中国中医科学院望京医院,北京市朝阳区中环南路6号,100102
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收稿:2023-07-11,
修回:2023-09-10,
纸质出版:2023-11-17
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李翔宇,李同侠,黄雪莹等.芪黄益肾颗粒联合中医慢病管理治疗糖尿病肾脏疾病气阴两虚型临床观察[J].中医杂志,2023,64(22):2314-2321.
LI Xiangyu,LI Tongxia,HUANG Xueying,et al.Qihuang Yishen Granules (芪黄益肾颗粒) Combined with Chronic Disease Management of Traditional Chinese Medicine for Diabetic Kidney Disease Patients with Deficiency of both Qi and Yin:A Clinical Observation[J].Journal of Traditional Chinese Medicine,2023,64(22):2314-2321.
李翔宇,李同侠,黄雪莹等.芪黄益肾颗粒联合中医慢病管理治疗糖尿病肾脏疾病气阴两虚型临床观察[J].中医杂志,2023,64(22):2314-2321. DOI: 10.13288/j.11-2166/r.2023.22.010.
LI Xiangyu,LI Tongxia,HUANG Xueying,et al.Qihuang Yishen Granules (芪黄益肾颗粒) Combined with Chronic Disease Management of Traditional Chinese Medicine for Diabetic Kidney Disease Patients with Deficiency of both Qi and Yin:A Clinical Observation[J].Journal of Traditional Chinese Medicine,2023,64(22):2314-2321. DOI: 10.13288/j.11-2166/r.2023.22.010.
目的
2
观察芪黄益肾颗粒联合中医慢病管理治疗糖尿病肾脏疾病气阴两虚型患者的临床疗效及安全性。
方法
2
140例糖尿病肾脏疾病气阴两虚型患者随机分为对照组、治疗组各70例。对照组予西医对症治疗及常规慢病管理,治疗组在西医对症治疗同时给予芪黄益肾颗粒口服联合中医特色的慢病管理,两组疗程均为6个月。比较两组患者治疗前及治疗3、6个月时实验室指标和慢病管理水平评分变化情况,并分析两者的相关性。实验室指标包括尿蛋白及肾功能相关指标[24 h尿蛋白定量(24 hUTP)、血肌酐(Scr)、尿素氮(BUN)、估算肾小球滤过率(eGFR)]以及控制达标率,血糖及血脂相关指标[糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)]以及控制达标率。慢病管理水平评分包括运动锻炼、认知性症状管理实践、与医生沟通、症状管理自我效能、疾病共性管理自我效能的评分。
结果
2
最终对照组67例,治疗组68例完成观察。与本组治疗前比较,治疗组治疗3个月时24 hUTP、Scr降低,运动锻炼、自我管理总分和所有自我效能量表评分均升高,TG升高,治疗6个月时24 hUTP降低,eGFR升高,各项慢性病自我管理评分及自我效能量表评分升高(
P
<0.05),对照组治疗6个月时自我管理总分升高(
P
<0.05)。治疗6个月时,治疗组较对照组24 hUTP、Scr、LDL-C、TG降低,eGFR升高,24 hUTP、eGFR、LDL-C、TG控制达标率升高,各项慢病管理指标评分均升高(
P
<
0.05)。相关性分析结果显示,24 hUTP与运动锻炼、症状管理自我效能、疾病共性管理自我效能均呈负相关(
P
<0.05或
P
<0.01);Scr与症状管理自我效能、疾病共性管理自我效能均呈负相关(
P
<0.01);eGFR与症状管理自我效能、疾病共性管理自我效能均呈正相关(
P
<0.01)。
结论
2
芪黄益肾颗粒联合中医慢病管理能够改善糖尿病肾脏疾病气阴两虚型患者的蛋白尿、肾功能和脂代谢水平,从而延缓糖尿病肾脏疾病的进展,提高患者的慢病管理水平。
Objective
2
To observe the effectiveness and safety of
Qihuang Yishen Granules
(芪黄益肾颗粒) combined with traditional Chinese medicine (TCM) chronic disease management on patients with diabetic kidney disease with deficiency
qi
and
yin
.
Methods
2
Totally 140 patients diagnosed as diabetic kidney diseases with deficiency of both
qi
and
yin
were randomly divided into control group and trial group,with 70 cases in each group. Patients in the control group were treated with symptomatic treatment and routine chronic disease management. Patients in the trial group added
Qihuang Yishen Granules
and chronic disease management with TCM characteristics on the basis of symptomatic treatment. The course of treatment in both groups lasted for 6 months. The changes of laboratory indexes and chronic disease management level scores of the two groups of patients before treatment and after 3 and 6 months of treatment were compared, and their correlation were analyzed.The laboratory indexes of urinary protein and renal function related indicators such as 24-hour urinary protein quantification (24 hUTP), serum creatinine (Scr), blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR), and control compliance rate, as well as blood glucose and lipid related indicators such as glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and control compliance rate were observed. The chronic disease management level scores included exercise,cognitive symptom management practice,communication with doctors, self-efficacy of symptom management,self-efficacy of disease commonness management.
Results
2
Finally,67 cases in the control group and 68 cases in the trial group completed the study. Compared with the group before treatment, the trial group had lower 24 hUTP and Scr, higher exercise score, total self-management score and all self-efficacy scale scores, higher TG at 3 months of treatment; at 6 months of treatment, the trial group had lower 24 hUTP, higher eGFR, and higher self-management scores and self-efficacy scale scores of all chronic diseases (
P
<0.05), and the control group had higher self-management total score (
P
<0.05). After 6 months of treatment, the trial group had lower 24 hUTP, Scr, LDL-C, and TG, higher eGFR, higher compliance rate of 24 hUTP, eGFR, LDL-C, and TG, and higher scores for all chronic disease management indexes compared with the control group (
P
<0.05). In terms of the correlation between laboratory indicators and chronic disease management level scores:there was a statistically significant difference in the correlation between 24hUTP and exercise,symptom management self-efficacy,and self-efficacy of disease commonness management (
P
<0.05 or
P
<0.01),all of which were negatively correlated. There was a statistically significant difference in the correlation between Scr and symptom management self-efficacy and self-efficacy of disease commonness management (
P
<0.01),both of which were negatively correlated. There was a statistically significant difference in the correlation between eGFR and symptom management self-efficacy and self-efficacy of disease commonness management (
P
<0.01),both of which were positively correlated.
Conclusion
2
Qihuang Yishen Granules
combined with chronic disease management of TCM can improve the level of proteinuria,renal function and lipid metabolism in patients with diabetic kidney disease with deficiency of both
qi
and
yin
,thus delaying the progress of diabetic kidney disease and also improve the level of chronic disease management of patients.
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