健脾益气活血汤联合阿仑膦酸钠治疗糖尿病合并骨质疏松症的疗效观察  

Observation on the curative effect of Jianpi Yiqi Huoxue Decoction combined with alendronate sodium in the treatment of diabetes mellitus complicated with osteoporosis

作　　者：刘德峰[1] 刘爱茹[2] 高娟娟 姜文慧 于文霞[2] 张鹏 苏秀海[2] 王丛香 LIU De-feng;LIU Ai-ru;GAO Juan-juan;JIANG Wen-hui;YU Wen-xia;ZHANG Peng;SU Xiu-hai;WANG Cong-xiang(Spinal and Spinal Surgery 3,Orthopedic Hospital Area,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province,Cangzhou 061000,China;Endocrine and Diabetes Department 1,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province,Cangzhou O61000;Endocrine and Diabetes Department,Orthopedic Hospital Area,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province,Cangzhou 061000)

机构地区：[1]河北省沧州中西医结合医院骨科院区脊柱脊髓外三科,沧州061000 [2]河北省沧州中西医结合医院内分泌糖尿病一科,沧州061000 [3]河北省沧州中西医结合医院骨科院区内分泌糖尿病科,沧州061000

出　　处：《北京中医药》2023年第10期1069-1075,共7页Beijing Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(2022600)。

摘　　要：目的观察健脾益气活血汤联合阿仑膦酸钠治疗糖尿病合并骨质疏松症(DOP)的临床疗效。方法选取2021年6月—2022年6月河北省沧州中西医结合医院内分泌糖尿病科门诊收治的DOP患者106例,采用随机数字表法分为2组。对照组53例给予阿仑膦酸钠片治疗,观察组53例给予健脾益气活血汤内服+阿仑膦酸钠片治疗。6个月后观察2组临床疗效;比较治疗前后2组糖代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)],骨密度,中医证候积分,血液流变学指标[血浆黏度(PV)、全血高切黏度(HBV)、全血低切黏度(LBV)、红细胞聚集指数(EAI)],以及血清骨代谢生化指标[碱性磷酸酶(ALP)、I型原胶原N-端前肽(P1NP)、Ⅰ型胶原交联C-末端肽β-降解产物(β-CTX)],胰岛素样生长因子1(IGF-1),趋化素(Chemerin)水平;统计2组不良反应发生情况。结果观察组总有效率88.68%,高于对照组的73.58%(P<0.05)。治疗后,2组血清FPG、HbA1c、FINS水平及HOMA-IR均较治疗前降低(P<0.05);观察组血清FINS水平及HOMA-IR均低于对照组(P<0.05)。治疗后,2组L1~4骨密度均较治疗前增加(P<0.05),中医证候积分较治疗前降低(P<0.05);观察组L1~4骨密度、中医证候积分与对照组比较,差异有统计学意义(P<0.05)。治疗后,观察组股骨颈、全髋骨密度均高于治疗前(P<0.05),对照组与治疗前比较,差异无统计学意义(P>0.05);2组PV、HBV、LBV、EAI均较治疗前降低(P<0.05),且观察组PV、HBV、LBV、EAI低于对照组(P<0.05);2组血清ALP、P1NP、β-CTX水平均较治疗前降低(P<0.05),且观察组血清ALP、P1NP、β-CTX水平低于对照组(P<0.05)。治疗后,2组血清IGF-1水平较治疗前升高(P<0.05),血清Chemerin水平较治疗前降低(P<0.05);且观察组血清IGF-1水平高于对照组(P<0.05),血清Chemerin水平低于对照组(P<0.05)。治疗过程中,对照组发生恶心1例、头痛1例,观察组发生恶心2例、腹痛1Objective To observe the clinical effect of Jianpi Yiqi Huoxue Decoction(invigorating spleen qi and activating blood)combined with alendronate sodium on diabetes mellitus complicated with osteoporosis(DOP).Methods A total of 106 DOP patients admitted to the Department of Endocrinology and Diabetes in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2021 to June 2022 were selected and divided into 2 groups according to random number table method.The control group was treated with alendronate sodium tablets.On this basis,the observation group was treated with Jianpi Yiqi Huoxui Decoction.The clinical effect of 2 groups was observed after 6 months of treatment,including Glucose metabolism indexes[fasting blood glucose(FPG),HbA1c,fasting insulin(FINS),insulin resistance index(HOMA-IR)],bone density,TCM syndrome score,hemorheology indexes[plasma viscosity(PV),whole blood high tangential viscosity(HBV),whole blood low tangential viscosity(LBV),red blood cell aggregation index(EAI)]of the two groups,serum biochemical indexes of bone metabolism,such as alkaline phosphatase(ALP),type I procollagen N-terminal peptide(P1NP),type I collagen cross-linked C-terminal peptideβ-degradation product(β-CTX),insulin-like growth factor 1(IGF-1)and Chemerin levels were were compared before and after treatment.The adverse reactions of the 2 groups were analyzed.Results The total effective rate of observation group(88.68%)was higher than that of control group(73.58%)(P<0.05).After treatment,serum levels of FPG,HbA1c,FINS and HOMA-IR in 2 groups were lower than that before treatment(P<0.05).Serum FINS level and HOMA-IR in observation group were lower than those in control group(P<0.05).Bone mineral density(BMD)from L1 to L4 in both groups was increased compared with that before treatment(P<0.05),and TCM syndrome score was decreased compared with that before treatment(P<0.05)and The difference was statistically significant(P<0.05).After the treatment,bone mineral density of femoral neck and total hip in

关 键 词：糖尿病 骨质疏松症 健脾益气活血汤 阿仑膦酸钠 

分 类 号：R580[医药卫生—内分泌] R587.2[医药卫生—内科学]