芪参益气滴丸联合替米沙坦治疗早期糖尿病肾病疗效及其对氧化应激指标的影响

摘要

目的：观察芪参益气滴丸联合替米沙坦治疗早期糖尿病肾病气虚血瘀证患者的临床疗效及对氧化应激指标的影响。方法将60例早期糖尿病肾病气阴两虚兼血瘀证患者随机分成治疗组和对照组各30例,均接受糖尿病教育、糖尿病饮食控制及胰岛素注射降糖治疗。对照组口服替米沙坦,治疗组在对照组治疗基础上口服芪参益气滴丸,疗程12周。分别于治疗前后观察2组血压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿白蛋白排泄率(UAER),血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)及尿8-异前列腺素 F2α(8-iso-PGF2α)排泄水平,评价临床疗效。结果治疗组总有效率高于对照组,差异有统计学意义(Z＝2.822,P＝0.005)。2组治疗后血压、FBG、HbA1c、血清MDA含量、尿8-iso-PGF2α排泄水平、UAER均明显下降,血清SOD、GSH-Px含量明显上升(P＜0.05)；治疗组治疗后血清MDA含量、尿8-iso-PGF2α排泄水平、UAER显著低于对照组,血清SOD、GSH-Px含量显著高于对照组(P＜0.05),组间血压、FBG、HbA1c比较差异无统计学意义(P＞0.05)。结论芪参益气滴丸联合替米沙坦治疗早期糖尿病肾病气阴两虚兼血瘀证能有效减少尿蛋白的排出,其肾脏保护机制可能与显著抑制糖尿病肾病早期的氧化应激损伤有关。%Objective To observe the clinical efficacy of Qishen Yiqi Dropping Pills combined with telmisartan on early diabetic nephropathy with Qi deficiency and blood stasis syndrome and changes of oxidative stress indicators. Methods Sixty patients with early diabetic nephropathy of qi-yin deficiency and blood stasis syndrome were randomly divided into treatment group (30 cases) and control group (30 cases). Both groups were given diabetes education, diabetes diet control and insulin injection. Patients in the control group took telmisartan orally, and patients in the treatment group were given Qishen Yiqi Dropping Pills additionally. The treatment course was 12 weeks. The indicators were observed before and after treatment including blood pressure (BP), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), urinary albumin excretion rate (UAER), urinary 8-iso-PGF2α excretion rate, serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and malonaldehyde (MDA), and the clinical efficacy was evaluated. Results The total effective rate of the treatment group was significantly higher than that of the control group, with statistical significance (Z=2.822, P=0.005). After treatment, the indicators including BP, FBG, HbA1c, serum MDA, UAER and urinary 8-iso-PGF2α excretion rate all decreased significantly in both groups (P<0.05). Serum SOD and GSH-Px increased significantly at the same time (P<0.05). BP, FBG and HbA1c were not statistically different between the two groups (P>0.05). However, serum MDA, UAER, and urinary 8-iso-PGF2αexcretion rate were significantly lower (P<0.05), and serum SOD and GSH-Px were significantly higher in treatment group than control group (P<0.05). Conclusion Qishen Yiqi Dropping Pill combined with telmisartan is effective in reducing proteinuria in patients with early diabetic nephropathy of qi-yin deficiency and blood stasis syndrome. Its protective mechanism for kidney is possibly related to inhibiting oxidative stress injury at the early stage of diabetic nephropathy.