| Objective: this study aims to through controlled clinical trials,evaluation of TCM slow Disease management scheme based on filling Kidney qi and intervention of Diabetic nephropathy(Diabetic Kidney diseases)Ⅲ ～ Ⅳ period of the patient’s clinical curative effect,with 24 hours urinary protein quantitative,blood lipid,blood glucose,nutrition,renal function,hemorrheology indexes and the evaluation index of TCM syndrome integral,discusses the advantages of TCM slow Disease management delay the progress of Diabetic nephropathy,provide the basis for clinical application.Methods: collected in January 2019-July 2019 for the first time in the affiliated hospital of tianjin academy of traditional Chinese medicine,nephrology outpatient and ward,tianjin hongqiao district bell pavilion community service center,t sell community health service centers,community health service center and garden into standard DKDⅢ ～ Ⅳ period,96 cases of patients,according to whether to accept patients with slow disease of TCM management scheme is divided into observation group and control group.The control group received health education,controlled blood pressure,blood lipid and blood glucose,corrected anemia,hypoproteinemia and other symptomatic basic treatment programs,and the observation group added a chronic disease management program based on the method of tonifying kidney and activating blood circulation on the basis of the control group.The intervention time was 6 months.General indicators such as age,sex and course of disease were recorded before the trial.Monitoring therapeutic indexes include: 24 hours urinary protein,serum creatinine,blood urea nitrogen,quantitative estimated glomerular filtration rate(in the group,2months,4 months,a group of each detection 1 times),urine trace albumin creatinine ratio,whole blood high shear reductive viscosity,whole blood low shear reduction viscosity,plasma viscosity,erythrocyte aggregation index,cholesterol,triglycerides,high-densitylipoprotein cholesterol,low density lipoprotein cholesterol,glycosylated hemoglobin,fasting blood sugar,2 h postprandial blood glucose and TCM syndrome integral(into the group,the group’s test 1 time).Nutrition and safety indicators: body mass index,blood routine,liver function,electrolytes,electrocardiogram,etc.(once in the group and once out of the group).SPSS21.0 was used to analyze the difference of observation indexes between the two groups before and after treatment.Results: by the end of the follow-up period,4 cases fell off in the observation group(2 cases did not take medicine as required and 2 cases lost follow-up),and 7 cases fell off in the control group(3 cases did not take medicine as required,2 cases lost follow-up and2 cases quit).Finally,44 patients in the observation group and 41 patients in the control group completed the whole follow-up period and were included in the statistics.1.Clinical efficacy: after intervention,the total effective rate of the observation group was 88.63%;The total effective rate of the control group was 68.29%.Compared with the two groups,the total clinical efficacy of the observation group was better than that of the control group(P < 0.05).1.1 kidney related indicators: control of proteinuria was accompanied by treatment in both groups and showed a gradual trend of improvement,which was more significant in the observation group(P < 0.05).In terms of controlling blood creatinine and urea nitrogen and improving glomerular filtration rate,the control group obtained certain curative effect at the initial stage of treatment,but the whole group was in a state of fluctuation and the trend of improvement was not obvious.In the observation group,the whole intervention process showed a trend of gradual improvement and then stability.In terms of improving urinary microalbumin creatinine ratio,both groups were better than before intervention(P < 0.05),and the effect of the observation group was better than that of the control group(P < 0.05).1.2 hemorheological indexes: in the observation group,there were significant improvements in the whole blood before and after intervention(P < 0.05)in terms of high cutting reduction viscosity,low cutting reduction viscosity,plasma viscosity and red blood cell aggregation index.In the control group,the whole blood viscosity was significantly improved after intervention(P < 0.05),while the plasma viscosity and red blood cell aggregation index were not significantly improved(P > 0.05).Compared with the control group,the improvement of the whole blood viscosity in the observation group was better than that in the control group(P < 0.05).1.3 lipid profile: there were significant improvements in cholesterol,triglycerides,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol in the observation group before and after intervention(P < 0.05).The control group showed significant improvement in cholesterol and LDL cholesterol before and after intervention(P < 0.05).The improvement of cholesterol,triglycerides and HDL in the observation group was better than that in the control group(P < 0.05).1.4 blood glucose index: there were significant improvements in glycosylated hemoglobin,fasting blood glucose and 2h postprandial blood glucose in the observation group before and after intervention(P < 0.05).There was no significant improvement in glycosylated hemoglobin,fasting blood glucose or 2h postprandial blood glucose in the control group before and after intervention(P >,0.05).Compared with the control group,the improvement of fasting blood glucose and 2h postprandial blood glucose in the observation group was better than that in the control group(P < 0.05).1.5 nutritional indicators: there was no significant change in body mass index,hemoglobin and albumin in the control group before and after intervention(P > 0.05),while the hemoglobin and albumin in the observation group remained stable before and after intervention(P > 0.05),and the body mass index improved(P < 0.05).There was no significant difference between the two groups(P >0.05).2.Curative effect of TCM syndrome: after treatment,the total effective rate of the observation group was 93.18%,and that of the control group was 73.17%,and the curative effect of the observation group was better than that of the control group(P <0.05).After treatment,patients in the observation group showed effective improvement in fatigue,lumbar and knee tenderness,limb fatigue,nocturia,limb numbness,edema,and chills(P < 0.05).After treatment,the patients in the control group showed effective improvement in fatigue,lumbar and knee tenderness,nocturia,limb numbness and edema(P < 0.05),but no significant improvement in limb sleepiness and chills(P > 0.05).Compared with the control group,the observation group had significant advantages in alleviating fatigue and fatigue,lumbar and knee tenderness,nocturia,and chills(P <0.05),but no significant advantages in improving limb sleepiness,limb numbness and edema(P > 0.05).Conclusion:1.Chronic disease management in traditional Chinese medicine can further effectively reduce albuminuria,improve renal function,blood rheology,blood lipid and blood glucose,and help patients control their weight,so as to delay the progress of DKD.2.Chronic disease management of traditional Chinese medicine can effectively improve clinical symptoms,among which,fatigue,weak waist and knees,clear night urine and cold limbs have significant advantages over the control group.3.TCM chronic disease management is of high safety and low economic burden,which can more effectively monitor disease progression and improve patient compliance,disease awareness and self-management ability.It is worthy of in-depth research and large-scale promotion. |
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