The System Of Diabetic Nephropathy Treatment And Clinical Effect Study Of Yiqi Yangyin Huoxue Intervention Probe

Part 1 Discussion on the law of syndrome management of diabetic nephropathy based on clinical path managementObject:Aiming at 200 inpatients with diabetic nephropathy managed by structured electronic DKD TCM clinical pathway,analyze the TCM syndromes and treatment methods of patients with different stages of diabetic nephropathy,explore the rules of diabetic nephropathy syndrome management,and evaluate the feasibility of DKD clinical pathway.Methods:The source of the cases was inpatients in the endocrinology ward of the Guang anmen Hospital from June 2017 to June 2019.According to the degree of renal damage,200 patients with diabetic nephropathy who were selected for clinical pathway management were divided into normal albuminuria group(normal group),micro albuminuria group(micro group)and a large amount of albuminuria group(large group).Studying for their age,duration of diabetes,smoking history,BMI,blood pressure,FBG,HbAlc,ACR,GFR,blood lipids,diagnosis of TCM syndromes,the distribution of TCM major and minor syndrome types,the corresponding symptoms,treatment prescriptions,and the traditional Chinese medicines in order to sum up the diabetic nephropathy risk factors and treatment outcomes of patients in the clinical pathway group.Results:①The degree of renal damage in patients with type 2 diabetes increased with the increase of body mass index,history of diabetes,smoking history,blood pressure,fasting blood glucose,triglycerides and cholesterol values,and type 2 diabetic nephropathy occurred on average 15 years after the diagnosis of diabetes.②The blood pressure of patients in the normal group and the micro group were within the normal range,and 82.6%of the patients in the large group had blood pressure SBP>140mmHg and DBP>90mmHg.③The results of retrospective analysis indicate that the top five TCM major syndromes in microalbuminuria patients with DKD are the syndromes of deficiency of qi and yin(44.17%),syndrome of dampness and heat(13.33%),syndrome of qi deficiency and blood stasis(9.17%),and yin Deficiency heat syndrome(8.33%)and phlegm and blood stasis obstruction syndrome(7.5%);the first five types of TCM main syndromes in clinical proteinuria are Qi and Yin deficiency syndromes(33.33%),damp heat syndrome(14.81%),The syndrome of deficiency of yin and fever(12.96%),syndrome of deficiency of qi and blood stasis(9.26%)and deficiency of spleen and kidney(7.41%),which can judge that the main syndromes of TCM in patients with diabetic nephropathy in early and middle stages are more common with deficiency of Qi and Yin.④In the early stage of diabetic nephropathy,the minor symptoms are mostly damp heat,phlegm,and blood stasis;when the disease progresses to the middle and late stages,the minor symptoms are mostly wet poison,phlegm and blood stasis.⑤The pre-prescriptions for diabetic nephropathy are mainly based on supplementing qi and nourishing yin,clearing away heat and dampness,and relieving liver and dissolving fire,etc.;in the later period,predominantly supplementing qi and nourishing yin,supplementing spleen and kidney,Tongfu Xiezhuo and other treatments are mainly used.⑥75.5%of patients with diabetic renal impairment have improved their symptoms and signs after treatment through clinical pathways.Conclusion:①Traditional Chinese medicine treatment of diabetic nephropathy can be divided into different stages as the main method,and then the medicine can be added or subtracted according to the patient’s symptoms;the main syndrome of early DKD traditional Chinese medicine is common deficiency of both qi and yin,as well as damp heat,phlegm,blood stasis,and blood stasis Throughout the course of the disease,the treatment method is mainly based on supplementing qi and nourishing yin,combined with the main distribution in the early stage,so it is concluded that the early DKD treatment is mostly supplementing qi and nourishing yin,promoting blood circulation and removing blood stasis.②High body mass index,long-term history of diabetes,smoking history,blood pressure above 140/90mmHg,FBG>7.0 mmol/L,hypertriglyceridemia and hypercholesterolemia are common risk factors for diabetic nephropathy.③75.5%of patients with diabetic renal impairment have effectively improved their symptoms and signs after treatment through the clinical pathway.The feasibility of the path management of staged and differentiated DKD is confirmed,and the law of syndrome management of diabetic nephropathy is further summarized.Part 2 Clinical Observation on the Intervention Effect of Qiqi Jiangtang Capsule of Yiqi Yangyin Huoxue on Early Diabetic NephropathyObject:To observe the clinical efficacy of Qiqi Jiangtang Capsule,which has the effects of yiqi yangyin,promoting blood circulation and removing blood stasis,in treating early type 2 diabetic nephropathy,and confirming that traditional Chinese medicine using the method of yiqiyangyin and activating blood to intervene in early DKD.The effectiveness of the progress of renal damage provide new theoretical and practical support for TCM intervention in the development of early diabetic nephropathy.Methods:A randomized,single-blind,placebo-parallel controlled,multi-center clinical study design method was used.The cases