柴胡加龙骨牡蛎汤治疗代谢综合征理论探讨及临床研究
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摘要
研究目的：①MS表现为一身多病的综合征,有其共同内在联系,调理三焦治疗代谢综合征,可发挥整体观优势及异病同治的特点,三焦为气、痰(湿)之通道,针对代谢综合征痰湿致病的病机特点：气化失常、气机失调、水液输布失调、痰湿阻滞。临床上可通过调理三焦的方法纠正水湿代谢紊乱,使人体恢复津液周流,气血通利,阴平阳秘状态,从而达到治疗代谢综合征的目的。同时对脏腑三焦辨治的思考也可以对三焦形质探讨提供新的思路。②柴胡加龙骨牡蛎汤加减对于痰热内蕴型的代谢综合征有着一定的临床疗效,但缺乏系统的临床研究,对其进行系统的临床研究可以探讨其效应机制。
研究方法：临床观察代谢综合征患者43例,均是于2012年4月-2013年4月于马来西亚益源中医诊所就诊患者,按随机化原则分为中西药结合组(23例)、西药组(20例)。纳入患者在饮食及运动治疗的基础上,分别以柴胡加龙骨牡蛎汤加减配合西药组以及单独西药组干预治疗,治疗周期为2个月,两组间及各组前后进行比较,观察患者治疗前后代谢综合征各诊断指标、临床症状积分、生存质量量表积分等指标在治疗后改善情况,数据处理使用SPSS18.0软件包,计数资料采用x2检验,计量资料采用t检验。
研究结果：(1)在疗效的总有效率方面,中西药组为82.61%,西药组为60%,两组间有显著性差异(P<0.01)；两组间中医证候积分改善方面,中西药组明显优于西药组,两组存在显著性差异(P<0.01),提示在辨证论治思想指导下,中西药作用较西药更为全面。(2)两组治疗后,各项均有明显下降(P<0.05),其中中西药结合组2hPG和HOMA-IR下降更显著(P<0.01),表明两组均可改善代谢综合征糖代谢水平,组间比较两组无明显差异(P>0.05),总体来看,中西药结合组在改善代谢综合征患者症状方面优于西药对照组。(3)两组治疗后,脂代谢方面,中医药结合组有明显下降(P<0.05),其中TC、TG下降显著(P<0.01)。西药组各项目有下降趋势,但与本组治疗前相比,没有统计学意义(P>0.05)。综合来看,表明两组均可改善代谢综合征脂代谢水平。组问比较,中医药结合组较西药对照组疗效更好,与西药对照组比较,TC、TG有显著性差异(P<0.01),HDL-C和LDL-C差异有统计学意义(P<0.05)。总体来看,中西药结合组在改善代谢综合征患者症状方面优于西药对照组。(4)两组治疗后,炎性因子方面,各组治疗后较治疗前均有下降,中西药结合组下降较治疗前TNF-α和IL-6差异都有显著意义(P<0.01)两组间相比,中西药结合组下降更多,统计学检验有显著性差异(P<0.01)。提示柴胡加龙骨牡蛎汤有较好的抗炎效果。
结论与启示：①MS的病因、发病机制十分复杂,其发病是多因素相互作用的结果,与遗传、环境和免疫因素均有关系。生活方式的改善是防治代谢综合征的根本措施。中医学“治未病”医学思想和丰富的养生学方法可以为MS的预防带来很多新思路、新方法。中医学辨证论治的诊疗体系,可以多成分、多环节、多靶点地综合调节人体机能,在防治MS中有着不可替代的明显优势,能有效调节、综合性治疗涉及多方面的代谢失常,改善生存质量。中药有着天然、低毒、安全、价廉的优点,在对本病的防治上有着天然优势。今后应加强对MS的中医临床和实验研究,相信中医药在防治代谢综合征将发挥更大的作用。②三焦之形质虽有争论,但其生理功能各家认识基本一致。三焦亦有其独立的临床病证。因此在临床上要重视三焦气化不利出现的各种病证,不可受“三焦有名而无形”的影响,忽略对三焦病证的诊断与治疗。三焦理论必须是来源于临床实践并能重新回到临床而对临床起指导作用,这样的理论才具有实际意义。③从三焦理论高度去重新认识柴胡加龙骨牡蛎汤加减辨治的灵活性和应用范围。总结古今医家所积累的丰富临床经验,从辨证论治出发,利用现代统计分析方法,加以系统梳理与剖析。
Objective:①MS showed a sick syndrome have a common internal relations, conditioning Sanjiao treatment of metabolic syndrom,Triple burner for gas, sputum (wet) of channel characteristics for metabolic syndrome phlegm disease pathogenesis:gasification disorders, disorders of the air-water fluid transmission and cloth disorders, phlegm block. Triple burner through the inside and outside and down about trades and also clinical to correct wet metabolism through conditioning sanjiao method disorder, the body recovery the body fluid Zhou flow, blood Tom Lee Yin Pingyang secret status, so as to achieve the purpose of the treatment of metabolic syndrome. At the same time the organs sanjiao the Diagnosis and Treatment of thinking can also be the triple burner shaped mass of new ideas.②Chaihujialonggumuli Decoction phlegm-heat intrinsic type of MS clinical efficacy, but the lack of a system of clinical research, its clinical research can explore its effector mechanisms.
