A report of three cases of diabetic nephropathy satisfactorily treated with traditional herbal medicine : Clinical evaluation of the effect of traditional herbal medicines containing Daio (Rhei Rhizoma) on the progression of diabetic nephropathy with overt proteinuria

摘要

顕性蛋白尿期にある糖尿病性腎症の患者に漢方治療を施行した。その結果,随伴する諸症状の改善のみならず長期間,腎機能低下の進行を抑制した3症例を経験したので報告した。症例1では,98ヶ月の観察でS-Cr値は1.2から2.0mg/dl,症例2では70ヶ月の観察で,S-Cr値は0.9から1.9mg/dl,症例3では81ヶ月の観察で,S-Cr値は1.1から2.9mg/dlと長期間腎機能低下の進行を抑制した。さらに,顕性蛋白尿期の糖尿病性腎症患者8症例[平均年齢60(45-73)才,糖尿病罹患期間18(7-36)年]に対する大黄含有漢方方剤の効果を検討した。各症例において平均7.4(5-12)方剤を用いた。和漢薬治療開始時のHbAlcは8.2%で,平均血清クレアチニン値は1.0±0.3mg/dlであった。各症例は,糖尿病性神経症と網膜症を有しており,3症例で高血圧症を4症例で虚血性心疾患を合併していた。平均107±25ヶ月後,血清クレアチニン値は4.8±2.6mg/dlと有意に上昇した。透析導入に至らなかった5症例の平均血清クレアチニン値は1.2±0.3から3.2±1.0mg/dlと上昇し,透析導入に至った3症例は,平均血清クレアチニン値が0.8±0.1から7.5±2.1mg/dlと上昇した。クレアチニンクリアランスを測定することのできた4症例において,その平均上昇率は,0.78±0.40ml/min/monthであった。持続的に蛋白尿を認める顕性腎症期に至った糖尿病性腎症は6-7年の経過で,末期腎不全から血液透析に至ると言われている。今回の検討から大黄含有漢方方剤は,糖尿病性腎症における腎機能障害の進行を抑制し血液透析導入までの期間を延長したと考えられた。 We reported that three cases of diabetic nephropathy, who had overt proteinuria, were treated satisfactorily not only for their symptoms but also renal nephropathy with traditional herbal medicine over a long term. In Case 1, the level of S-Cr had changed from 1.2 to 2.0 mg/dl over 98 months, in Case 2 from 0.9 to 1.9 mg/dl over 70 months, and in Case 3 from 1.1 to 2.9 mg/dl over 81 months, acceptably moderate increases, meaning that the progression of their renal insufficiency was controlled over the long term. We also studied the effect of traditional herbal medicines containing Daio (Rhei Rhizoma) on the long-term progression of diabetic nephropathy with overt proteinuria in 8 patients [mean age 60 (45-73) years; duration of diabetes 18 (7-36) years]. An average of 7.4 (5-12) kinds of traditional herbal prescriptions was used for each patient. At the beginning of the study mean HbAlc was 8.2% and mean serum creatinine was 1.0±0.3mg/dl. After a mean of 107±25 months, the mean serum creatinine level had significantly increased to 4.8±2.6 mg/dl. The mean serum creatinine levels of 5 patients not advancing to dialysis treatment increased from 1.2±0.3 to 3.2±1.0mg/dl, and those of 3 patients requiring dialysis increased from 0.8±0.1 to 7.5±2.1mg/dl. The mean rate of decline of creatinine clearance in the measurable 4 patients was 0.78 ±0.40ml/min/month. Diabetic nephropathy with overt proteinuria is reported to develop into renal failure after 6-7 years. In this study, traditional herbal medicines with Daio were considered to be effective in prolonging the pre-dialysis period of diabetic nephropathy.