针药结合治疗2型糖尿病合并冠心病心绞痛:随机对照研究  

Acupuncture combined with western medication in treatment of type 2 diabetes mellitus with angina pectoris of coronary heart disease:a randomized controlled study

作　　者：王军媛[1] 张军[1] 刘颖[1] 高阎满 孙佳佳 刘晓曼[1] WANG Jun-yuan;ZHANG Jun;LIU Ying;GAO Yan-man;SUN Jia-jia;LIU Xiao-man(Department of Endocrinology,Tangshan Hospital of TCM,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市中医医院内分泌科,河北唐山063000

出　　处：《中国针灸》2021年第4期371-375,共5页Chinese Acupuncture & Moxibustion

基　　金：河北省科技厅科技支撑项目:142777115D;河北省中医药管理局经费资助项目:2014104。

摘　　要：目的:比较针刺联合西药与单纯西药治疗2型糖尿病合并冠心病心绞痛的临床疗效。方法:将134例2型糖尿病合并冠心病心绞痛患者随机分成针药组(67例,脱落3例)和药物组(67例,脱落4例)。两组患者均对症给予常规西药治疗。针药组在药物治疗基础上予针刺治疗,穴取间使、曲池、内关等,留针20 min,每周治疗3次。两组患者均连续治疗8周。分别于治疗前后观察两组患者中医症状积分,检测糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2h PG)、糖化血红蛋白(Hb A1c)、三酰甘油(TG)、总胆固醇(TC)],胰岛β细胞功能指标[胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)],心功能指标[心排血量(CO)、二尖瓣口舒张早期流速峰值/舒张晚期流速峰值(E/A)、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)],心电图QT离散度(QTd),并比较两组临床疗效。结果:治疗后两组患者中医症状积分,FPG、2hPG、HbA1c、TG、TC、HOMA-IR、FINS、E/A、LVEDD水平及心电图QTd均低于治疗前(P<0.05),且针药组均低于药物组(P<0.05);两组HOMA-β、ISI、CO、LVEF水平均高于治疗前(P<0.05),且针药组均高于药物组(P<0.05)。针药组总有效率为93.8%(60/64),高于药物组的79.4%(50/63,P<0.05)。结论:针刺联合药物可有效治疗2型糖尿病合并冠心病心绞痛,改善患者糖脂代谢、胰岛β细胞功能、心功能及心肌供血,疗效优于单纯西药治疗。Objective To compare the therapeutic effect on type 2 diabetes mellitus(T2DM)complicated with angina pectoris of coronary heart disease between the combined therapy of acupuncture and western medication and the simple administration of western medication.Methods A total of 134 patients with T2DM and angina pectoris of coronary heart disease were randomly divided into two groups,i.e.an acupuncture plus medication group(67 cases,3 cases dropped off)and a medication group(67 cases,4 cases dropped off).The routine western medication was used according to symptoms in the patients of both groups.In the acupuncture plus medication group,on the base of medication,acupuncture was applied to Jianshi(PC 5),Quchi(LI 11),Neiguan(PC 6),etc.The needles were retained for 20 min in each treatment and 3 treatments of acupuncture were required weekly.The treatment was given consecutively for 8 weeks in the two groups.Separately,before and after treatment,the symptom scores of TCM were observed and the indexes were detected,including glycolipid metabolism[fasting plasma glucose(FPG),2-h plasma glucose(2 hPG),glucosylated hemoglobin(Hb A1 c),triacylglycerol(TG)and total cholesterol(TC)],isletβcell function[homeostasis model assessment-β(HOMA-β),homeostasis model assessment-IR(HOMA-IR),fasting insulin(FINS)and insulin sensitivity index(ISI)],cardiac function indexes[cardiac output(CO),early diastolic peak velocity/late diastolic peak velocity(E/A),left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)],as well as electrocardiogram QT dispersion(QTd).Besides,the clinical therapeutic effects were compared between the two groups.Results After treatment,the TCM symptom scores and the values of FPG,2 hPG,HbA1 c,TG,TC,HOMA-IR,FINS,E/A and LVEDD as well as QTd were all lower than those before treatment in the two groups(P<0.05),and the levels of the above-mentioned indexes in the acupuncture plus medication group were all lower than those in the medication group(P<0.05).The values of HOMA-β,ISI,CO and

关 键 词：2型糖尿病 冠心病心绞痛 针刺 糖脂代谢 胰岛Β细胞功能 心功能 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]