摘要
【目的】探讨补肾健脾方(主要由黄芪、淫羊藿、山药、丹参、鹿角胶、沙苑子、制何首乌、黄精、葛根、大黄等中药组成)对脾肾两虚型2型糖尿病(T2DM)合并血脂异常患者临床疗效及脂联素(adiponectin,ADP)的影响。【方法】将90例脾肾两虚型T2DM合并血脂异常患者随机分为西药治疗组(简称西药组)、中药治疗组(简称中药组)、中西医结合治疗组(简称联合组),每组各30例。3组患者均给予常规降糖治疗,在此基础上,西药组给予阿托伐他汀钙片口服治疗,中药组给予补肾健脾方治疗,联合组给予阿托伐他汀钙片联合补肾健脾方治疗,疗程为8周。观察3组患者治疗前后中医证候积分、糖脂代谢指标、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及血清ADP水平的变化情况,并评价3组患者的中医证候疗效。【结果】(1)疗效方面,治疗8周后,西药组、中药组、联合组患者的总有效率分别为66.67%(20/30)、90.00%(27/30)、93.33%(28/30),组间比较,中药组和联合组的中医证候疗效均明显优于西药组(P<0.05)。(2)中医证候积分方面,治疗后,3组患者的中医证候积分均较治疗前下降(P<0.01),且中药组和联合组对中医证候积分的下降幅度均优于西药组(P<0.05或P<0.01)。(3)脂代谢方面,治疗后,3组患者的总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前有不同程度的改善,其中TC、TG、LDL-C水平均较治疗前显著下降,HDL-C水平均较治疗前显著升高,差异均有统计学意义(P<0.05或P<0.01);组间比较,中药组对TC、LDL-C的下降幅度和对HDL-C的升高幅度均不及西药组和联合组(P<0.05或P<0.01)。(4)糖代谢方面,治疗后,中药组和联合组患者的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、FINS、HOMA-IR水平均较治疗前显著下降(P<0.05或P<0.01),西药组患者仅FPG、2hPG、HOMA-IR水平较治疗前下降(P<0.05或P<0.01);组间比较,中药组和联合组患者对FPG、2hPG、HbA1c、FINS、HOMA-IR水平的下降幅度均明显优于西药组(P<0.05或P<0.01)。(5)脂肪激素方面,治疗后,3组患者的血清ADP水平均较治疗前显著升高(P<0.05或P<0.01),且中药组和联合组患者血清ADP水平的升高幅度均显著优于西药组(P<0.05)。【结论】补肾健脾方具有一定的调节脂质代谢作用,在改善脾肾两虚型T2DM合并血脂异常患者的临床症状、胰岛素抵抗,降低血糖,升高ADP水平等方面具有明显优势。
Objective To investigate the clinical efficacy of Bushen Jianpi Recipe(mainly composed of Astragali Radix,Epimedii Folium,Dioscoreae Rhizoma,Salviae Miltiorrhizae Radix et Rhizoma,Cervi Cornus Colla,Astragali Complanati Semen,Polygoni Multiflori Radix Preparata,Polygonati Rhizoma,Puerariae Lobatae Radix,and Rhei Radix et Rhizoma)on patients with type 2 diabetes mellitus(T2DM)complicated with dyslipidemia and differentiated as spleen-kidney deficiency type,and to observe its effect on the level of adiponectin(ADP).Methods Ninety patients with T2DM complicated with dyslipidemia and differentiated as spleen-kidney deficiency type were randomly divided into western medicine group,Chinese medicine(CM)group,and combination of CM and western medicine group(hereinafter referred to as combination group),and each group had 30 patients.All of the 3 groups were given conventional hypoglycemic treatment.Moreover,the western medicine group was given oral use of Atorvastatin Calcium Tablets,CM group was given Bushen Jianpi Recipe,and the combination group was given Atorvastatin Calcium Tablets together with Bushen Jianpi Recipe orally.The course of treatment lasted for 8 weeks.The changes of traditional Chinese medicine(TCM)syndrome scores,glucose and lipid metabolism indexes,fasting insulin(FINS),insulin resistance index(HOMA-IR)and serum ADP levels of the three groups were observed before and after the treatment.After treatment,the efficacy of TCM syndrome of the three groups was evaluated.Results(1)After 8 weeks of treatment,the total effective rates for TCM syndrome efficacy in the western medicine group,CM group,and combination group were 66.67%(20/30),90.00%(27/30),and 93.33%(28/30),respectively.The intergroup comparison showed that the TCM syndrome efficacy of the CM group and the combination group was significantly superior to that of the western medicine group(P<0.05).(2)After treatment,the TCM syndrome scores in all of the three groups were decreased compared with those before treatment(P<0.01),and the decreases of the scores in both CM group and combination group was superior to that in the western medicine group(P<0.05 or P<0.01).(3)After treatment,the levels of lipid metabolism parameters of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)in the three groups were improved to various degrees compared with the pre-treatment levels,of which the levels of TC,TG,and LDL-C were significantly decreased,and the level of HDL-C was significantly increased in comparison with that before treatment,and the differences were statistically significant(P<0.05 or P<0.01).The intergroup comparison showed that the decrease of TC and LDL-C and the increase of HDL-C in the CM group were inferior to those in the western medicine group and the combination group(P<0.05 or P<0.01).(4)After treatment,the levels of glucose metabolism parameters of fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),glycated hemoglobin(HbA1c),FINS,and HOMA-IR in the CM group and the combination group were significantly decreased compared with those before treatment(P<0.05 or P<0.01),while only the levels of FPG,2hPG,and HOMA-IR in the western medicine group were decreased compared with those before treatment(P<0.05 or P<0.01).The intergroup comparison showed that the patients in the decrease of FPG,2hPG,HbA1c,FINS,and HOMA-IR levels in the CM group and the combination group was significantly superior to that in the western medicine group(P<0.05 or P<0.01).(5)In terms of adipokines,the serum ADP level in the three groups after treatment was significantly increased compared with that before treatment(P<0.05 or P<0.01),and the increase of serum ADP level in both CM group and combination group was significantly superior to that in the western medicine group(P<0.05).Conclusion Bushen Jianpi Recipe has certain effect on regulating lipid metabolism,and has obvious advantages in improving clinical symptoms and insulin resistance,lowering blood glucose,and increasing ADP level in patients with T2DM complicated with dyslipidemia and differentiated as spleen-kidney deficiency type.
作者
潘梓珊
李东玲
冯敏瑶
季兵
刘峰
PAN Zi-Shan;LI Dong-Ling;FENG Min-Yao;JI Bing;LIU Feng(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of Endocrinology,Clifford Hospital,Guangzhou 511495 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2024年第1期54-61,共8页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省中医药局科研项目(编号:20191414)
广州市卫生健康委科技计划项目(编号:20202A011031)。
关键词
补肾健脾方
脾肾两虚
2型糖尿病
血脂异常
脂联素
Bushen Jianpi Recipe
deficiency of spleen and kidney
type 2 diabetes mellitus(T2DM)
dyslipidemia
adiponectin
作者简介
潘梓珊(1996-),女,硕士研究生,E-mail:Pan_zs@yeah.net;通信作者:刘峰(1980-),男,医学博士,主任医师,硕士研究生导师,E-mail:lftcm@163.com。
