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1.成都中医药大学 附属医院,成都 610075
2.成都市第八人民医院,成都 610081
欧璐,住院医师,从事内分泌疾病的临床诊疗工作,E-mail:517574196@qq.com
龙芙蓉,主任医师,从事内分泌疾病的临床诊疗工作,E-mail:lijvn@qq.com
收稿日期:2020-05-26,
网络出版日期:2020-08-20,
纸质出版日期:2021-01-05
移动端阅览
欧璐,李晓琴,李宇等.加味黄连温胆汤治疗新诊2型糖尿病痰(湿)热互结证临床观察[J].中国实验方剂学杂志,2021,27(01):128-134.
OU Lu,LI Xiao-qin,LI Yu,et al.Clinical Efficacy of Modified Huanglian Wendantang in Treatment of Newly Diagnosed Type 2 Diabetes Mellitus with Phlegm (Dampness)-Heat Syndrome[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(01):128-134.
欧璐,李晓琴,李宇等.加味黄连温胆汤治疗新诊2型糖尿病痰(湿)热互结证临床观察[J].中国实验方剂学杂志,2021,27(01):128-134. DOI: 10.13422/j.cnki.syfjx.20202125.
OU Lu,LI Xiao-qin,LI Yu,et al.Clinical Efficacy of Modified Huanglian Wendantang in Treatment of Newly Diagnosed Type 2 Diabetes Mellitus with Phlegm (Dampness)-Heat Syndrome[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(01):128-134. DOI: 10.13422/j.cnki.syfjx.20202125.
目的
2
观察加味黄连温胆汤治疗新诊2型糖尿病(T2DM)痰(湿)热互结证的疗效及对胰岛
β
细胞功能和脂肪细胞因子的影响。
方法
2
将130例患者随机分为观察组和对照组各65例。对照组,脱落、失访3例,违背方案剔除2例,完成60例;观察组,脱落、失访3例,剔除1例,完成61例。另选20例健康志愿者作为正常组。两组进行生活方式干预和盐酸二甲双胍片内服治疗(1片/次,1次/d,随餐服用)。对照组口服化浊轻身颗粒,5 g/次,2次/d,早晚2次冲服;观察组口服加味黄连温胆汤,1剂/d。疗程均为3个月。评价治疗前后空腹血糖(FBG),餐后2 h血糖(PBG),糖化血红蛋白(HbA1c)和空腹胰岛素(FINS),并计算胰岛素抵抗指数(HOMA-IR),胰岛素敏感指数(InISI),胰岛
β
细胞功能指数(HOMA-
β
),早相胰岛素分泌指数(I
30
/
△
G
30
)和晚相胰岛素分泌指数(AUC
I30~I120/G30~G120
);检测治疗前后总胆固醇(TC),甘油三脂(TG),高密度脂蛋白(HDL-C),低密度脂蛋白(LDL-C),脂联素,肿瘤坏死因子-
α
(TNF-
α
),抵抗素和瘦素水平,进行治疗前后痰(湿)热互结证评分;并进行安全性评价。
结果
2
观察组疾病疗效总有效率为91.80%(56/61),高于对照组的78.33%(47/60)(
χ
2
=4.333,
P
<
0.05);观察组痰(湿)热互结证评分低于对照组(
P
<
0.01),FBG,PBG,HbA1c低于对照组(
P
<
0.01),FINS高于对照组(
P
<
0.01);观察组HOMA-IR和AUC
I30~I120/G30~G120
低于对照组(
P
<
0.01),I
30
/
△
G
30
,HOMA-
β
和InISI高于对照组(
P
<
0.01);观察组TC,TG和LDL-C水平低于对照组(
P
<
0.01),HDL-C高于对照组(
P
<
0.01);观察组患者TNF-
α
,瘦素和抵抗素水平低于对照组(
P
<
0.01),脂联素水平高于对照组(
P
<
0.01)。没有发现与加味黄连温胆汤内服相关不良反应。
结论
2
在二甲双胍治疗的基础上,采用加味黄连温胆汤内服用于新诊T2DM痰(湿)热互结证患者,能进一步有效控制血糖、血脂,调节脂肪细胞因子,改善早相和晚相胰岛素分泌,提高了胰岛
β
细胞功能和胰岛素敏感性,改善了IR,有着较好的综合疗效,且临床使用安全。
Objective
2
To observe the efficacy of modified Huanglian Wendantang in treating newly diagnosed type 2 diabetes mellitus (T2DM) with phlegm (dampness)-heat syndrome, in order to study the effect on islet
β
cell function and adipocytokines.
Method
2
A total of 130 patients were randomly divided into two groups by random number table (65 cases in each group). The 60 patients in control group completed the treatment (4 patients fell off or lost visit, 2 were eliminated because of breach of plan), and the 61 patients in observation group completed the treatment (3 patients fell off, 1 were eliminated). And 20 healthy volunteers were taken as normal control group. Both groups′ patients got lifestyle interventions and metformin hydrochloride tablets (1 tablet/time, 1 time/day during the meal). In addition, patients in control group got Huazhuo Qingshen Keli in the morning and at night, 5 g/time, 2 times/day, and patients in observation group got modified Huanglian Wendantang, 1 dose/day. And the treatment was lasted for 3 months. Before and after treatment, levels of fasting blood glucose (FBG), postprandial 2 blood glucose (PBG), HbA1c and fasting insulin (FINS), insulin resistance index (HOMA-IR), insulin sensitivity index (InISI), islet β cell function index (HOMA-
β
), early insulin secretion index (I
30
/
△
G
30
) and late insulin secretion index (AUC
I30~I120/G30~G120
), total cholesterol (TC) and triglycerides (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), adiponectin, TNF -
α
(TNF-
α
), resistin and leptin were detected. And syndrome of phlegm (dampness) combined with heat were scored, and the safety was discussed.
Result
2
The total effective rate in observation group was 91.80% (56/61), which was higher than 78.33% (47/60) in control group (
χ
2
=4.333,
P
<
0.05). And the score of phlegm (dampness)-heat syndrome was lower than that in control group (
P
<
0.01), levels of FBG, PBG, HbA1c, HOMA-IR, AUC
I30~I120/G30~G120
, TC, TG, LDL-C, TNF-
α
, leptin and resistin were lower than those in control group (
P
<
0.01), while levels of I
30
/△G
30
, HOMA-
β
, InISI, HDL-C and adiponectin were higher than those in control group (
P
<
0.01). There was no adverse reaction related to modified Huanglian Wendantang.
Conclusion
2
In addition to treatment with metformin, modified Huanglian Wendantang can effectively control blood glucose and lipid, regulate adipocyte factor, improve early and late phase insulin secretion, improve the function of
β
cell and insulin sensitivity of islet, improve IR, with a better comprehensive efficacy and a safety in clinical use.
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