代谢综合征中医综合疗法临床观察

发布时间：2018-08-26 10:54

【摘要】：目的：根据中医文献及导师多年临床经验提出,代谢综合征最常见的证型是脾虚湿阻夹痰热证。故通过中医综合疗法来对病患进行干预,以病患临床空腹及餐后2h血糖、甘油三脂、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、BMI、腰围、收缩压、舒张压、空腹胰岛素、胰岛素抵抗指数、CRP、TNF-α等成为评价指标,探讨中医综合疗法对于代谢综合征患者的临床疗效。方法：将60例符合临床西医诊断的代谢综合征的病患,随机分配成为治疗组(n=30)和对照组(n--30),两组患者都进行基础西药控制血压、血糖、血脂等,治疗组另给予中医中药的综合疗法(包括服用中药汤剂、针灸治疗及八段锦锻炼),主要是针对中医是脾虚湿阻夹痰热证的病患进行。以3个月为一疗程,分别评价两组治疗前后患者的空腹血糖(FPG)、中医证候积分、餐后2h血糖(2hPG)、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、BMI、腰围、收缩压、舒张压、空腹胰岛素、胰岛素抵抗指数、CRP、TNF-α等指标对照。探讨中医综合疗法的疗效与作用机理,并评价它的安全性,为临床的应用提供了客观依据,提高代谢综合征的临床疗效及患者生活质量。结果：所有病患均按试验要求完成了治疗及评估。①治疗后两组患者中医证候积分较治疗前都有不同程度改良,经积分评价后,治疗组显效10人,有效14人,无效6人,总有效率达80%；在对照组中,显效人数6人,有效人数10人,无效的人数14人,总有效率53.33%,两组间比较差别具有显著性(p0.05)。②治疗前,两组患者的2hPG、FPG都没显著性差异；治疗后,治疗组以及对照组的FPG、2hPG均较治疗前改善；组间对比,治疗组的2hPG、FPG和对照组相比差异不明显。③治疗组治疗后BMI以及W均显著下降(P0.01),对照组治疗后BMI和W均有所下降,但无显著性差异(P0.05),组间比较有明显性差异(P0.01),表明在减轻体重方面,治疗组优于对照组。④脂系列方面：治疗组在治疗后提示：总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)均是降低的(P0.01),而高密度脂蛋白胆固醇且P(HDL-C)提示有所升高(P0.01),对照组在治疗后提示甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)均有所下降,高密度脂蛋白胆固醇(HDL-C)显示提高,但是并无明显性差异(P0.05),这四项指标组间比较存在显著性的差异(P0.01),表明治疗组降低血脂方面优于对照组⑤治疗组后收缩压(SBP)下降(P0.05),舒张压(DBP)有所下降,但无明显性差异(P0.05),对照组治疗后舒张压(DBP)、收缩压(SBP)有所下降,但无显著性的差异(P0.05),收缩压(SBP)组间比较有差别(P0.05),舒张压(DBP)组间比较无差别,表明治疗组在降低收缩压(SBP)水平上稍优秀于对照组,在降低舒张压方面二者功效不显著。⑥治疗组治疗后空腹胰岛素、胰岛素抵抗指数均改善(P0.01),对照组治疗后空腹胰岛素、胰岛素抵抗指数均改善,但无显著性差异(P0.05),组间比较有明显性差异(P0.01),表明在胰岛素抵抗方面,治疗组优于对照组。⑦2组患者经治疗后CRP、TNF-α均有明显降低(P均0.05),组间比较并无显著性差异(P0.05),也就是说,和原来的症状相比,两组患者的慢性炎症状态都能够得到一定的缓解,这主要是由于药物的使用,能够使IR引起的炎症反应得到明显缓解导致的。说明在纳入本次实验的MS患者的中,通过传统治疗和配合中医治疗的人群中并没有明显的差别,提示二者均可以降低MS患者的TNF-α,进而能够使代谢综合征患者的炎症系统得到显着地缓解,从而能够在一定程度上治疗与预防代谢综合征。⑧治疗后,2组患者空腹胰岛素水平及胰岛素抵抗指数较前改善,与对照组比较(P0.05),与治疗前比较(P0.05)。结论：1、通过本课题研究,说明中医综合疗法治疗代谢综合征具有安全性与有效性。2、本次研究课题,为中医药防治代谢综合征并改善已患病患者的临床症状,起到了良好的指导作用。3、本研究较好的提高了代谢综合征病患的生活质量,为未来治疗代谢综合征提供了新的临床方法。
[Abstract]:Objective: According to the literature of traditional Chinese medicine and the clinical experience of tutors for many years, the most common type of metabolic syndrome is spleen deficiency dampness obstruction with phlegm-heat syndrome.Therefore, through the comprehensive treatment of traditional Chinese medicine to intervene in patients with clinical fasting and postprandial 2 hours blood glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, BMI, Waist circumference, systolic blood pressure, diastolic blood pressure, fasting insulin, insulin resistance index, CRP, TNF-alpha and so on were used as evaluation indexes to explore the clinical efficacy of TCM combined therapy for metabolic syndrome. Methods: 60 patients with metabolic syndrome were randomly assigned to treatment group (n=30) and control group (n--30). All the patients were treated with basic Western medicine to control blood pressure, blood glucose, blood lipids, etc. The treatment group was treated with traditional Chinese medicine (including taking Chinese medicine decoction, acupuncture treatment and Baduanjin exercise), mainly for the patients with spleen deficiency dampness obstruction and phlegm-heat syndrome. TCM syndrome score, 2h postprandial blood glucose (2hPG), triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting insulin, insulin resistance index, CRP, TNF-a and other indicators were compared. To explore the efficacy and mechanism of TCM comprehensive therapy, and evaluate its safety, for the imminent. Results: All the patients completed the treatment and evaluation according to the experimental requirements. After treatment, the scores of TCM syndromes in the two groups were improved to varying degrees compared with those before treatment. The total effective rate was 80%. In the control group, 6 effective people, 10 effective people, 14 ineffective people, the total effective rate was 53.33%. There was a significant difference between the two groups (p0.05). 