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安徽中医药大学 第一附属医院,合肥 230031
吴吉萍,硕士,副主任医师,从事中医药防治代谢内分泌疾病研究,E-mail:2457022376@qq.com
方朝晖,博士,主任医师,从事内分泌疾病临床诊治及科研工作,E-mail:fangzhaohui9097@163.com
收稿日期:2022-08-03,
网络出版日期:2022-12-14,
纸质出版日期:2023-09-20
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吴吉萍,方朝晖,陆瑞敏等.丹蛭降糖胶囊对2型糖尿病合并下肢大血管病变患者临床疗效及血清Hcy、Cys C水平的影响[J].中国实验方剂学杂志,2023,29(18):102-108.
WU Jiping,FANG Zhaohui,LU Ruimin,et al.Clinical Efficacy of Danzhi Jiangtang Capsules on Patients with Type 2 Diabetes Mellitus Complicated with Lower-extremity Macroangiopathy and Serum Levels of Hcy and Cys C[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(18):102-108.
吴吉萍,方朝晖,陆瑞敏等.丹蛭降糖胶囊对2型糖尿病合并下肢大血管病变患者临床疗效及血清Hcy、Cys C水平的影响[J].中国实验方剂学杂志,2023,29(18):102-108. DOI: 10.13422/j.cnki.syfjx.20230324.
WU Jiping,FANG Zhaohui,LU Ruimin,et al.Clinical Efficacy of Danzhi Jiangtang Capsules on Patients with Type 2 Diabetes Mellitus Complicated with Lower-extremity Macroangiopathy and Serum Levels of Hcy and Cys C[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(18):102-108. DOI: 10.13422/j.cnki.syfjx.20230324.
目的
2
观察具有益气养阴通络功效的丹蛭降糖胶囊对2型糖尿病(T2DM)合并下肢大血管病变患者临床疗效及血清同型半胱氨酸(Hcy)、胱抑素C(Cys C)水平的影响。
方法
2
选择2017年5月至2019年12月安徽中医药大学第一附属医院内分泌科住院的T2DM合并下肢大血管病变患者80例,随机分为治疗组和对照组,两组各40例,两组患者均给予糖尿病相关的基础治疗,治疗组在基础治疗的基础上加用丹蛭降糖胶囊口服,治疗前后分别测定两组的糖基化血红蛋白A1c(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、空腹C肽(C-P)、餐后2 h C肽(2 hC-P)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),血清Hcy及Cys C水平,计算两组患者治疗前后中医证候积分。
结果
2
治疗12周后门诊随访,治疗后两组患者HbA1c、FPG、2 hPG水平均较本组治疗前明显下降(
P
<
0.05),C-P水平均较本组治疗前明显升高(
P
<
0.05),2 hC-P水平有升高,但差异无统计学意义;与对照组治疗后比较,治疗组患者HbA1c、FPG、2 hPG水平下降程度更为明显(
P
<
0.05),C-P、2 hC-P水平差异无统计学意义;治疗后两组患者TG、TC、LDL-C水平均较本组治疗前明显下降(
P
<
0.05),HDL-C明显升高(
P
<
0.05),且治疗组患者TG、LDL-C水平降低程度明显大于对照组(
P
<
0.05),而TC、HDL-C水平比较差异无统计学意义;治疗后两组患者中医证候积分均较本组治疗前改善(
P
<
0.05),且治疗组中医证候积分改善优于对照组(
P
<
0.05);治疗后治疗组总有效率明显优于对照组(
χ
2
=7.585,
P
<
0.05)。治疗后两组患者CysC及Hcy水平均较本组治疗前明显下降(
P
<
0.05),且治疗组患者CysC、Hcy水平降低程度明显大于对照组(
P
<
0.05);对照组患者治疗后下肢多普勒超声图无明显改善,而治疗组患者治疗后下肢多普勒超声图显示下肢动脉内-中膜厚度稍下降,斑块面积稍有缩小,但差异无统计学意义。
结论
2
丹蛭降糖胶囊对T2DM合并下肢大血管病疗效确切,同时能够改善糖脂代谢,降低血清Hcy、CysC水平,为中医药防治T2DM合并大血管病变的进展提供了疗法和思路。
Objective
2
To observe the clinical efficacy of Danzhi Jiangtang capsules with the functions of replenishing Qi, nourishing Yin, and dredging collaterals on patients with type 2 diabetes mellitus (T2DM) combined with lower-extremity macroangiopathy and serum levels of homocysteine (Hcy) and cystatin C (Cys C).
Method
2
A total of 80 eligible patients who were treated in the department of endocrinology of the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2017 to December 2019 were randomized into the treatment group (40 cases) and control group (40 cases). Both groups received the basic therapies for diabetes and Danzhi Jiangtang capsules (oral) was added to the treatment group. The levels of glycosylated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial glucose (2 hPG), fasting C-peptide (C-P), and 2-hour postprandial C-peptide (2 hC-P), triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) and serum levels of Hcy and Cys C were measured and the traditional Chinese medicine(TCM) syndrome scores were calculated before and after treatment in the two groups.
Result
2
After 12 weeks of treatment, levels of HbA1c, FPG, and 2 hPG were lower than those before treatment in the two groups (
P
<
0.05). Levels of C-P (
P
<
0.05) and 2 hC-P were higher than those before treatment in the two groups. After treatment, levels of HbA1c, FPG, and 2 hPG in the treatment group were lower than those in the control group (
P
<
0.05), while levels of C-P and 2 hC-P showed no significant difference between two groups. After treatment, the levels of TG, TC, and LDL-C were lower than those before treatment (
P
<
0.05) and HDL-C level was higher than that before treatment (
P
<
0.05) in both groups. After treatment, levels of TG and LDL-C in the treatment group were lower than those in the control group (
P
<
0.05), and levels of TC and HDL-C demonstrated no significant difference between two groups. After the treatment, the TCM syndrome score was lower than that before the treatment in both groups (
P
<
0.05) and lower in the treatment group than in the control group (
P
<
0.05). The overall effective rate of the treatment group was higher than that of the control group (
χ
2
=7.585,
P
<
0.05). The levels of Cys C and Hcy were lower than those before treatment in the two groups (
P
<
0.05) and lower in the treatment group than in the control group (
P
<
0.05). Doppler echocardiography of the lower limbs showed no obvious improvement in the control group after treatment. However, for the treatment group, slight decrease in intima-media thickness of the lower limb arteries and a slight reduction in the plaque area were observed, but the difference was not statistically significant.
Conclusion
2
Danzhi Jiangtang capsules has definite therapeutic effect on T2DM combined with lower-extremity macroangiopathy, which can improve glucolipid metabolism and reduce serum levels of Hcy and Cys C. This study can serve a reference for the prevention and treatment of T2DM combined with macroangiopathy.
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