （Scr） in the experimental group were lower than those before treatment（P<0.05）， and the 24-hour urinary albumin quantification and Acr in the experimental group were lower than those in the control group（P<0.05）. After treatment， there was no statistically significant difference in glycosylated hemoglobin between the experimental group and the control group（P>0.05）， but there was statistically significant difference in low density lipoprotein between the experimental group and the control group（P<0.05）. There was no statistically significant difference in alanine aminotransferase， aspartate aminotransferase， white blood cell and platelets of the two groups before and after the treatment. The overall response rate of the experimental group was 84%， which was higher than 33% of the control group， with statistically significant difference（P<0.05）. Conclusion Compound Centella Asiatica No.2 Prescription can effectively improve the urinary albumin level and renal function index level of patients with DKD， which may be helpful to control the blood lipid of patients and improve the prognosis quality of patients. It is safe and worthy of promotion and application.

[Key words] Compound centella asiatica No.2 priscription; Diabetic kidney disease; Urinary albumin level; Renal function

糖尿病肾病（Diabetic kidney disease，DKD）是2型糖尿病最常见的微血管并发症之一，以肾小球基底膜增厚、肾小管及肾间质纤维化为主要病理表现，是导致终末期肾脏病的常见原因[1-2]。近年来不断增加的糖尿病肾病患者是血液透析人群数量逐年快速增长的主要原因。糖尿病肾病Ⅲ～Ⅳ期是疾病治疗的关键时期，若不及时积极治疗，部分患者将会因水钠潴留、低白蛋白血症、肾功能快速恶化提前步入血液透析状态。在DKD早中期进行积极有效的干预，可延缓病情进展，甚至逆转，对减少终末期肾病（End-stage renal disease，ESRD）及心血管事件发生率是十分关键的。目前糖尿病肾病的治疗中已采取控制血糖、血压、血脂和阻断肾素-血管紧张素-醛固酮系统（Renin angiotensin aldosterone system，RAAS）等方案[3]，但由于DKD的发病机制复杂及特殊性，临床治疗效果不甚理想。……