糖脂平治疗痰瘀互阻型2型糖尿病合并非酒精性脂肪性肝病临床研究  

Clinical study on Tangzhiping in the treatment of type 2 diabetes mellitus with phlegm-blood stasis type combined with nonalcoholic fatty liver disease

作　　者：李勤[1] 谢冰昕[2] 张颖[1] 吴瑞[1] 高彦彬[3] LI Qin;XIE Bingxi;ZHANG Ying(Department of Endocrinology,Guang'anmen Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 102600)

机构地区：[1]中国中医科学院广安门医院南区内分泌科,北京102600 [2]中国中医科学院广安门医院南区医务处,北京102600 [3]首都医科大学中医药学院,北京100069

出　　处：《河北中医》2020年第3期365-369,378,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：中国中医科学院广安门医院南区院级科研基金课题(编号:Y2017-05)。

摘　　要：目的观察糖脂平治疗痰瘀互阻型2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)的临床疗效。方法将80例痰瘀互阻型T2DM合并NAFLD患者按照随机数字表法分为2组。对照组40例予盐酸二甲双胍片治疗,治疗组40例在对照组治疗基础上加服糖脂平。2组疗程均3个月。比较2组中医证候疗效及肝脏彩超疗效;观察2组治疗前后肝功能指标、血脂指标、血糖指标变化。结果中医证候治疗组总有效率89.7%(35/39),对照组总有效率52.6%(20/38),治疗组中医证候疗效优于对照组(P<0.05)。肝脏彩超治疗组总有效率84.6%(33/39),对照组总有效率55.3%(21/38),治疗组肝脏彩超疗效优于对照组(P<0.05)。2组治疗后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及γ-谷氨酰转移酶(γ-GT)均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白胆固醇(LDL-C)均较本组治疗前降低(P<0.05),且治疗后治疗组TC、TG及LDL-C均低于对照组(P<0.05)。2组治疗后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA 1c)、空腹胰岛素(FINS)、餐后2 h胰岛素、胰岛素抵抗指数(HOMA-IR)均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。治疗组治疗后各项中医证候评分及总评分均较本组治疗前降低(P<0.05),对照组治疗后除形体肥胖、胁下疼痛评分外,其余各项中医证候评分及总评分均较本组治疗前降低(P<0.05)。治疗组治疗后各项中医证候评分及总评分均低于对照组(P<0.05)。结论糖脂平能有效纠正T2DM合并NAFLD患者的糖脂代谢紊乱,减轻胰岛素抵抗,改善肝功能及肝脏B超异常指标,同时还可有效改善患者临床症状及体征。Objective To observe the effect of Tangzhiping in the treatment of type 2 diabetes mellitus(T2DM)with phlegm-blood stasis type combined with nonalcoholic fatty liver disease(NAFLD).Methods 80 cases of T2DM with NAFLD were divided into two groups according to the random number table method.40 cases in control group were treated by metformin hydrochloride tablets.40 cases in treatment group were treated by Tangzhiping on the basis of the control group.The course of treatment was 3 months in both groups.The therapeutic effect of TCM syndrome and liver color Doppler ultrasound were compared between the two groups,and the changes of liver function index,blood lipid index and blood glucose index before and after treatment were observed.Results The total effective rate of TCM syndrome was 89.7%(35/39)in the treatment group and 52.6%(20/38)in the control group.The clinical curative effect of the treatment group was better than that of the control group(P<0.05).The total effective rate of liver color Doppler ultrasound in the treatment group was 84.6%(33/39),while that in the control group was 55.3%(21/38).The clinical curative effect of color Doppler ultrasound in the treatment group was better than that of the control group(P<0.05).After treatment,the alanine aminotransferase(ALT),aspartate aminotransferase(AST)andγ-glutamyltranspeptidase(γ-GT)in the two groups were lower than those in the group before treatment(P<0.05),and the decrease was more significant in the treatment group(P<0.05).After treatment,total cholesterol(TC),triglyceride(TG)and low density lipoprotein-cholesterol(LDL-C)in the two groups were lower than those in the group before treatment(P<0.05),and TC,TG and LDL-C in the treatment group were lower than those in the control group(P<0.05).After treatment,the Fasting plasma glucose(FPG),plasma glucose 2 hours after meal(2 hPG),glycosylated hemoglobin(HbA 1c),fasting insulin(FINS),insulin 2 hours after meal,insulin resistance index(HOMA-IR)in the two groups were lower than those in the group before treat

关 键 词：糖尿病 2型 脂肪肝 中药疗法 

分 类 号：R587.105.31[医药卫生—内分泌] R289.6[医药卫生—内科学]