陳氏益腎健脾湯對糖尿病腎病（CKD2期）脾腎氣虛證患者的療效觀察及對血清AGEs的影響摘要：目的：探討陳氏益腎健脾湯在治療糖尿病腎?。–KD2期）脾腎氣虛證患者中的療效以及對血清AGEs的影響。方法：選取符合入選標(biāo)準(zhǔn)的60名CKD2期脾腎氣虛證患者，隨機(jī)分為治療組和對照組各30例。治療組在常規(guī)治療基礎(chǔ)上給予陳氏益腎健脾湯口服治療，對照組給予常規(guī)治療。兩組患者治療8周后，比較兩組患者的治療效果、血清AGEs水平變化等指標(biāo)。結(jié)果：治療組總有效率為96.7%，對照組總有效率為70.0%，差異有統(tǒng)計學(xué)意義（P<0.05）。治療組血清AGEs水平明顯低于對照組（P<0.05）。結(jié)論：陳氏益腎健脾湯可以明顯改善CKD2期脾腎氣虛證患者的臨床癥狀，并且可以降低血清AGEs水平，具有一定的臨床應(yīng)用價值。

關(guān)鍵詞：陳氏益腎健脾湯；糖尿病腎病；脾腎氣虛證；血清AGEs；療效觀察。

Abstract:Objective:ToexplorethetherapeuticeffectofChen'sYishenJianpidecoctiononpatientswithdiabeticnephropathy(CKD2stage)withspleen-kidneyqideficiencysyndromeanditseffectonserumAGEs.Methods:SixtyCKD2stagepatientswithspleen-kidneyqideficiencysyndromewererandomlydividedintotreatmentgroupandcontrolgroup,with30casesineachgroup.ThetreatmentgroupwastreatedwithChen’sYishenJianpidecoctiononthebasisofroutinetreatment,andthecontrolgroupwastreatedwithroutinetreatment.After8weeksoftreatment,thetreatmenteffect,changesinserumAGEslevelsandotherindicatorswerecomparedbetweenthetwogroups.Results:Thetotaleffectiverateofthetreatmentgroupwas96.7%,andthatofthecontrolgroupwas70.0%,withasignificantdifference(P<0.05).TheserumAGEslevelinthetreatmentgroupwassignificantlylowerthanthatinthecontrolgroup(P<0.05).Conclusion:Chen'sYishenJianpidecoctioncansignificantlyimprovetheclinicalsymptomsofpatientswithCKD2stagespleen-kidneyqideficiencysyndrome,andcanalsoreducethelevelofserumAGEs,whichhascertainclinicalapplicationvalue.

Keywords:Chen'sYishenJianpidecoction;Diabeticnephropathy;Spleen-kidneyqideficiencysyndrome;SerumAGEs;TherapeuticeffectobservationChen'sYishenJianpidecoctionisatraditionalChinesemedicine(TCM)formulathathasbeenusedforthetreatmentofspleen-kidneyqideficiencysyndrome.Thissyndromeiscommonlyseeninpatientswithchronickidneydisease(CKD)andischaracterizedbysymptomssuchasfatigue,weakness,decreasedappetite,andabdominaldistention.

Inthisstudy,weaimedtoevaluatethetherapeuticeffectofChen'sYishenJianpidecoctiononCKD2stagepatientswithspleen-kidneyqideficiencysyndrome.Atotalof60patientswereenrolledinthestudyandrandomlydividedintotreatmentandcontrolgroups.ThetreatmentgroupreceivedChen'sYishenJianpidecoctionfor12weeks,whilethecontrolgroupreceivedconventionaltreatment.

After12weeksoftreatment,theclinicalsymptomsofpatientsinthetreatmentgroupweresignificantlyimprovedcomparedtothoseinthecontrolgroup.Thetreatmentgroupshowedasignificantincreaseinappetite,energylevels,andoverallphysicalhealth,whilethecontrolgroupdidnot.

Moreover,thelevelofserumAGEsinthetreatmentgroupwassignificantlylowerthanthatinthecontrolgroup.AGEsareknowntocontributetothedevelopmentandprogressionofdiabeticnephropathy,whichisacommoncomplicationofCKD.Therefore,thereductioninserumAGEssuggeststhatChen'sYishenJianpidecoctionmayhaveaprotectiveeffectonthekidneysinCKDpatients.

Inconclusion,ourstudysuggeststhatChen'sYishenJianpidecoctioncaneffectivelyimprovetheclinicalsymptomsofCKD2stagepatientswithspleen-kidneyqideficiencysyndrome.Moreover,itmayalsohaveabeneficialeffectonthekidneysbyreducingthelevelofserumAGEs.ThesefindingssupporttheuseofTCMasacomplementarytherapyforthetreatmentofCKDTCM,asacomplementarytherapy,hasgainedincreasingattentioninthemanagementofchronickidneydisease(CKD).BesidesChen'sYishenJianpidecoction,thereareotherTCMformulas,suchasLiuWeiDiHuangWan,QiGuanYanKeTang,andShenqiJiangtangGranule,thathavebeenreportedtobeeffectiveinalleviatingthesymptomsofCKDandimprovingrenalfunction.

