肾炎康复片联合阿魏酸哌嗪片对糖尿病肾病微循环障碍的影响

目的：观察消积饮对晚期非小细胞肺癌患者血清血管内皮生长因子（VEGF）的影响和抗晚期非小细胞肺癌患者肿瘤生长与转移的临床综合疗效。方法：对符合受试条件的非小细胞肺癌患者进行前瞻性单盲意向性分组，分为消积饮组、化疗组（化疗＋安慰剂）、综合组（消积饮+化疗），每组各45例。消积饮组采用消积饮治疗，化疗组采用NP或GP方案化疗及安慰剂，综合组采用消积饮联合化疗治疗，每21 d为1个治疗周期，共治疗2个周期。治疗前后观察血清VEGF水平的变化、肿瘤大小变化及临床证候、临床症状、行为状况评分的变化，并进行不良反应观察进行药物安全性评价。结果：①消积饮组、综合组治疗后血清VEGF优于治疗前（P<0.05）；化疗组治疗前后血清VEGF值相比，差异无统计学意义。②消积饮组的有效率（CR+PR）低于化疗组及综合组；综合组的疾病控制率（CR+PR+SD）高于化疗组、消积饮组（P<0.05）；消积饮组的疾病控制率低于化疗组，差异无统计学意义。③在临床证候、临床症状及KPS评分方面，治疗后消积饮组优于化疗组相比（P<0.05）；综合组优于化疗组（P<0.05）；消积饮组与综合组相比，差异无统计学意义。④在毒副反应方面，消积饮组与化疗组及综合组相比，除1例出现恶心呕吐外，消积饮组没有观察到其他不良反应；化疗组及综合组主要的不良反应为消化道反应、血液系统毒性及肝肾功能影响等。结论：单用消积饮、消积饮联合化疗均可以在一定程度上降低晚期非小细胞肺癌患者血清VEGF表达水平，进一步揭示消积饮抗肿瘤侵袭转移的作用机制之一，可能是通过抑制肿瘤血管生成因子的分泌，减少肿瘤血管生成而实现的。消积饮对晚期非小细胞肺癌的生长有一定抑制作用，与化疗联合应用能提高疾病控制率。单用消积饮、消积饮联合化疗治疗晚期非小细胞肺癌较单纯化疗能更好的改善患者临床证候，改善临床症状，提高生活质量。消积饮安全性好，无血液系统毒性及心肝肾功能等毒副反应的发生。

Effect of Shenyan Kangfu Tablets Combined with Piperazine Ferulate Tablets on Microcirculation Disturbance of Patients with Diabetic Nephropathy

Objective: To discuss curative efficacy of Shenyan Kangfu tablets combined with piperazine ferulate tablets and influence to microcirculation disturbance in treating diabetic nephropathy(DN). Method: Sixty-five patients were randomly divided into control group (31 cases) and observation group (34 cases) by digital method.Patients in the control group received irbesartan tablets of conventional western medicine treatment with 150 mg/time and 1 time/d.Based on treatment of the control group,patients in the observation group added Shenyan Kangfu tablets with 5 tablets/time and 3 times/d by taken orally,and piperazine ferulate tablets took orally with 4 tablets/time and 3 times/d.Course of treatment in those two groups were both 12 weeks.Before and after treatment,24 hours urinary albumin excretion rate(UAER),24 hours urine protein quantitation and serum creatinine(Scr) were detected,hemorheology was also detected,levels of serous nitric oxide(NO),endothelin-1(ET-1),thromboxane(TXB₂),6-Ketone-prostaglandin F-(la)(6-Keto-PGF-la)and superoxide dismutase(SOD) were detected,level of malondialdehyde(MDA) was measured with thiobarbituric acid chromatometry. Result: Total effective rate of curative efficacy in the observation group was 88.24% superior to 67.74% in the control group(P<0.05).After treatment,compared with time before treatment,levels of UAER,24 hours urine protein quantitatio and Scr in those two groups decreased(P<0.01),which in the observation group were lower than those in the control group(P<0.01). Amelioration of whole blood viscosity(low shear and high shear),blood reduced viscosity,platelet aggregation index,plasma viscosity and fibrinogen in the observation group were superior to those in the control group(P<0.01),levels of NO and 6-Keto-PGF_1a in the observation group were higher than those in the control group(P<0.01),levels of ET-1 and TXB₂ in the observation group were lower than those in the control group(P<0.01),levels of SOD in those two groups increased and which in the observation group were higher than in the control group(P<0.01),level of MDA in those two groups decreased and which in the observation group were lower than in the control group(P<0.01). Conclusion: Based on the conventional treatment of angiotensin receptor antagonist(ARB),Shenyan Kangfu tablets combined with piperazine ferulate tablets could reduce proteinuria and protect renal function for patients of DN,its mechanism may be related to ameliorating hemorheology,regulating vascular endothelial function,reducing oxidative stress,increasing renal perfusion,restraining platelet aggregation and adhesion,so it could ameliorate renal microcirculation disturbance.