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  

Clinical Efficacy of Modified Huanglian Wendantang in Treatment of Newly Diagnosed Type 2 Diabetes Mellitus with Phlegm(Dampness)-Heat Syndrome

作　　者：欧璐[1] 李晓琴 李宇 黎江[1] 龙芙蓉[1] OU Lu;LI Xiao-qin;LI Yu;LI Jiang;LONG Fu-rong(Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Chengdu Eighth People's Hospital,Chengdu 610081,China)

机构地区：[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

出　　处：《中国实验方剂学杂志》2021年第1期128-134,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局科研课题项目(zyjc20150339)。

摘　　要：目的: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: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(I30/△G30)和晚相胰岛素分泌指数(AUCI30~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: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AUCI30~I120/G30~G120低于对照组(P<0.01),I30/△G30,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: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Objective: To observe the efficacy of modified Huanglian Wendantang in treating newly diagnosed type 2 diabetes mellitus(T2 DM)with phlegm(dampness)-heat syndrome,in order to study the effect on islet β cell function and adipocytokines. Method: 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),HbA1 c and fasting insulin(FINS),insulin resistance index(HOMA-IR),insulin sensitivity index(InISI),islet β cell function index(HOMA-β),early insulin secretion index(I30/△ G30)and late insulin secretion index(AUCI30~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: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,HbA1 c,HOMA-IR,AUCI30~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 I30/△ G30,HOMA-β,InISI,HDL-C a

关 键 词：2型糖尿病 新诊 黄连温胆汤 痰(湿)热互结证 胰岛素抵抗 胰岛Β细胞 脂肪细胞因子 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]