中醫藥治療糖尿病腎病變之病例報告

近年來台灣成年人糖尿病發生率居高不下，且慢性腎臟病盛行率逐年上升，其中糖尿病腎病變佔了大宗，已成為嚴重威脅國民健康及高度耗費醫療資源的重大疾病。中醫古代雖然沒有相同的病名，但有類似的症狀表現，自古至今都有中醫藥治療腎病的諸多經驗，對於應用在治療慢性腎臟病上會有許多幫助。本病案患者為一60歲女性，有視網膜病變史，長期服用西藥控制高血壓與糖尿病，2019年11月在內科診所治療泌尿道感染時，例行檢查發現腎功能下降到3a期（eGFR：56.4mL/min/1.73m^2）並出現微量白蛋白尿（UACR：34.5mg/g），遂由西醫轉介中醫治療。患者於2020.12.25求診中醫，診斷主要證型為腎氣虛虧、濕熱阻絡，兼有水熱互結、血虛血瘀。治則以補腎助陽，清利濕熱，養血化瘀，隨證加減。經過治療，腎功能回復到第2期（eGFR：72.5mL/min/1.73m^2），白蛋白尿降到正常（UACR：17.2mg/g），糖化血色素達到控制的標準（HbA1c：7.0%），患者自覺症狀改善，生活品質得以提升，持續服藥維持療效。希望本案例提供給醫師同道參考。

關鍵字

慢性腎臟病；糖尿病腎病變；中醫藥

並列摘要

In recent years, the incidence of diabetes in Taiwanese adults has remained high, and the prevalence of chronic kidney disease has increased year by year. Diabetic nephropathy accounts for the bulk of it, and has become a major disease that seriously threatens national health and consumes medical resources. Although traditional Chinese medicine does not have the same disease name in ancient times, it has similar symptoms. Since ancient times, there have been many experiences in the treatment of kidney disease with traditional Chinese medicine, which will help a lot in the treatment of chronic kidney disease. The patient in this medical case is a 60-year-old woman with a history of retinopathy and long-term use of western medicine to control high blood pressure and diabetes. In November 2019, when the urinary tract infection was treated in the Internal Medicine Clinic, the routine examination found that the renal function decreased to stage 3a (eGFR: 56.4mL/min/1.73m^2) and developed microalbuminuria (UACR: 34.5 mg/g), so she was referred to Chinese Medicine Clinic for treatment. The patient sought a TCM doctor on December 25, 2020, and the main syndromes were diagnosed as deficiency of kidney Qi, damp-heat blocking the collaterals, mutual congestion of water and heat, and blood deficiency and blood stasis. The treatment was to invigorate the kidney and assist Yang Qi, clear up damp-heat, nourish blood and dissipate blood stasis, adding and subtracting according to the syndrome. After treatment, renal function returned to stage 2 (eGFR: 72.5mL/min/1.73m^2), albuminuria dropped to normal (UACR: 17.2 mg/g), Glycated hemoglobin reached the control standard (HbA1c: 7.0%), the patient's symptoms were relieved, the quality of life was improved, and the medication was continued to maintain the efficacy. I hope this case can be used for reference.