| BackgroundIn recent years, the global incidence of diabetes is increasing rapidly. March25,2010"New England Journal of Medicine" published "China the prevalence of diabetes," the report said China reached9240million the number of patients with diabetes, the prevalence rate of9.7%; Potential150million people with diabetes. Diabetic nephropathy (diabetic nephropathy, DN) or diabetic glomerular sclerosis, is one of the most common complications of diabetes, According to general statistics, type2diabetes (T2DM) nephropathy prevalence rate of20%to60%. Once clinical diabetic nephropathy stage kidney disease, renal function continued to deteriorate, Type2diabetes, kidney disease caused by dominant, Therefore, in patients with type2DN effective early treatment and delay or even reverse its progress forward with important medical and social values.Increasingly evidence-based medicine and recognized the importance of domestic and foreign scholars, the development of treatment guidelines is the main foreign ways and means, However, experience in medicine is a medicine, many Chinese experts have accumulated a wealth of experience, expertise in Chinese medicine has a unique role and high status, DN treatment program development can not copy the methods of evidence-based medicine, the medicine should be based on their own features, full expert advice, combined with the development of evidence-based medicine approach to medicine. Currently a large number of randomized controlled trials show that on the basis of western medicine with traditional Chinese medicine treatment of early DN effective than Western medicine alone treatment, but no one has recognized to support evidence-based medicine to optimize the treatment program. There is an urgent need to adopt various methods to solve these problems, available for the development of type2diabetes, promote early diagnosis and treatment of kidney disease program provide a basis for countries to reduce the burden for the people to relieve pain.ObjectiveBased on the principles of evidence-based medicine, evidence-based medicine to support exploration of the type2diabetic nephropathy common diseases of the sick place, the main syndromes, the main treatment method, treatment characteristics, and treatment of systematic reviews of literature is, with reference to the above results and experience with teachers to develop treatment programs.Methods1、from the perspective of the literature of the early type2diabetic nephropathy treatment law1.1a comprehensive collection of literatureComprehensive collection of published randomized type2diabetic nephropathy and quasi-randomized clinical literature.1.2design information collection databaseReference card elements of theory and current literature to establish the ability to literature authors believe that the early type2diabetic nephropathy disease resistance, disease location, governance, should be taken to the treatment program, the literature related to evidence-based treatment group used drugs (Western medicine, Chinese medicine) information collection form.1.3data extractionTwo researchers in accordance with the subject of a special information collection database, a researcher to extract and input data, another to check the use of discussion to resolve differences, the lack of clinical trial data and contact person in charge to be added.1.4statistical analysisuse Epidata3.1establish information collection database, using the double entry method of data entry and correction, SPSS13.0software for statistical analysis.2、expert survey2.1select the survey:the selection of20-30from the National "Eleventh Five-Year Technology Support Program diabetic nephropathy group of hospitals of experts across the country. Selection principle:Chinese medicine, integrative medicine diabetes or kidney disease professional clinicians and researchers; Deputy High above title; engaged in this profession for more than10years.2.2design and payment of expert questionnaire:the results based on the principles of evidence-based medicine, according to the literature research and prepared to seek the expert advice on the basis of the expert questionnaire.2.3statistical analysis:①The the application Epidata3.1data management. The questionnaire data entry using double independent entry, after verification, correction, checked and verified, the database lock. And database into SPSS format and analyzed with SPSS13.0statistical software.