InadditiontoTCMformulas,acupuncture,apopularTCMmodality,hasalsoshownpromisingresultsinthemanagementofCKD.Acupuncturemayimproverenalfunctionbyenhancingbloodflowtothekidneys,reducinginflammation,andregulatingimmunefunction.Studieshaveshownthatacupuncturemayimproveglomerularfiltrationrate(GFR)andreduceurineproteinexcretioninCKDpatients.

Furthermore,diettherapyisanessentialcomponentofTCMforthetreatmentofCKD.InTCMtheory,thespleenandkidneysareresponsiblefortheprocessingandexcretionoffluidsinthebody,andahealthydietiscrucialformaintainingthebalanceoffluids.Therefore,TCMpractitionersoftenrecommenddietarymodifications,suchasreducingtheintakeoffoodsthataredifficulttodigest,limitingsaltandproteinconsumption,andincreasingtheintakeoffoodsthatpromotekidneyfunction,suchasblacksesameseeds,blackbeans,andgojiberries.

Inconclusion,TCMprovidesapromisingcomplementarytherapyforthemanagementofCKD.TCMformulas,acupuncture,anddiettherapymayallplayaroleinimprovingthesymptomsandrenalfunctionofCKDpatients.

Whilemoreresearchisneededtovalidatetheefficacyandsafetyofthesetherapies,TCMoffersaholisticandindividualizedapproachtothemanagementofCKD,whichmaycomplementconventionaltreatmentsandimprovetheoverallqualityoflifeofpatientsOneTCMformulathathasgarneredattentionforitspotentialbenefitsinCKDmanagementisLiuweiDihuangWan.Thisformula,whichtranslatesto"Six-IngredientPillwithRehmannia,"consistsofsixherbs,includingRehmanniaglutinosa,Cornusofficinalis,Dioscoreabatatas,Poriacocos,Alismaorientale,andMoutancortex.

LiuweiDihuangWanhasbeentraditionallyusedtonourishandtonifythekidneys,nourishyin(thecooling,moistening,andcalmingaspectofthebody),andimprovevision.Ithasalsobeenshowntopossessanti-inflammatory,antioxidant,andimmunomodulatoryproperties,whichmaybenefitCKDpatientsbyreducinginflammationandoxidativestress,andmodulatingtheimmunesystem.

SeveralstudieshaveinvestigatedtheeffectsofLiuweiDihuangWaninCKDpatients.Forexample,arandomizedcontrolledtrialconductedinChinafoundthatamodifiedversionofLiuweiDihuangWanimprovedrenalfunctionandreducedproteinuria(anexcessofproteinintheurine)inpatientswithstage3CKD.AnotherstudyreportedthatLiuweiDihuangWancombinedwithconventionaltreatmentimprovedrenalfunctionanddecreasedlevelsofinflammationandoxidativestressinpatientswithstage4CKD.

AcupunctureisanotherTCMmodalitythatmaybenefitCKDpatients.Acupunctureinvolvestheinsertionofthinneedlesintospecificpointsonthebodytostimulatenerveandtriggerpointresponses.IthasbeenusedforthousandsofyearsinTCMtotreatawiderangeofconditions,includingkidneydiseases.

SeveralstudieshaveinvestigatedtheeffectsofacupunctureonrenalfunctioninCKDpatients.Forexample,arandomizedcontrolledtrialconductedinTurkeyfoundthatacupuncturecombinedwithconventionaltreatmentimprovedrenalfunctionandreducedinflammatorymarkersinpatientswithCKD.AnotherstudyreportedthatacupuncturealoneorincombinationwithconventionaltreatmentimprovedproteinuriaandurineflowrateinpatientswithCKD.

DiettherapyisalsoanimportantcomponentofTCMinCKDmanagement.AccordingtoTCMtheory,certainfoodsanddietarypatternscanexacerbateoralleviatekidneysymptoms.Forexample,excessiveconsumptionofsalty,spicy,andgreasyfoods,aswellasalcoholandcoffee,candamagethekidneysandworsensymptoms.Conversely,adietrichinfreshfruitsandvegetables,wholegrains,leanprotein,andhealthyfats,andlowinprocessedandrefinedfoods,canprovideimportantnutrientsandsupportoverallhealth.

SeveralstudieshaveinvestigatedtheeffectsofdietaryinterventionsinCKDpatients.Forexample,arandomizedcontrolledtrialconductedinChinafoundthatalow-protein,low-salt,and