清肝补脾降糖饮联合针刺疗法对超重/肥胖2型糖尿病患者糖脂代谢及细胞因子水平的影响  

Effect of Qinggan Bupi Jiangtang Decoction combined with acupuncture on glucose and lipid metabolism and cytokines in patients with overweight/obese type 2 diabetes mellitus

作　　者：高文澜[1] 王文艳[1] 李斯斯[1] 王雪菲 陈易 陶枫[1] 蔡淦[2] Gao Wenlan;Wang Wenyan;Li Sisi;Wang Xuefei;Chen Yi;Tao Feng;Cai Gan(Department of Endocrinology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Department of Internal Medicine,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属上海市中医医院内分泌科,上海200071 [2]上海中医药大学附属曙光医院内科,上海201203

出　　处：《国际中医中药杂志》2025年第1期29-35,共7页International Journal of Traditional Chinese Medicine

基　　金：上海医学创新发展基金会中医药传承发展项目(WLJH2022ZY-ZYY004)。

摘　　要：目的探讨清肝补脾降糖饮联合针刺疗法对超重/肥胖T2DM患者糖脂代谢及细胞因子水平的影响。方法随机对照试验研究。选取2022年9月-2023年3月上海中医药大学附属上海市中医医院内分泌科104例超重/肥胖T2DM患者作为观察对象,按随机数字表法分为2组,每组52例。对照组采用西医常规疗法联合针刺治疗,联合组在对照组基础上加服清肝补脾降糖饮。2组均连续治疗3个月。分别于治疗前后进行中医证候评分,采用葡萄糖氧化酶法检测空腹血糖(FPG)、2 hPG,高效液相层析法检测HbAlc,电化学发光法检测空腹胰岛素(FINS),计算胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR);采用全自动生化分析仪检测TC、TG、LDL-C、HDL-C水平,ELISA双抗体夹心法检测C1q/肿瘤坏死因子相关蛋白12(CTRP12)、成纤维细胞生长因子(FGF-21)、摄食抑制因子1(Nesfatin1)水平;观察治疗后12周HbA1c达标率(HbAlc<7%)、复合终点达标率(HbA1c<7%),以及体重变化及低血糖发生情况;记录不良反应,评价临床疗效。结果联合组总有效率为90.38%(47/52)、对照组为73.08%(38/52),2组比较差异有统计学意义(χ^(2)=5.22,P=0.022)。治疗后联合组中医证候积分[(13.21±1.48)分比(18.54±2.01)分,t=15.40]低于对照组(P<0.001);FPG[(6.05±1.01)mmol/L比(7.26±1.13)mmol/L,t=5.73]、2 hPG[(8.23±1.12)mmol/L比(10.41±1.26)mmol/L,t=9.54]、HbAlc[(5.84±0.84)%比(6.31±0.93)%,t=2.84]水平及HOMA-IR[(2.57±0.26)比(2.86±0.30),t=3.75]低于对照组(P<0.05),HOMA-β[(61.34±6.75)比(56.69±5.72),t=5.87]高于对照组(P<0.05);TC、TG、LDL-C水平低于对照组(t值分别为10.25、5.35、3.51,P<0.01),HDL-C水平高于对照组(t=11.59,P<0.01);CTRP12[(296.05±30.11)ng/L比(280.23±28.44)ng/L,t=2.76]、FGF-21[(184.12±19.05)μg/L比(170.04±17.03)μg/L,t=2.77]、Nesfatin1[(0.92±0.10)μg/L比(0.77±0.08)μg/L,t=5.99]和降脂素[(4.89±0.51)mg/L比(4.12±0.48)mg/L,t=8.58]水平高于对照组(P<0.05)。联合组复Objective To investigate the effect of Qinggan Bupi Jiangtang Decoction combined with acupuncture on glucose and lipid metabolism and cytokines in patients with overweight/obese T2DM.Methods Randomized controlled trial.A total of 104 patient with overweight/obese T2DM who were admitted to the Shanghai Municipal Hospital of Traditional Chinese Medicine of Shanghai University of Traditional Chinese Medicine from September 2022 to March 2023 were selected as the research subjects.They were randomly divided into the control group(52 cases)and the combination group(52 cases).The control group was given conventional symptomatic treatment and treated with acupuncture.On this basis,the combination group was treated with Qinggan Bupi Jiangtang Decoction.The two groups were compared in terms of efficacy,TCM syndrome scores,glucose metabolism indicators,islet function indicators,lipid metabolism indicators,cytokines,and blood glucose control.Results The total effective rate was 90.38%(47/52)in the combined group and 73.08%(38/52)in the control group,and the difference between the two groups was statistically significant(χ^(2)=5.22,P=0.022).After treatment,the TCM syndrome score(13.21±1.48 vs.18.54±2.01,t=15.40)of the combination group was lower than that of the control group(P<0.001).After treatment,the combination group FPG[(6.05±1.01)mmol/L vs.(7.26±1.13)mmol/L,t=5.73],2 hPG[(8.23±1.12)mmol/L vs.(10.41±1.26)mmol/L,t=9.54],HbAlc[(5.84±0.84)%vs.(6.31±0.93)%,t=2.84]and HOMA-IR(2.57±0.26 vs.2.86±0.30,t=3.75)were lower than those in the control group(P<0.05),and HOMA-β(61.34±6.75 vs.56.69±5.72,t=5.87)was higher than that of the control group(P<0.05).After treatment,the combination group TC,TG and LDL-C were lower than those in the control group(t values were 10.25,5.35,3.51,respectively,P<0.01),HDL-C was higher than that of the control group(t=11.59,P<0.01).After treatment,the combination group CTRP12[(296.05±30.11)ng/L vs.(280.23±28.44)ng/L,t=2.76],FGF-21[(184.12±19.05)μg/L vs.(170.04±17.03)μg/L,t=2.77],Ne

关 键 词：糖尿病 2型 肥胖 超重 清肝补脾降糖饮 针刺 糖脂代谢 细胞因子 

分 类 号：R259[医药卫生—中西医结合]