②the general information of the expert use of descriptive statistical analysis.3、2diabetic nephropathy syndrome distribution survey3.1the inclusion criteria:①The diagnosis of diabetes are in line with the standards of the WHO (1980,1985,1999), or the ADA (1997);②diabetic nephropathy early diagnostic criteria for staging of urinary albumin excretion rate (UAER) and Mogensen in phase Ⅲ;③secondary diabetic nephropathy in type2diabetes for the first diagnosis for hospitalized patients. All the patients were clear consciousness, intelligence, integrity, and referred to an accurate understanding of the problem to answer.3.2discharge criteria:pregnant or lactating women, diabetic ketoacidosis and other acute metabolic disorders, and concurrent infection3.3survey design:the questionnaire related to symptoms, clinical research of Chinese and Western disease name according to Traditional Chinese Drug guiding principles and national standards, combined with literature research and clinical practice experience, a questionnaire after the patient is admitted, and accurate records. The statistical analysis of all the symptoms of frequency recording and analysis.3.4data processing analysis:using the complete data cases for statistical analysis. Lock the database to use Excel’s1to establish a database, the whole process with two dual-independent data entry and data verification and logic checks to ensure data is correct.All the symptoms of frequency records and analysis, general information on the t-test, data on the statistical software SPSS13.0.4、2-type of early treatment of diabetic nephropathy literature Systematic reviews4.1collection of literature:A comprehensive collection of published type2diabetic nephropathy were randomly and quasi-randomized clinical treatment literature4.2screening the literature:Qi, Nourishing Yin and Promoting Blood Circulation Herbal Prescription+benazepril+basic treatment vs benazepril+basic treatment. In addition to the experimental group Qi and Nourishing Yin and Promoting Blood Circulation Herbal Prescription, other therapeutic measures and treatment was no difference.4.3quality Assessment:The quality evaluation criteria used by the Cochrane renal group into clinical trial methodological quality.4.4the analysis of data:Provides the RevMan5.0software Meta-analysis of all the data collected, using the Cochrane Collaboration.Results1、type2diabetic nephropathy Treatment of law from the perspective of literature1.1Qiyinliangxu folder stasis is the most basic card type. The results of this study show that disease resistance to qi+Yin+Blood of the triple combination of the highest frequency of occurrence, accounting for71.3%, Stasis Syndrome Qiyinliangxu folder broad syndromes of diabetic nephropathy can be preliminary description ofQiyinliangxu folder stasis is the most basic of type2diabetic nephropathy syndrome type.1.2disease to kidney, and involving the spleen, liver, lung, stomach, spleen and kidney are the most common disease location. This study shows that the highest frequency of the disease to kidney, accounting for88.3percent, the highest frequency of the composite organs spleen and kidney, to a certain extent that disease to the kidney, spleen and kidney of the disease the most common disease location.1.3Qi and Yin and promoting blood circulation to the main and subtraction with the disease is its basic governing law. This study showed that the disease Governing Law Governing Law and diverse combination of Qi+Yin+blood circulation, the highest frequency. Preliminary indication of the type2diabetic nephropathy Governing Law and diverse, and qi and nourishing yin the main blood circulation and subtraction with the disease is its basic governing law. nephropathy therapies varied, nourishing blood circulation and subtraction with the disease is the basic rule in its current method.2、2diabetic nephropathy early Chinese medicine drug law2.1drugs frequency statistics:retrieval be effectively223, involving a total of138kinds of traditional Chinese medicine. The frequency of drug residing in the top10, astragalus, red sage root, dogwood, yams, Rehmanniae, Chuanxiong, Poria, Chinese angelica, motherwort, rhubarb. Frequency of10and more than one drug, a total of43species, the following43kinds of drugs, the frequency of a total of1978times, accounting for all drugs was88.2%.2.2Literature involving138kinds of traditional Chinese medicine, according to the "Pharmacy","National Herbal Compendium of Classification involving a total of21categories. Qi and medicine to the top, followed by the blood drug, the drug of heat and cooling blood, nourishing yin and medicine, astringent drug, diuresis Shenshi drug, blood tonic, and expelling blood stasis drug also accounted for a large proportion.3、diabetic nephropathy and Treatment law expert questionnaire3.1Symptoms:Symptoms