Short-term Clinical Observation Of Early Diabetic Nephropathy By Treating With Huang Kui Capsule Combined And Benazepril

Objective:Diabetes mellitus(DM) has become a major health hazard, non-communicable diseases for mankind with its prevalence increasing year by year. Diabetic nephropathy is one of the most common chronic microvascular complications of diabetes, and it is the main cause of death in patients with diabetes. How to effectively prevent the occurrence and development of diabetic nephropathy, is an important work for medical workers. Glucose metabolism, lipid metabolism, renal hemodynamic abnormalities and oxidative stress play an important role in the process of pathophysiology of diabetic nephropathy. The glucose is converted to a large number of sorbitol, permeability damage on cells, glomerular and tubular function, under high glucose environment. Lipid metabolism, makes excessive fat deposition in the non-fat cells, increased foam cells deposition in the glomeruli.The increasing glomerular sclerosis could induce blood viscosity,reduce the role of the fibrinolytic system, prone to glomerular capillary vascular thrombosis, and lead to reduction in renal blood flow, glomerular sclerosis and tubular injury. The activation of intrarenal RAS system, especially the increased expression of renin-angiotensin(AngⅡ Ⅱ), could stimulate the transforming growth factor β(TGF-β) receptor upregulation in the glomerular expression of kidney and to promote epithelial cells,mesangial cells, proximal tubule epithelial cells and an outer fibrous extracellular matrix proteins increased production, but also to prevent the newly synthesized extracellular matrix degradation, the gradual accumulation of extracellular matrix, accelerate glomerular sclerosis, also can damage the glomerular filtration barrier, promote renal tubular-interstitial fibrosis. In diabetic metabolic disorders ROS(ROS), such as excessive free radical production,increased production,which can be adjusted as a second messenger protein kinase C, mitogen-activated protein kinases,etc.,and thus lead to a series of cascade, leading to podocyte damage, damage to the glomerular basement membrane charge barrier, then there proteinuria. When diabetic patients entering clinical diabetic nephropathy period, significantly increased urinary protein, high filtration can lead to glomerular endothelial cells and renal tubular epithelial cell damage, so filtration barrier function decline, increased urinary protein formation, and ultimately the development of end-stage kidney failure,a serious threat to human health.Promptly and effectively reduce urinary protein excretion may delay the progression of diabetic nephropathy, so early diagnosis and treatment of diabetic nephropathy is particularly important in the clinical work. That benazepril by reducing "three highs" status and inhibit glomerular mesangial cells and matrix hyperplasia lower urinary protein leakage, and Huang Kui capsule through anti-inflammatory, antioxidant, inhibition of platelet aggregation, improve microcirculation, repair charge barrier, such as reducing urinary protein leakage.This study of 60 patients with diabetic nephropathy in patients with early to compare the clinical efficacy of a single early diabetic nephropathy with benazepril and Huang Kui capsule combined with benazepril, to further explore the pathogenesis of diabetic nephropathy and benazepril, Huang Kui capsule protective effect on the kidney of diabetic patients.Methods:1 Sixty diabetes patients with early renal disease in the people’s hospital of hebei anpingxian, were randomly divided into control group and the observation group, according to the inclusion and exclusion criteria. Two groups of patients develop diabetes diet plan and oral hypoglycemic drugs program, using high-quality low-protein diet(protein intake should be limited to a daily per kilogram of body weight 0.6g.). Two groups patients were given a reasonable heat quantity, oral biguanide(metformin enteric-coated tablets), sulfonylurea or other non-sulfonylurea secretagogues antidiabetic drugs(glimepiride tablets, glipizide, repaglinide, etc.), α-glucosidase inhibitors(Aka wave sugar, etc.) and sensitizer(pioglitazone), etc. and the exclusion of insulin application patients and glycated hemoglobin was less than 9.0%, poor glycemic control patient demanded reaching the target in two weeks: fasting blood glucose target value is less than 7.0mmol/L, 2-hour postprandial blood glucose less than 10.0mmol/L, blood pressure of poorly controlled patients were applicated antihypertensive drugs to control and blood pressure target was less than or equal to 140 / 80 mm Hg. The control group treaded by benazepril 10 mg one day orally. Observation group were treaded by benazepril 10 mg one day and Huang Kui capsules 2.5g three times a day orally. Clinical data including age and gender and the Course of the disease were asked. Body weight and height were measured and body mass index(BMI) was calculated before and after 12 weeks, The urine trace albumin excretion rate(Um Alb),Glycosylated hemoglobin(Hb A1C), renal function(SCr,BUN) and plasma lipid(cholesterol, triglycerides, LDL-c, HDL- c were measured.2 SPSS 16.0 software was used for statistical analyses. for data analysis. Quantitative data meeting normal distribution were summarized using mean and standard deviation,Count data by chi-square test. Measurement data before and after treatment in the control group and observation group data difference is adopted t test, P﹤0.05 said the difference was statistically significant.Results:1 In the control group and observation group of patients with general data comparison: course, gender, age, height, weight, body mass index, there was no significant difference, comparable(P>0.05).Systolic pressure, diastolic blood pressure before treatment, glycosylated hemoglobin, total cholesterol, triglyceride, LDL- c, HDL- c are accord with normal distribution data.2 The Um Alb, SCr and BUN were significantly decreased after treatment in both the control and the observation groups(P<0.05).3 The difference of the Um Alb, SCr and BUN in the observation group was significantly higher than the control group(P<0.05). That is to say, observation group after treatment Um Alb、SCr、BUN significantly lower than the control group.Conclusions:1 Benazepril and Huang Kui capsule combined with benazepril could effectively reduced urinary albumin excretion rate, lower serum creatinine, blood urea nitrogen levels, improve renal function for diabetic nephropathy patients.2 Huang Kui capsule combined with benazepril benazepril could gain better clinical efficacy for early diabetic nephropathy and worthy of clinically promotion.