泻胃补脾法针刺治疗糖尿病前期的临床研究

发布时间：2018-01-05 01:23

本文关键词：泻胃补脾法针刺治疗糖尿病前期的临床研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:1.观察泻胃补脾针刺法对糖尿病前期患者的临床疗效。2.探讨泻胃补脾针刺法对糖尿病前期患者糖脂代谢指标及胰岛素抵抗效应的影响。3.探索泻胃补脾法干预糖尿病前期的病理学机制。方法:将60例患者按照随机数字表法分为针灸组(32例)与对照组(28例)。对照组采用健康教育、控制饮食、合理运动,单纯生活方式干预;针刺治疗组在科学生活方式干预基础上予泻胃补脾为指导原则选穴针灸,主取脾俞、中脘、足三里、三阴交、太白、内庭,先刺脾俞,后刺余穴,中脘、足三里、内庭用泻法,先行提插泻法,轻插重提,行针6次,后行捻转泻法,拇指向后、食指向前捻转,行针6次。脾俞、太白、三阴交用补法,先行提插补法,重插轻提,行针6次,后行捻转补法,拇指向前,食指向后,行针6次,余穴平补平泻,留针30 min。每周3次,隔日一次,两组皆干预12周。记录患者治疗前后证候积分,检测治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹胰岛素(FINS)、空腹血清C肽(FCP)、瘦素(LEP)、抵抗素(RETN)、胰升糖素样肽-1(GLP-1),计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)胰岛β细胞功能指数(HOMA-β),评价疗效。结果:1.两组临床疗效分布比较,差异有统计学意义(P0.05)。两组症状积分干预前后相较差异均有统计学意义(P0.05),组间比较,针刺组总症状积分显著低于对照组,差异有统计学意义(P0.05)。治疗前多食易饥、口渴多饮、倦怠乏力、便秘或腹泻症状积分比重较大,针刺治疗对以上症状积分下调效果明显。2.与干预前比较,两组干预后FPG、HbA1c、FINS、FCP差异有统计学意义(P0.05)。针刺组以上指标下降程度显著大于对照组(P0.05)。3.与干预前比较,针刺组干预后ISI、HOMA-IR差异有统计学意义(P0.05),对照组干预后无明显差异(P0.05)。针刺组干预后ISI、HOMA-IR差异显著大于对照组。4.与干预前比较,针刺组干预后TG、LDL-C差异有统计学意义(P0.05),对照组干预后脂代谢指标无明显差异(P0.05),针灸组对TG、HDL-C、LDL-C改善优于对照组。5.与干预相比较,针刺组干预后RETN、GLP-1差异有统计学意义(P0.05),对照组RETN、LEP、GLP-1干预前后差异均无统计学意义(P0.05)。针刺组干预后RETN、GLP-1差异显著大于对照组(P0.05)。结论:1.生活方式干预对糖尿病前期患者糖脂代谢有改善作用,但其疗效低于针刺治疗。2.糖尿病前期患者证候多以胃强脾弱表现为主,泻胃补脾法能缓解临床症状,纠正糖脂代谢紊乱状态,调节胰岛素分泌,增强胰岛素敏感性,改善胰岛素抵抗,其作用机制可能与下调RETN水平,增加外周组织对葡萄糖利用率,上调GLP-1表达,促进胰岛β细胞增生,减少β细胞凋亡有关。3.泻胃补脾法是改善糖尿病前期患者症状的有效治疗手段。
[Abstract]:Objective:. 1. To observe the clinical effect of the acupuncture of purging stomach and reinforcing spleen on the patients with prediabetes. 2. To explore the effect of acupuncture of purging stomach and reinforcing spleen on the indexes of glucose and lipid metabolism and the effect of insulin resistance in patients with prediabetes. 3. To explore the effect of purging stomach and replenishing spleen. Methods: methods:. 60 patients were divided into acupuncture and moxibustion group (. Health education was used in the control group (n = 32) and the control group (n = 28). Control diet, reasonable exercise, simple lifestyle intervention; Acupuncture treatment group on the basis of scientific lifestyle intervention on the basis of diarrhea stomach spleen as the guiding principle of acupuncture and moxibustion, the main spleen Yu, Zhongwan, Zusanli, Sanyinjiao, Taibai, chamber, first prick spleen Yu, then prick Yu, Zhongwan. Zusanli, the chamber with the method of diarrhea, the first lifting and reducing method, gently inserted re-raise, needle 6 times, after twirling diarrhea, thumb backward, index finger forward twist, needle 6 times. Spleen Yu, Taibai, Sanyinjiao with the complement method. The method of lifting and inserting first, heavy inserting light lifting, taking needle 6 times, then twirling complement method, thumb forward, index finger backward, needle 6 times, remaining acupoint flat reinforcing and reducing, keeping needle 30 mins. 3 times a week, every other day. The symptom scores of patients before and after treatment were recorded. Fasting blood glucose (FPGN), HbA1cn, total cholesterol TCU and triglyceride (TGG) were measured before and after treatment. High density lipoprotein (HDL-C), low density lipoprotein (LDL-C), fasting insulin (FINSN), fasting serum C-peptide (FCPP), leptin, resistin (RETNN). Insulin resistance index (HOMA-IRI), insulin sensitivity index (ISI) and islet 尾 cell function index (HOMA- 尾) were calculated. Results: there were significant differences in the distribution of clinical efficacy between the two groups (P 0.05). There was significant difference between the two groups before and after the intervention of symptom score (P 0.05). The total symptom score of the acupuncture group was significantly lower than that of the control group (P 0.05). Before treatment, it was easy to eat, thirsty, tired, constipation or diarrhea. The effect of acupuncture treatment on the score of above symptoms was significantly down-regulated .2.Compared with that before intervention, the two groups were treated with FPGG HbA1cFINS after intervention. The difference of FCP was statistically significant (P 0.05). The degree of decrease of above indexes in acupuncture group was significantly higher than that in control group (P 0. 05. 3). Compared with before intervention, ISI in acupuncture group was higher than that in control group (P < 0. 05). The difference of HOMA-IR was statistically significant (P 0.05), but there was no significant difference after intervention in control group (P 0.05). There was no significant difference in ISI after acupuncture intervention in the control group. The difference of HOMA-IR was significantly higher than that of control group. 4. Compared with before intervention, the difference of LDL-C between acupuncture group and control group was statistically significant (P0.05). There was no significant difference in lipid metabolism indexes after intervention in the control group (P 0.05). The improvement of LDL-C in the acupuncture group was better than that in the control group (.5.Compared with the intervention, the RETN after the intervention in the acupuncture group was better than that in the control group. The difference of GLP-1 was statistically significant (P 0.05), but there was no significant difference before and after intervention of GLP-1 in control group (P 0.05). RETN in acupuncture group after intervention was not significant. The difference of GLP-1 was significantly higher than that of control group (P 0.05). Conclusion the intervention of life style can improve the metabolism of glucose and lipid in prediabetic patients. But its curative effect is lower than acupuncture treatment .2.The symptoms of prediabetes patients are mainly stomach strong spleen weakness. The method of purging stomach and invigorating spleen can relieve clinical symptoms, correct disorder of glucose and lipid metabolism, and regulate insulin secretion. The mechanism of enhancing insulin sensitivity and improving insulin resistance may be related to down-regulation of RETN level, increase of glucose utilization rate in peripheral tissues, up-regulation of GLP-1 expression, and promotion of islet 尾 cell proliferation. Reduction of 尾-cell apoptosis is related to. 3. The method of purging stomach and reinforcing spleen is an effective method to improve the symptoms of prediabetic patients.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.1

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