Methods:clinical observation metabolic syndrome in43patients, Malaysia Yiyuan TCM clinics patients are in the April2012April2013, according to the principle of randomization divided into western medicine group (23cases) and group B (20cases). Observation of patients included in the patients on the basis of the diet and exercise therapy, respectively Decoction and pharmaceutical group Chaihujialonggumuli intervention, treatment period of2months, the comparison between the two groups and each group before and after, before and after metabolism comprehensive indicators levy various diagnostic indicators, clinical symptom scores, quality of life scale score improved after treatment, the use of data processing SPSS18.0package, count data using χ2test, measurement data using t-test.
Results:(1) the efficacy of the total efficiency in the western medicine group was82.61%,60%in the western medicine group, there are significant differences between the two groups (P<001); between the two groups and the symptom score improvement aspects, in the western medicine group was significantly better than western medicine group, two groups there is a significant difference (P<0.01), suggesting that more comprehensive than Western medicine, western medicine role in the diagnosis and treatment thought.(2) After treatment, all were significantly decreased (P<0.05), which, in Western medicine combined group2hPG and HOMA-IR decreased more significantly (P<0.01), indicating the two groups can improve the metabolic syndrome sugar metabolite levels between the two groups were compared, no significant difference (P>0.05) Overall, in the western medicine group is better than the comparison group in improving metabolic syndrome in patients with symptoms.(3) treatment, lipid metabolism, Chinese medicine combined group decreased significantly (P<0.05), including TC, TG decreased significantly (P<0.01). The WM group projects downward trend, but not statistically significant (P>0.05), compared with the group before treatment. Together, indicating that the two groups can improve the level of metabolic syndrome lipid metabolism. Between the two groups were compared, in medicine better efficacy of the combination group compared with the comparison group, compared with the comparison group, TC, TG significant difference (P <0.05), HDL-C and LDL-C difference was statistically significant. Overall, in the western medicine group in improving metabolic syndrome in patients with symptoms better than the comparison group.(4)treatment of inflammatory cytokines, each group after treatment than before treatment were decreased, compared with treatment of TNF-α and IL-6has a significant meaning in the western medicine group decreased. Between the two groups compared to the combination of Chinese and Western medicine group decreased more statistically significant difference test (P<0.01). Tip Bupleurum Plus Longgumuli soup better anti-inflammatory effect.
Conclusions and Implications:①MS etiology, pathogenesis is very complex, and its incidence is the result of the interaction of multiple factors, with genetic, environmental and immunologic factors have a relationship. Lifestyle improvement is fundamental measures of prevention and treatment of metabolic syndrome. Medicine,"treating disease" medical thought and health science can bring a lot of new ideas for the prevention of MS, the new method:diagnosis and treatment system in medical diagnosis and treatment, can be multi-component, multi-link, multi-target integrated regulation of human The obvious advantage of an irreplaceable function in the prevention and cure MS, effective regulation, comprehensive treatment involving a wide range of metabolic disorders, and to improve the quality of life:traditional Chinese medicine has a natural, low toxicity, safe, inexpensive advantages. Has a natural advantage in the prevention and treatment of this disease. MS TCM clinical and experimental studies should be strengthened in the future. I believe that Chinese medicine will play a bigger role in the fight.②sanjiao form of quality despite the controversy, but the understanding of the physiological function of various basic. Triple burner has its separate clinical syndromes. Attention should be paid to clinical the various syndromes the San Jiao adversely appears, can not be subject to the "triple burner famous invisible" effect, ignore the diagnosis and treatment of the triple burner syndromes. The triple burner theory must be derived from clinical practice and clinical and clinical guide back this theory of practical significance.③from sanjiao level of theory to new understanding of Bupleurum plus Longgumuli Decoction Diagnosis and Treatment of flexibility and range of applications. Summary of the ancient and modern physicians have accumulated rich clinical experience in the diagnosis and treatment, the use of modern statistical analysis methods, systematic combing and profiling.