were taken from the Shunyi District Traditional Chinese Medicine Hospital of Beijing,Beijing Miyun District Traditional Chinese Medicine Hospital,Beijing Pinggu District Traditional Chinese Medicine Hospital,and the early stages of ward admission Patients with type 2 diabetic nephropathy,120 early DKD patients who met the diagnostic criteria were randomly divided into the test group(A Qizhi Jiangtang Capsule Group,C western medicine symptomatic treatment(losartan potassium tablets)plus Qi Zhi Jiangtang capsule group)And control group(B Qizhi Jiangtang Capsule placebo group,D western medicine symptomatic treatment(losartan potassium tablets)plus Qi Zhi JiangtangCapsule placebo group),of which C and D groups are based on A and B groups Add ARB antihypertensive drugs.During the trial,four groups of patients were combined with basic diet and exercise therapy.On the basis of this,the control group received orally Qiqi Jiangtang Capsules placebo,5 capsules/time,3 times/day;the test group took Qiqi Jiangtang capsules 5 capsules/time 3 times a day for 24 weeks.Focus on the changes in the clinical symptoms of traditional Chinese medicine,urine microalbumin creatinine ratio,serum creatinine,glomerular filtration rate,four blood lipids,blood pressure and other indicators before and after treatment.Results:The clinical research results show that after 6 months of treatment,the improvement of TCM symptoms and syndrome scores of the experimental group are better than the control group(P<0.05),and the same group of syndrome scores have improved significantly before and after treatment(P<0.01),the total effective rate of syndrome points in group A was 66.67%,and the total effective rate of group C was 82.61%.According to the main clinical indicator ACR,the total effective rate of the experimental group A(simple Chinese medicine group)is 60.0%,and the total effective rate of the group C(Chinese medicine+Western medicine antihypertensive drugs)is 69.6%.In terms of Western medical indicators,the experimental group is superior to the control group in reducing urine protein excretion,lowering patients’FBG,HbAlc,TG,LDL-C and stabilizing blood pressure.Among them,in terms of reducing urine protein excretion and controlling blood pressure,ARB class The effect of suppressing medicine is more significant.During the test and within 1 month after the end of the test,there were no adverse reactions and toxic and side effectsConclusion:Qizhi Jiangtang capsule is a safe and effective drug for early diabetic nephropathy.It can improve the symptoms and syndromes of traditional Chinese medicine in patients with early diabetic nephropathy,control urinary protein excretion,and also has a certain role in reducing blood sugar,blood lipids and controlling the rise of blood pressure.The method of supplementing qi,nourishing yin and promoting blood circulation can delay the progression of kidney damage in early diabetic nephropathy and provide a practical basis for the treatment of early DKD.Part 3 Literature review sectionsSummarizing the domestic and foreign literature on diabetic nephropathy in the past 15 years,TCM has focused on the etiology and pathogenesis of diabetic nephropathy,traditional Chinese medicine syndromes,and special prescription drugs.Modern medicine has focused on the research progress of diabetic nephropathy risk factors,etiology,and clinical treatment.The instructor’s clinical diagnosis and treatment experience is summarized in detail,which lays the theoretical foundation for the intervention of early DKD by supplementing qi,nourishing yin and activating blood circulation.Part 4 Innovation points,deficiencies and prospects of this researchDiabetic kidney disease is a common diabetic microvascular complication.Due to its high incidence,the current diagnosis and treatment plan is relatively clear,so it is feasible to construct a clinical pathway.The clinical path of diabetic nephropathy combines the stages of diabetic nephropathy with syndrome differentiation,focusing on the main clinical symptoms of patients for syndrome differentiation treatment,so as to exert the advantages and characteristics of traditional Chinese medicine.Qizhi Jiangtang capsule is a representative medicine of Yiqi Yangyin method.Although a large number of basic studies and literatures have reported the clinical efficacy of Yiqi Yangyin Huoxue method in the treatment of early diabetic nephropathy,and basic research has confirmed that its pharmacological mechanism can play a role in delaying The role of early DKD progress,but there is currently no domestic clinical research on the treatment of Qizhi Jiangtang capsules combined with Western medicine(ARB antihypertensive drugs).This subject adopts a randomized,single-blind,placebo-controlled,multi-center clinical trial design method.It is the first to conduct a four-component group,and the pure Chinese medicine and western medicine combined with traditional Chinese medicine are grouped to observe the efficacy,and discuss the Qizhi Jiangtang capsules to delay the early DKD Clinical efficacy and safety of patients with stasis syndrome.Due to the limitation of conditions in this study,the number of cases studied is relatively small,and the research on the mechanism of the drug’s first-order mechanism needs to be continuously deepened in the future.