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江南大学 附属医院,江苏 无锡 214062
谢绮,硕士,主治中医师,从事妇科的临床工作,E-mail:wenjunrrr@126.com
收稿日期:2020-10-16,
网络出版日期:2020-11-05,
纸质出版日期:2021-06-20
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谢绮,张媛,韦依依.人参麦冬散加减治疗气阴两虚证妊娠期糖尿病的临床观察[J].中国实验方剂学杂志,2021,27(12):111-116.
XIE Qi,ZHANG Yuan,WEI Yi-yi.Clinical Study on Addition and Subtraction Treatment to Renshen Maidong San to Gestational Diabetes Mellitus of Deficiency of Both Qi and Yin[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(12):111-116.
谢绮,张媛,韦依依.人参麦冬散加减治疗气阴两虚证妊娠期糖尿病的临床观察[J].中国实验方剂学杂志,2021,27(12):111-116. DOI: 10.13422/j.cnki.syfjx.20210231.
XIE Qi,ZHANG Yuan,WEI Yi-yi.Clinical Study on Addition and Subtraction Treatment to Renshen Maidong San to Gestational Diabetes Mellitus of Deficiency of Both Qi and Yin[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(12):111-116. DOI: 10.13422/j.cnki.syfjx.20210231.
目的
2
观察人参麦冬散加减对气阴两虚证妊娠期糖尿病(GDM)糖、脂代谢和妊娠结局的影响。
方法
2
将108例GDM患者按随机数字表法分为观察组和对照组各54例。对照组口服玉泉丸,6 g/次,4次/d,观察组内服人参麦冬散加减,1剂/d。两组疗程均为4周。治疗前后进行口服葡萄糖耐量试验(OGTT),测量空腹血糖(FBG),1 h血糖(1 h PG),2 h血糖(2 h PG),糖化血红蛋白(HbA1c)等指标,记录妊娠结局情况;检测治疗前后总胆固醇(TC),甘油三脂(TG),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),脂联素、血清淀粉样蛋白A(SAA),肿瘤坏死因子-
α
(TNF-
α
),抵抗素、白细胞介素-1
β
(IL-1
β
)和IL-6水平;进行安全性评价。
结果
2
观察组患者胰岛素抵抗指数(HOMA-IR),FBG,1 h PG,2 h PG和HbA1c均低于对照组(
P
<
0.01),胰岛
β
细胞功能指数(HOMA-
β
),胰岛素敏感指数(InISI)均高于对照组(
P
<
0.01);观察组患者TC,LDL-C,TG均低于对照组(
P
<
0.01);观察组IL-6,IL-1
β
,TNF-
α
,SAA,瘦素和抵抗素均低于对照组(
P
<
0.01),脂联素高于对照组(
P
<
0.01);观察组患者医学剖宫产、妊娠期高血压、羊水过多、胎膜早破和早产及不良妊娠结局发生率均低于对照组(
P
<
0.01)。
结论
2
人参麦冬散加减内服治疗GDM气阴两虚证患者,能提高胰岛素敏感和胰岛
β
细胞功能,调节炎症因子和脂肪因子,改善了IR,有效调控了糖、脂代谢,改善了母婴不良妊娠结局,且使用安全。
Objective
2
This study aims to investigate the effect of addition and subtraction treatment to Renshen Maidongsan on metabolism of glucose, lipid and pregnancy outcome when used to gestational diabetes mellitus (GDM) with deficiency of both Qi and Yin.
Method
2
In this study, 108 patients with GDM were randomly divided into observation group with 54 cases and control group with 54 cases. Patients in control group took Yuquan wan orally, 6 g/time, 4 times/day , and patients in observation group were prescribed addition and subtraction treatment to Renshen Maidongsan, 1 dose/day. The course of treatment for both groups was 4 weeks. Oral glucose tolerance test (OGTT) was performed before and after treatment. Fasting blood glucose (FBG) , 1 h our plasma glucose (1 h PG), 2 h our plasma glucose (2 h PG), glycosylated hemoglobin (HbA1c) and other indicators were detected to record the pregnancy outcome. Also, the levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), adiponectin, serum amyloid A (SAA), tumor necrosis factor-
α
(TNF-
α
), resistin, interleukin-1
β
(IL-1
β
) and interleukin-6 (IL-6) were detected before and after treatment. Then the safety evalution was carried out.
Result
2
The levels of insulin resistance index (HOMA-IR), FBG, 1 h PG, 2 h PG, HbA1c, TC, LDL-C, TG, IL-6, IL-1
β
, TNF-
α
, SAA, leptin and resistin in observation group were lower than the data checked in control group (
P
<
0.01), and the levels of HOMA-
β
, insulin sensitivity index (InISI) and adiponectin were higher than the standards of from control group (
P
<
0.01). Then the incidence of medical cesarean section, pregnancy induced hypertension, polyhydramnios, premature rupture of membranes, premature delivery and adverse pregnancy outcomes were lower than those in control group (
P
<
0.01).
Conclusion
2
Addition and subtraction treatment to Renshen Maidongsan can improve insulin sensitivity and islet
β
-cell function, regulate inflammatory factors and adipokines, improve insulin resistance (IR), effectively regulate glucose and lipid metabolism, improve maternal and infant adverse pregnancy outcomes when used on patients with GDM and deficiency of Qi and Yin, and it was safe to use in clinic.
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