益气养阴，活血通腑法对代谢综合征患者外周胰岛素抵抗的影响
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摘要
目的:代谢综合征是以中心性肥胖、糖尿病 或糖调节受损高血压、血脂异常为主要内涵,以胰岛素抵抗为共同病理生理基础,以多种代谢性疾病合并出现为临床特点的一组严重影响人类健康的临床症候群。纵观代谢综合征的发展演变,由早期的超重、肥胖,继而出现高血压、高血脂、糖尿病(或糖耐量低减)等疾病,随着病程的迁延又会出现诸多并发症,如冠心病、中风、视网膜病变、神经病变、肾功能衰竭等。目前中医界还没有与其相对应的名称。
关于代谢综合征,目前中医界还没有与其相对应的名称。通过中医证候学分析,其病机多以气阴两虚为本,痰湿、气郁、瘀血、内热为标。治疗上应以益气养阴、理气活血法为主。加味桃核承气汤具有益气养阴、活血通腑、润肠通下的功效。通过补虚祛邪、标本兼治,使产生和加重胰岛素受体缺陷的病理因素得以祛除或减轻,进而增强机体对胰岛素的敏感性的胰外作用途径,达到减轻外周胰岛素抵抗的目的;并具有改善气虚证候及瘀血征象及降脂作用的特点。本文以糖尿病为主要表现的代谢综合征患者为研究对象,着重了解加味桃核承气汤对患者外周胰岛素抵抗的影响,并对比了不同治疗方法对糖尿病各种临床表现的治疗效果。以期为今后加味桃核承气汤的进一步有效应用提供有价值的理论依据。
方法:220例研究对象均是于2000年1月～2004年1月于我院就诊的糖尿病患者。按随机化原则分为A、B、C三组。A组治疗方法为西药西药美吡达加加味桃核承气汤;B组为西药美吡达加其它益气养阴、活血通腑中医治疗方法;C组为单纯西药美吡达。各组患者均检测或观察血糖、糖化血红蛋白、胰岛素、血脂、外周胰岛素敏感度、胰岛素释放率等指标,并观察了不同治疗方法对糖尿病性肾病的治疗效果。
结果:(1)对糖尿病治疗效果:各组降糖疗效差异无显着性,P>0.05,各组治疗后空腹血糖与GHbAlc均低于本组治疗前,P<0.05,表明三种治疗方法的降糖疗效相当;A、B两组治疗后,血脂三项均低于治疗前,P<0.05;而C组治疗前后,血脂三项差异无显着性,P>0.05。(2)对胰岛素抵抗影响比较结果:糖尿病患者外周胰岛素抵抗的改善情况为A组>B组>C组,P<0.05;A组SI、IAI治疗后均升高,与治疗前比较,P<0.05,而B、C组SI、IAI治疗前后,差异无显着性,P>0.05;(3)对糖尿病肾病疗效的观察指标为24h尿蛋白定量、肌酐、尿素氮、血压与脉搏,结果
Objectives: The main content of MS were central obesity , DM, impaired glucose regulation, hypertension, and abnormal blood fat., and IR was its pathology and physiology base. Many specialists looked DM as the main part of MS. The course of DM included the beginning obesity or over-weight and the following disease as hypertension, DM, and hyperlipidemia, and many complications resulted from the development of those disease.While there is no a suitable name for MS in Chinese Medicine now, many Chinese Medicine scholar thought the mechanism of MS were Qi Yin Liang xu being essence and Tan Shi, Qi Yu, Yu Xue, Nei Re being appearance, and treatment of it were Yiqi Yangyin and Liqi Huoxue. As a treatment of Yiqi Yangyin , Huoxue Tongfu, and Runchang Tongxia, Jiawei Taohe Chengqi Soup could reduce the factors which induce or strengthen the lack of insulin receptor, so that reduce insulin resistance by the way of Yiqi Yangyin and Liqi Huoxu. Jiawei Taohe Chengqi Soup could also better the appearance of Qiyu of the MS patients and cut down their blood fat. In this study, the MS patients were selected as the object to know the effect of Jiawei Taohe Chengqi Soup on IR, and different treating methods were compared about their curative effect on DM. The aim of this study was to provide scientific basis for the appliance of Jiawei Taohe Chengqi Soup.Methods: All 220 DM patients were treated in our hospital during Jan 2002 to Jan 2004. They were divided into three groups. Group A was the treating method of Glipizide and Jiawei Taohe Chengqi Soup. Group B was the treating method of Glipizide other Chinese medicine treatment of Yiqi Yangyin and Huoxue Tongfu. Group C was the treating method of Glipizide only. The following Targets of every patient in different group were tested: blood glucose, GHbAlc, insulin, blood fat, SI, IRG. The effect of different curative