are more complex, frequency of greater than6times in descending order:23fatigue, backache18times,13times more nocturia foamy urine12times11times, dry mouth, blurred vision10times, and dizzinessstool diluted nine times, shortness of breath, eight times, tinnitus seven times.3.2Etiology:the more risk factors, the frequency of the first five risk factors followed by nephron inadequate, loss of government mistreatment, anxiety, overeating Feigan, For excessive labor.3.3Disease:Visceral Syndrome disease to kidney, the highest frequency;22experts (one of whom did not fill out) think the most important organs disease spleen and kidney, the highest frequency.3.4Disease resistance:the highest frequency of qi deficiency,23, the frequency of100%, followed by blood stasis, yin deficiency, phlegm.3.5the best treatment options:22experts believe that Integrative Medicine is the best treatment options, a Chinese medicine treatment is the best treatment4、type2diabetic nephropathy syndrome distribution characteristics4.1Common symptoms of frequency:69cases of type2diabetic nephropathy in patients with a total of59symptoms, there a total of25frequency greater than10times, including the highest frequency of symptoms Shenpi fatigue, prompted qi deficiency in this period of great significance. While the stool dry and hard, insomnia, and more food to hunger Yi, stool frequency, dry mouth, irritability, heat intolerance, dry skin, hands and feet and heart heat symptoms tends to occur, you are prompted Yin (chun injury), and Heat Syndrome During this period of significance. The use of Chinese medicine theory for analysis of these symptoms, we can see Qi and Yin deficiency is most prominent for the DN III of pathogenesis characteristics. Blurred vision, numbness, pain, diabetic vascular neuropathy caused by symptoms of frequency higher, these disease and more suggestive of the emergence of blood stasis in traditional Chinese medicine theory. Backache, soft knee, deafness and other symptoms of frequency is also higher, these disorders are more suggestive of kidney deficiency syndrome in TCM theory. In addition, the symptoms of depression, hi quiet, hi, heave a deep sigh frequency was also higher disease in TCM theory is more suggestive of qi card.5、Qi, Nourishing Yin and Promoting Blood Circulation evaluation of the treatment of type2diabetic nephropathyParticipants included nine RCT, including686cases of type2diabetic kidney disease patients with early, but methodological quality evaluation shows included in the study quality is not high, only1B level, and the rest are for eight grade C. Meta analysis shows that the compared with those on the Pulitzer, qi blood-activation+bei that was lower in early the diabetes nephrosis patient urinary albumin excretion rate [WMD=-23.49,95%CI (87.54-0.44,)], serum creatinine [WMD=-48.99,95%CI (90.59,7.40)], urea nitrogen [WMD=-1.91,95%CI (4.82,1.00)], glycated hemoglobin [WMD=-1.08,95%CI (1.64,0.54)], triglycerides [WMD=-1.49,95%CI (2.90,0.09)] advantages, one group2cases reported in the literature to a dry cough, did not see the other adverse reactions.ConclusionThis study in accordance with the principles of evidence-based medicine, a comprehensive study of early treatment of type2diabetic nephropathy literature, extract relevant information and to do systematic reviews, expert survey, according to the characteristics of traditional Chinese medicine, clinical investigation, found that the literature research and clinical researchresults and expert advice is basically the same, the above findings and with tutor experience, preliminary to the following conclusions:1、The pathogenesis of type2diabetic nephropathy:basic pathogenesis of type2diabetic nephropathy of Qi and Yin deficiency, often of blood stasis, damp, and so on, which Qiyinliangxu folder stasis is the most basic card type, common forspleen and kidney, the kidney is of great significance.2、Type2diabetic nephropathy recommended treatment program:treatment options recommended Integrative treatment programs, specific treatment programs recommended qi and nourishing yin and activating blood circulation combined with ACEI or ARB class of drugs, while giving the routine western medicine, such as enhanced blood glucose control, reasonable buck.lipid-lowering, anticoagulant medication, diet, exercise prescription, psychological enlighten and diabetes education and developed according to the situation.This study into how evidence-based medicine among the Chinese study were useful to explore, study the modernization of Chinese medicine have some inspiration. |
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