祝氏降糖方加味联合单硝酸异山梨酯片治疗糖尿病性冠心病的临床观察

发布时间：2018-06-03 06:22

本文选题：祝氏降糖方 + 气阴两虚　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的旨在通过运用祝氏降糖方加味联合单硝酸异山梨酯片治疗气阴两虚夹瘀型2型糖尿病性冠心病患者,观察其最终临床疗效、中医症候、客观临床指标以及安全性。方法在2015年10月至2016年10月就诊于武汉市第一医院内分泌科门诊及病房的患者,参照中西医的诊断标准,将符合要求的60例确诊为2型糖尿病性冠心病(气阴两虚夹瘀型)的患者随机分为2组,每组患者占30例。所有受试者均给予降糖、调脂及降压等基础治疗,对照组在维持基础治疗同时,加用单硝酸异山梨酯片(20mg/次,2次/日,口服);而治疗组在对照组治疗基础上联用中药祝氏降糖方加味,由药房统一代煎,每天一付,每付两袋,各150ml,早、晚饭后半小时温服。治疗期12周。记录两组治疗前后观察指标的变化情况。结果⑴治疗组的总有效率82.1%,对照组总有效率48.1%,两组相比较差异有统计学意义(P0.05);⑵治治疗后两组临床症状较治疗前均有所改善(P0.05),且治疗组改善更加明显(P0.05),特别在心胸疼痛、口渴喜饮、心悸失眠、倦怠乏力等症状上改善更加明显;⑶两组治疗前证候总积分比较无显著差异(P0.05);两组治疗后证候总积分与治疗前比较均有差异(P0.05),且治疗后两组间比较积分有差异(P0.05);⑷治疗前两组FBG、2h PG、Hb A1c比较均无显著差异(P0.05);治疗后两组各自组内FBG、2h PG、Hb A1c比较,差异具有统计学意义(P0.05),治疗后组间比较,治疗组较对照组改善明显,差异有统计学意义(P0.05);⑸治疗前两组血脂比较,无统计学差异(P0.05);治疗后组内比较,血脂除HDL-C外,均有显著差异(P0.05),治疗后两组间LDL-C比较,有统计学差异(P0.05),组间TC、TG、HDL-C比较,差异无统计学意义(P0.05);⑹两组治疗前BP、BMI、CRP比较无显著差异(P0.05),治疗后组内比较BP、BMI、CRP,有显著差异(P0.05),治疗后组间BP、BMI比较无显著差异(P0.05),但治疗后组间CRP比较,有显著差异(P0.05);⑺治疗前,两组间血液流变学指标进行比较,差异无统计学意义(P0.05);治疗后,两组血流变指标与治疗前比较,有显著差异(P0.05);治疗后两组间血流变指标比较,差异有统计学意义(P0.05);⑻治疗后两组间心电图总有效率相比较,具有显著差异(P0.05);⑼治疗前两组间E/A、EF、SV、室间隔厚度、主动脉内径比较,差异无统计学意义(P0.05);两组治疗前后E/A比值,射血分数(EF)、每搏输出量(SV)均显著升高,差异有统计学意义(P0.05),治疗后两组间E/A、EF、SV比较,有显著差异(P0.05),两组治疗前后室间隔厚度、主动脉内径均无显著性差异(P0.05),且治疗后组间比较也无差异(P0.05);⑽两组患者在治疗阶段都没有出现明显的不良反应,生命体征平稳,血常规、尿常规、大便常规、肝肾功能等安全性指标均未见明显异常。治疗组出现头痛、头晕2例,面红2例,对照组出现3例头晕、头痛,面红2例,均可耐受。两组患者均未出现其他严重并发症、终末事件,完成了整个实验。结论通过运用祝氏降糖方加味联合单硝酸异山梨酯片治疗气阴两虚夹瘀型2型糖尿病性冠心病患者,不仅可以显著提高治疗的总有效率,降低患者的中医证候总积分,改善患者的中医临床症状,而且能够更好地改善患者血糖、血液流变学、心功能等水平,但在血脂、血压、体重指数、心肌缺血指标方面未见明显优势。与单用西药治疗相比,未有不良反应等,安全性较高,在临床治疗2型糖尿病性冠心病中值得推广。
[Abstract]:Objective To observe the final clinical efficacy, TCM syndrome, objective clinical index and safety in the treatment of patients with type 2 diabetic coronary heart disease with two deficiency of Qi and Yin and stagnation of stasis type 2 diabetic coronary heart disease by using Zhu's Jiangtang recipe. Methods from October 2015 to October 2016 were diagnosed in the Department of endocrinology of the Wuhan No.1 Hospital and the disease. 60 patients with type 2 diabetic coronary heart disease (Qi Yin deficiency and stasis type) were randomly divided into 2 groups according to the diagnostic criteria of Chinese and Western medicine. All the patients in each group accounted for 30 cases. All the subjects were given basic treatment, such as hypoglycemic, lipid and blood pressure lowering, and the control group was combined with isosorbide mononitrate at the same time with the maintenance of basic treatment. Tablets (20mg/ times, 2 times per day, oral), and the treatment group on the basis of the control group on the basis of the combination of Chinese medicine Zhu Shi Jiangtang prescription added, by the pharmacy unified decoction, one pay per day, two bags, each 150ml, early, after supper half an hour's warm clothes. The treatment period of 12 weeks before and after treatment. Results (1) the total effective rate of treatment group is 82.1%, (1) the total effective rate is 82.1%, and The total effective rate of the group was 48.1%, and the difference of the two groups was statistically significant (P0.05). After treatment, the clinical symptoms of the two groups were improved (P0.05), and the improvement of the treatment group was more obvious (P0.05), especially in the symptoms of heart pain, thirst and joy drink, palpitation and insomnia, fatigue and fatigue, and 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. The symptoms of the symptoms were more obvious in the heart pain, thirst and joy drink, palpitation, insomnia, fatigue and fatigue; 3. 3. 3. 3. 3. 3. 