研究方法：临床观察代谢综合征患者43例,均是于2012年4月-2013年4月于马来西亚益源中医诊所就诊患者,按随机化原则分为中西药结合组(23例)、西药组(20例)。纳入患者在饮食及运动治疗的基础上,分别以柴胡加龙骨牡蛎汤加减配合西药组以及单独西药组干预治疗,治疗周期为2个月,两组间及各组前后进行比较,观察患者治疗前后代谢综合征各诊断指标、临床症状积分、生存质量量表积分等指标在治疗后改善情况,数据处理使用SPSS18.0软件包,计数资料采用x2检验,计量资料采用t检验。
研究结果：(1)在疗效的总有效率方面,中西药组为82.61%,西药组为60%,两组间有显著性差异(P<0.01)；两组间中医证候积分改善方面,中西药组明显优于西药组,两组存在显著性差异(P<0.01),提示在辨证论治思想指导下,中西药作用较西药更为全面。(2)两组治疗后,各项均有明显下降(P<0.05),其中中西药结合组2hPG和HOMA-IR下降更显著(P<0.01),表明两组均可改善代谢综合征糖代谢水平,组间比较两组无明显差异(P>0.05),总体来看,中西药结合组在改善代谢综合征患者症状方面优于西药对照组。(3)两组治疗后,脂代谢方面,中医药结合组有明显下降(P<0.05),其中TC、TG下降显著(P<0.01)。西药组各项目有下降趋势,但与本组治疗前相比,没有统计学意义(P>0.05)。综合来看,表明两组均可改善代谢综合征脂代谢水平。组问比较,中医药结合组较西药对照组疗效更好,与西药对照组比较,TC、TG有显著性差异(P<0.01),HDL-C和LDL-C差异有统计学意义(P<0.05)。总体来看,中西药结合组在改善代谢综合征患者症状方面优于西药对照组。(4)两组治疗后,炎性因子方面,各组治疗后较治疗前均有下降,中西药结合组下降较治疗前TNF-α和IL-6差异都有显著意义(P<0.01)两组间相比,中西药结合组下降更多,统计学检验有显著性差异(P<0.01)。提示柴胡加龙骨牡蛎汤有较好的抗炎效果。
结论与启示：①MS的病因、发病机制十分复杂,其发病是多因素相互作用的结果,与遗传、环境和免疫因素均有关系。生活方式的改善是防治代谢综合征的根本措施。中医学“治未病”医学思想和丰富的养生学方法可以为MS的预防带来很多新思路、新方法。中医学辨证论治的诊疗体系,可以多成分、多环节、多靶点地综合调节人体机能,在防治MS中有着不可替代的明显优势,能有效调节、综合性治疗涉及多方面的代谢失常,改善生存质量。中药有着天然、低毒、安全、价廉的优点,在对本病的防治上有着天然优势。今后应加强对MS的中医临床和实验研究,相信中医药在防治代谢综合征将发挥更大的作用。②三焦之形质虽有争论,但其生理功能各家认识基本一致。三焦亦有其独立的临床病证。因此在临床上要重视三焦气化不利出现的各种病证,不可受“三焦有名而无形”的影响,忽略对三焦病证的诊断与治疗。三焦理论必须是来源于临床实践并能重新回到临床而对临床起指导作用,这样的理论才具有实际意义。③从三焦理论高度去重新认识柴胡加龙骨牡蛎汤加减辨治的灵活性和应用范围。总结古今医家所积累的丰富临床经验,从辨证论治出发,利用现代统计分析方法,加以系统梳理与剖析。
Objective:①MS showed a sick syndrome have a common internal relations, conditioning Sanjiao treatment of metabolic syndrom,Triple burner for gas, sputum (wet) of channel characteristics for metabolic syndrome phlegm disease pathogenesis:gasification disorders, disorders of the air-water fluid transmission and cloth disorders, phlegm block. Triple burner through the inside and outside and down about trades and also clinical to correct wet metabolism through conditioning sanjiao method disorder, the body recovery the body fluid Zhou flow, blood Tom Lee Yin Pingyang secret status, so as to achieve the purpose of the treatment of metabolic syndrome. At the same time the organs sanjiao the Diagnosis and Treatment of thinking can also be the triple burner shaped mass of new ideas.②Chaihujialonggumuli Decoction phlegm-heat intrinsic type of MS clinical efficacy, but the lack of a system of clinical research, its clinical research can explore its effector mechanisms.