2) Before treatment, there was no significant difference between the two groups of patients 2 hPG, FPG; after treatment, the treatment group and the control group FPG, 2 hPG were improved compared with before treatment. The BMI and W of the treatment group decreased significantly after treatment (P 0.01), but there was no significant difference between the two groups (P 0.05), indicating that the treatment group was superior to the control group in weight loss. After treatment, the total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) were decreased (P 0.01), while high density lipoprotein cholesterol and P (HDL-C) were increased (P 0.01). After treatment, the control group showed that triglyceride (TG), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC) were decreased, high density lipoprotein cholesterol (HDL-C) was increased (P 0.01). Lipoprotein cholesterol (HDL-C) showed an increase, but there was no significant difference (P 0.05), there were significant differences among the four indicators (P 0.01), indicating that the treatment group was superior to the control group in reducing blood lipids_Systolic blood pressure (SBP) decreased after treatment (P 0.05), diastolic blood pressure (DBP) decreased, but there was no significant difference (P 0.05), the control group after treatment. Diastolic blood pressure (DBP), systolic blood pressure (SBP) decreased, but there was no significant difference (P 0.05), systolic blood pressure (SBP) between groups was different (P 0.05), diastolic blood pressure (DBP) between groups was no difference, indicating that the treatment group in reducing systolic blood pressure (SBP) level slightly better than the control group, in reducing diastolic blood pressure in the fasting pancreas was not significant. Insulin resistance index and insulin resistance index were improved (P 0.01). Fasting insulin and insulin resistance index were improved in the control group after treatment, but there was no significant difference (P 0.05). There was significant difference between the two groups (P 0.01), indicating that the treatment group was superior to the control group in insulin resistance. There was no significant difference between the two groups (P 0.05). That is to say, compared with the original symptoms, the chronic inflammatory state of the two groups were alleviated. This was mainly due to the use of drugs, which could significantly alleviate the inflammation caused by IR. This indicated that in MS patients included in this study, traditional treatment was adopted. There is no significant difference between the two groups, suggesting that both of them can reduce TNF-alpha in MS patients, and then significantly alleviate the inflammatory system in patients with metabolic syndrome, so as to be able to treat and prevent metabolic syndrome to a certain extent. _After treatment, fasting insulin levels and insulin resistance in both groups. Conclusion: 1. Through this research, it shows that the comprehensive therapy of traditional Chinese medicine is safe and effective in the treatment of metabolic syndrome. 2. This research topic, for the prevention and treatment of metabolic syndrome and improve the clinical symptoms of patients with metabolic syndrome, played a good guide. 3. This study improved the quality of life of patients with metabolic syndrome and provided a new clinical method for the treatment of metabolic syndrome in the future.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R259

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