3. There was no significant difference (P0.05) in the total score of the two groups after treatment (P0.05), and there was a difference (P0.05) between the two groups after the treatment (P0.05). (4) there was no significant difference between the two groups of FBG, 2h PG and Hb A1c before treatment (P0.05), and the difference was statistically significant in the two groups of FBG, 2h PG. After treatment, compared with the control group, the treatment group was significantly better than the control group (P0.05). There was no statistical difference between the two groups before the treatment (P0.05). After the treatment, there were significant differences (P0.05) in the blood lipid except HDL-C (P0.05), and there was a statistical difference between the groups after the treatment (P0.05), and the difference of TC, TG, HDL-C in the group was the difference. There was no significant difference (P0.05). There was no significant difference in BP, BMI and CRP before treatment (P0.05). There were significant differences (P0.05) in BP, BMI, CRP in the group after treatment (P0.05). There was no significant difference between the two groups after treatment (P0.05), but there was a significant difference between the groups after treatment (P0.05), but the blood rheology indexes were compared between the two groups before treatment. There was no statistical significance (P0.05). After treatment, the blood rheology index of the two groups was significantly different from that before treatment (P0.05). The blood rheology indexes of the two groups after treatment were statistically significant (P0.05). The total electrocardiogram rate of the two groups after treatment was significantly different (P0.05); E/A, EF, SV, interventricular septum thickness between the groups before the treatment were of the thickness, There was no significant difference in the aortic diameter (P0.05). The E/A ratio, the ejection fraction (EF) and the output of SV were significantly increased in the two groups, and the difference was statistically significant (P0.05). There were significant differences (P0.05) between the two groups after treatment (P0.05). There was no significant difference in the thickness of the interventricular septum between the two groups before and after treatment (P0.05, P0.05). There were no significant adverse reactions between the two groups. The two groups had no obvious adverse reactions in the treatment stage, the signs of life were stable, blood routine, urine routine, routine stool, liver and kidney function and other safety indexes were not obvious abnormality. The treatment group had head pain, dizziness in 2 cases, 2 cases of face red, and 3 cases of dizziness, headache, and face in the control group. 2 cases in red were well tolerated. No other serious complications were found in the two groups. The whole experiment was completed. Conclusion by using Zhu's Jiangtang recipe combined with Isosorbide Mononitrate Tablets to treat patients with type 2 diabetic coronary heart disease with two deficiency of Qi and Yin, not only can the total effective rate of treatment be improved and the patients' traditional Chinese medicine can be reduced. The total score of syndrome can improve the clinical symptoms of Chinese medicine and improve the blood sugar, Hemorrheology and cardiac function of patients, but it has no obvious advantages in blood lipid, blood pressure, body mass index and myocardial ischemia. Compared with the treatment of Western medicine alone, there is no adverse reaction, the safety is higher, and the clinical treatment of type 2 diabetes is very high. It is worth popularizing in coronary heart disease.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R541.4

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