疏肝健脾颗粒剂在肝郁脾虚型2型糖尿病合并非酒精性脂肪肝治疗中的增效观察

发布时间：2018-06-20 14:27

本文选题：非酒精性脂肪肝 + 肝郁脾虚证　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：通过观察疏肝健脾颗粒剂组方对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)肝郁脾虚证型患者的胰岛素抵抗(IR)、血脂、血糖及临床症状的影响,结合目前现代中西医研究成果,进一步探讨其作用机理,进而为治疗T2DM合并NAFLD提供新的思路及方法。方法：将2014年12月至2016年1月收集入组的T2DM合并NAFLD肝郁脾虚证患者,按照随机对照的方法分为实验组和对照组,每组各30例。对照组采用生活方式干预+西医基础治疗进行治疗,而实验组则是在对照组的基础上加用自拟中药疏肝健脾颗粒剂组方,每日一剂,水冲200m1,早晚各服100ml,两组均干预2月。评估干预前后中医证候积分及体征变化、糖化血红蛋白(HbAlc).血脂(TG、TC、LDL-C、HDL-C)、肝功能(AST、ALT)水平,并行国际标准葡萄糖耐量实验,同步测定0,30,120min血糖及同步胰岛素(INS),计算胰岛抵抗指数(HOMA-IR)、早期胰岛素分泌指数(EISI)、120min胰岛素曲线下面积(AUCINS)、120min血糖曲线下面积(AUCIBG)等相关指标,并采用SPSS17.0进行统计学分析,评估干预前后及两组之间的差异。结果：①观察两组患者症状、体征变化：两组患者证候积分均较前明显下降,有显著差异(P0.01),实验组明显优于对照组(P0.01),两组有效率分别为86.67%、66.67%,实验组明显优于对照组(P0.05)；②比较两组血糖水平：两组患者FPG、2hPG、 120minAUCIBG、HbAlc较治疗前明显下降(P0.01),实验组较对照组下降更为明显(P0.05)；③在胰岛功能方面：两组患者HOMA-IR均有明显下降,与治疗前相比有显著差异(P0.01),实验组明显优于对照组(P0.01),实验组患者EISI较前明显改善,(P0.01),对照组EISI较前也有所上升,差异有统计学意义(P0.05),但两组之间无明显差异(P0.05),两组患者120minAUCINS与治疗前相比虽有所下降,但差异无统计学意义(P0.05)。④在血脂水平上：实验组在降低TC、LDL-C,升高HDL-C方面,与对照组相比有明显优势,差异有统计学意义(P0.05)；实验组、对照组与治疗前相比TG均有明显下降(P0.01),但两组之间差异无统计学意义。⑤比较两组患者肝功能指标发现,实验组与对照组相比在降低ALT、AST方面有显著优势(P0.01)；⑥两组患者治疗期间安全性观察指标均在正常范围内,未发现明显不良反应及副作用。结论：疏肝健脾颗粒剂能明显减轻T2DM合并NAFLD肝郁脾虚证患者的胰岛素抵抗,改善血糖、血脂水平,保护其肝功能,并且对于缓解其临床症状有明显的优势,而且无明显副作用,安全性较好,值得临床广泛运用。
[Abstract]:Objective: to observe the effects of Shugan Jianpi granule on insulin resistance, blood lipid, blood glucose and clinical symptoms in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver (NAFLDD) syndrome of liver stagnation and spleen deficiency. The mechanism of NAFLD was further discussed and a new method for the treatment of T2DM combined with NAFLD was provided. Methods: T2DM patients with NAFLD liver stagnation and spleen deficiency syndrome were collected from December 2014 to January 2016 and divided into experimental group and control group with 30 cases in each group according to the method of random control. The control group was treated with lifestyle intervention and western medicine basic treatment, while the experimental group was treated with Shugan Jianpi granule, one dose daily, one dose per day, 100 ml in the morning and evening. Both groups intervened for 2 months. To evaluate the changes of syndromes and signs of TCM before and after intervention, and to evaluate HbAlcP in glycosylated hemoglobin. Serum lipids, TGG, LDL-Cn, liver function, ASTL-ALT) levels, and international standard glucose tolerance test were performed. The islet resistance index (HOMA-IRN), the early insulin secretion index (ISI) and the area under the 120min insulin curve were measured simultaneously, and the correlation indexes were analyzed by SPSS 17.0. The differences before and after intervention and between the two groups were evaluated. Results the changes of symptoms and signs of the two groups were observed: the scores of symptoms and signs of the two groups were significantly lower than those of the former, and there was a significant difference between the two groups. The experimental group was obviously superior to the control group (P 0.01), the effective rate of the two groups was 86.67 and 66.67, respectively, and the experimental group was obviously superior to the control group (P 0.05). 2 the levels of blood glucose in the two groups were compared: the levels of FPGG 2hPGand AUCIBGG HbAlc at 120min were significantly decreased compared with those before treatment, and that of the experimental group was significantly lower than that of the control group. In the islet function, HOMA-IR was significantly decreased in both groups. Compared with before treatment, there was a significant difference between the two groups (P 0.01), the experimental group was better than the control group (P 0.01), the EISI of the experimental group was significantly improved than that of the former, and the EISI of the control group was also higher than that of the control group. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups (P 0.05). Although AUCINS at 120 min in the two groups was lower than that before treatment, there was no significant difference in blood lipid level: in the experimental group, LDL-C was decreased and HDL-C was increased in the experimental group. Compared with the control group, the TG in the experimental group decreased significantly compared with the control group, but there was no significant difference between the two groups in terms of liver function, the difference between the two groups was statistically significant, and the difference between the two groups was statistically significant (P 0.05), while that of the control group was significantly lower than that of the control group (P 0.05), but there was no significant difference between the two groups. Compared with the control group, the experimental group had significant advantages in reducing alt. The safety observation indexes of the two groups were within the normal range during the treatment period, and no obvious adverse reactions and side effects were found. Conclusion: Shugan Jianpi granule can obviously reduce insulin resistance, improve blood glucose and blood lipid level, protect liver function in patients with T2DM combined with liver stagnation and spleen deficiency of NAFLD, and has obvious advantages in relieving clinical symptoms and has no obvious side effects. It is safe and worthy of wide clinical application.
【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】：2016
【分类号】：R259

【相似文献】