Methods:clinical observation metabolic syndrome in43patients, Malaysia Yiyuan TCM clinics patients are in the April2012April2013, according to the principle of randomization divided into western medicine group (23cases) and group B (20cases). Observation of patients included in the patients on the basis of the diet and exercise therapy, respectively Decoction and pharmaceutical group Chaihujialonggumuli intervention, treatment period of2months, the comparison between the two groups and each group before and after, before and after metabolism comprehensive indicators levy various diagnostic indicators, clinical symptom scores, quality of life scale score improved after treatment, the use of data processing SPSS18.0package, count data using χ2test, measurement data using t-test.
Results:(1) the efficacy of the total efficiency in the western medicine group was82.61%,60%in the western medicine group, there are significant differences between the two groups (P<001); between the two groups and the symptom score improvement aspects, in the western medicine group was significantly better than western medicine group, two groups there is a significant difference (P<0.01), suggesting that more comprehensive than Western medicine, western medicine role in the diagnosis and treatment thought.(2) After treatment, all were significantly decreased (P<0.05), which, in Western medicine combined group2hPG and HOMA-IR decreased more significantly (P<0.01), indicating the two groups can improve the metabolic syndrome sugar metabolite levels between the two groups were compared, no significant difference (P>0.05) Overall, in the western medicine group is better than the comparison group in improving metabolic syndrome in patients with symptoms.(3) treatment, lipid metabolism, Chinese medicine combined group decreased significantly (P<0.05), including TC, TG decreased significantly (P<0.01). The WM group projects downward trend, but not statistically significant (P>0.05), compared with the group before treatment. Together, indicating that the two groups can improve the level of metabolic syndrome lipid metabolism. Between the two groups were compared, in medicine better efficacy of the combination group compared with the comparison group, compared with the comparison group, TC, TG significant difference (P <0.05), HDL-C and LDL-C difference was statistically significant. Overall, in the western medicine group in improving metabolic syndrome in patients with symptoms better than the comparison group.(4)treatment of inflammatory cytokines, each group after treatment than before treatment were decreased, compared with treatment of TNF-α and IL-6has a significant meaning in the western medicine group decreased. Between the two groups compared to the combination of Chinese and Western medicine group decreased more statistically significant difference test (P<0.01). Tip Bupleurum Plus Longgumuli soup better anti-inflammatory effect.
Conclusions and Implications:①MS etiology, pathogenesis is very complex, and its incidence is the result of the interaction of multiple factors, with genetic, environmental and immunologic factors have a relationship. Lifestyle improvement is fundamental measures of prevention and treatment of metabolic syndrome. Medicine,"treating disease" medical thought and health science can bring a lot of new ideas for the prevention of MS, the new method:diagnosis and treatment system in medical diagnosis and treatment, can be multi-component, multi-link, multi-target integrated regulation of human The obvious advantage of an irreplaceable function in the prevention and cure MS, effective regulation, comprehensive treatment involving a wide range of metabolic disorders, and to improve the quality of life:traditional Chinese medicine has a natural, low toxicity, safe, inexpensive advantages. Has a natural advantage in the prevention and treatment of this disease. MS TCM clinical and experimental studies should be strengthened in the future. I believe that Chinese medicine will play a bigger role in the fight.②sanjiao form of quality despite the controversy, but the understanding of the physiological function of various basic. Triple burner has its separate clinical syndromes. Attention should be paid to clinical the various syndromes the San Jiao adversely appears, can not be subject to the "triple burner famous invisible" effect, ignore the diagnosis and treatment of the triple burner syndromes. The triple burner theory must be derived from clinical practice and clinical and clinical guide back this theory of practical significance.③from sanjiao level of theory to new understanding of Bupleurum plus Longgumuli Decoction Diagnosis and Treatment of flexibility and range of applications. Summary of the ancient and modern physicians have accumulated rich clinical experience in the diagnosis and treatment, the use of modern statistical analysis methods, systematic combing and profiling.
引文
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