关于代谢综合征,目前中医界还没有与其相对应的名称。通过中医证候学分析,其病机多以气阴两虚为本,痰湿、气郁、瘀血、内热为标。治疗上应以益气养阴、理气活血法为主。加味桃核承气汤具有益气养阴、活血通腑、润肠通下的功效。通过补虚祛邪、标本兼治,使产生和加重胰岛素受体缺陷的病理因素得以祛除或减轻,进而增强机体对胰岛素的敏感性的胰外作用途径,达到减轻外周胰岛素抵抗的目的;并具有改善气虚证候及瘀血征象及降脂作用的特点。本文以糖尿病为主要表现的代谢综合征患者为研究对象,着重了解加味桃核承气汤对患者外周胰岛素抵抗的影响,并对比了不同治疗方法对糖尿病各种临床表现的治疗效果。以期为今后加味桃核承气汤的进一步有效应用提供有价值的理论依据。
方法:220例研究对象均是于2000年1月～2004年1月于我院就诊的糖尿病患者。按随机化原则分为A、B、C三组。A组治疗方法为西药西药美吡达加加味桃核承气汤;B组为西药美吡达加其它益气养阴、活血通腑中医治疗方法;C组为单纯西药美吡达。各组患者均检测或观察血糖、糖化血红蛋白、胰岛素、血脂、外周胰岛素敏感度、胰岛素释放率等指标,并观察了不同治疗方法对糖尿病性肾病的治疗效果。
结果:(1)对糖尿病治疗效果:各组降糖疗效差异无显着性,P>0.05,各组治疗后空腹血糖与GHbAlc均低于本组治疗前,P<0.05,表明三种治疗方法的降糖疗效相当;A、B两组治疗后,血脂三项均低于治疗前,P<0.05;而C组治疗前后,血脂三项差异无显着性,P>0.05。(2)对胰岛素抵抗影响比较结果:糖尿病患者外周胰岛素抵抗的改善情况为A组>B组>C组,P<0.05;A组SI、IAI治疗后均升高,与治疗前比较,P<0.05,而B、C组SI、IAI治疗前后,差异无显着性,P>0.05;(3)对糖尿病肾病疗效的观察指标为24h尿蛋白定量、肌酐、尿素氮、血压与脉搏,结果
Objectives: The main content of MS were central obesity , DM, impaired glucose regulation, hypertension, and abnormal blood fat., and IR was its pathology and physiology base. Many specialists looked DM as the main part of MS. The course of DM included the beginning obesity or over-weight and the following disease as hypertension, DM, and hyperlipidemia, and many complications resulted from the development of those disease.While there is no a suitable name for MS in Chinese Medicine now, many Chinese Medicine scholar thought the mechanism of MS were Qi Yin Liang xu being essence and Tan Shi, Qi Yu, Yu Xue, Nei Re being appearance, and treatment of it were Yiqi Yangyin and Liqi Huoxue. As a treatment of Yiqi Yangyin , Huoxue Tongfu, and Runchang Tongxia, Jiawei Taohe Chengqi Soup could reduce the factors which induce or strengthen the lack of insulin receptor, so that reduce insulin resistance by the way of Yiqi Yangyin and Liqi Huoxu. Jiawei Taohe Chengqi Soup could also better the appearance of Qiyu of the MS patients and cut down their blood fat. In this study, the MS patients were selected as the object to know the effect of Jiawei Taohe Chengqi Soup on IR, and different treating methods were compared about their curative effect on DM. The aim of this study was to provide scientific basis for the appliance of Jiawei Taohe Chengqi Soup.Methods: All 220 DM patients were treated in our hospital during Jan 2002 to Jan 2004. They were divided into three groups. Group A was the treating method of Glipizide and Jiawei Taohe Chengqi Soup. Group B was the treating method of Glipizide other Chinese medicine treatment of Yiqi Yangyin and Huoxue Tongfu. Group C was the treating method of Glipizide only. The following Targets of every patient in different group were tested: blood glucose, GHbAlc, insulin, blood fat, SI, IRG. The effect of different curative
引文
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[2] 袁庆新.糖尿病患者调脂治疗的临床研究及其意义.实用临床医药杂志,2004:8(4):30—35.
[3] 简小兵,戴莲仪,伊娜.中西医结合治疗2型糖尿病口服降糖药继发性失效20例临床观察.中国中医药科技,2004;11(5):304—305。
[4] 程汉娇等.肝气郁结与消渴病关系的理论研究.江苏中医,1997;18(9):5。
[5] 李雯,邓尚平.糖尿病中医辨证分型与胰岛素功能关系的探讨.四川医学,1999:20(4):350。
[6] 丁学屏,陆毅,虞芳华等.非胰岛素依赖型糖尿病中医辨证分型与胰高糖素、胰岛素敏感性的相关研究.上海中医药杂志,1999;(9):18—20。
[7] 熊曼琪,李惠林。脾气虚是消渴病的重要病机。广州中医学院学报,1991;(1):1
[8] 高彦彬。中医药辨治糖尿病概述。中医药杂志,1988;(8):64
[9] 张云如等。成人糖尿病辩证分型的初步探讨。辽宁中医杂志,1982:(5):40
[10] 周金黄等。中药药理学。第一版。上海科技出版社,1986:45:269-270
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