补肾方药改善糖尿病听力下降的临床研究

发布时间：2019-03-25 17:40

【摘要】：糖尿病是危害人类健康的重大疾病,随着生活水平的提高、营养结构的改变、交通工具的发达、劳动强度的降低、再加上环境恶化、公民社会心理压力的渐增,糖尿病已经发展成为一种常见病、多发病,可能为终身性的慢性疾病。目前已成为严重危害人类健康的公共卫生问题。在我国糖尿病发病率呈增高趋势,并且出现向低龄化发展的严重性。因此,防治极为重要。目前,糖尿病造成听力下降与神经性耳聋相近似,病理机制尚未明确,所有治疗的效果非常有限。本文依据“肾主骨”、“肾开窍于耳”理论,结合本组患者均有不同程度肾虚证并伴有听力下降,观察补肾中药方结合辨证疗法治疗糖尿病听力临床研究。目的:糖尿病是危害人类健康的重大疾病,糖尿病所致感音神经性耳聋,因其病因尚未明确,所以治疗极其困难,根据糖尿病听力下降患者均表现程度不同肾虚证,参照“肾主骨”、“肾开窍于耳”理论。本研究观察补肾中药方对糖尿病听力下降患者疗效的影响,为补肾中药方防治糖尿病听力下降提供思路与方法。方法:根据国际标准化组织(ISO)1964年公布的耳聋等级标准,选取2012年10月至2015年11月在河北医科大学附属邢台市人民医院内分泌科及邢台医学高等专科学校第二附属医院中西医结合科308例(416耳)2型糖尿病(NIDDM)伴耳聋患者。属轻度聋72耳,中度聋120耳,中重度聋132耳,重度聋60耳,深度聋32耳;单侧耳聋236耳,双侧耳聋180耳;出现突发性耳聋患者46耳,逐渐发生所引起耳聋患者370耳。上述患者按病情分组分别进行随机分为治疗组和对照组:治疗组(补肾中药组)170例(220耳),男73例,女97例,年龄36-69岁,平均50.6岁,病程1-10年,平均4.6年。对照组(西药组)138例(196耳),男67例,女71例,年龄34-67岁,平均49.8岁,病程1-9年,平均4.3年。两组分组经齐同性检验无统计学差异(P0.05)。另外两组均排除的病因包括,药物中毒性耳聋、脑外伤、噪音性耳聋,以及其它中毒性疾病等病史。诊断标准符合世界卫生组织(WHO)确诊为NIDDM标准。辩证分型依据《新药(中药)治疗糖尿病(消渴病)临床研究指导原则》。耳聋分级为国际标准化组织(ISO)1964年公布的耳聋等级标准。听力学疗效标准:痊愈:治疗后听力逐渐恢复,耳鸣逐渐减至消失,全频率听阈曲线渐回升至正常范围或与健侧相似;显效:全频率听阈曲线较治疗前回升超过30d B或进入实用听区,主观症状明显好转;进步:听阈曲线的多频率回升15-30d B,主观症状亦好转;无效:听阈曲线的多数频率较治疗前上升不足15d B,无论主观症状是否好转。治疗组170例(220耳)用补肾中药方结合辩证论治用药。对照组132例糖尿病耳聋患者,用格列本脲片和治疗常规所采用的耳聋药物。观察两组治疗前后听力影响,空腹血糖(FBG)、餐后2h血糖(PBG)、24h尿糖定量,主要见症改善情况,血小板功能,超氧化物歧化酶(SOD)、过氧化脂质(LPO)等变化。结果:1两组治疗前后听力比较治疗组治疗后听力提高总有效率为57.7%,对照组为28.5%,两组比较有明显差异(P0.05)。2两组FBG、PBG、24h治疗前后变化两组空腹血糖(FBG)、餐后2h血糖(PBG)、24h尿血糖定量和治疗前相比改善明显(P0.05.P0.01),其中餐后2h血糖(PBG)、24h尿血糖定量治疗组疗效明显优于对照组(P0.01),两组空腹血糖(FBG)无明显差异(P0.05)。3两组治疗前后主要症状改善情况治疗组和治疗前相比较,在腰膝酸软、小便量多、易肌善食,消瘦无力等症状改善比较明显,(P0.05.P0.01),而对照组在上述症状改善不明显。4两组血小板粘附率、血小板聚集率、超氧化物歧化酶(SOD)、过氧化脂质(LPO)治疗前后情况治疗组治疗后血小板粘附率,血小板聚集率,超氧化物歧化酶(SOD),过氧化脂质(LPO)有较好改变(P0.05.P0.01),而对照组除LPO有改变外(P0.05),余三项指标均无明显差异(P0.05)。结论:1补肾中药方结合辨证治疗糖尿病听力下降患者疗效确切,未见患者引起副作用症状。2补肾中药方能够提高糖尿病听力下降患者听力、提高超氧化物歧化酶活性,改善糖尿病听力下降患者主要症状,降低血小板聚集、过氧化脂质含量,且疗效优于常规对照组治疗方法,该研究为中西医结合防治糖尿病耳聋提供较好思路与方法。
[Abstract]:diabetes is a major disease which is harmful to human health, with the improvement of living standard, the change of the nutrition structure, the development of the transportation vehicle, the reduction of the labor intensity, the environment deterioration, the increasing of the psychological pressure of the citizen, the diabetes has developed into a common disease, It may be a life-long, chronic disease. At present, it has become a public health problem which is seriously harmful to human health. The incidence of diabetes in China is increasing, and the severity of the development of diabetes is present. Therefore, the prevention and control is of great importance. At present, the hearing loss caused by diabetes is similar to that of the nerve deafness, the pathological mechanism is not clear, and the effect of all treatments is very limited. According to the "kidney main bone" and "The kidney opens to the ear" theory, in combination with the different degree of kidney deficiency syndrome and the hearing loss of the patients in this group, the clinical study on the treatment of diabetes with the combination of the traditional Chinese medicine prescription and the syndrome differentiation therapy is observed. Objective: Diabetes is a major disease which is harmful to human health. The sensorineural hearing loss due to diabetes is not clear due to its etiology. Therefore, it is extremely difficult to treat, and according to the different degree of kidney deficiency of the patients with impaired hearing, refer to the "kidney main bone" and the "The kidney opens to the ear" theory. The purpose of this study is to observe the effect of the prescription for tonifying the kidney and the effect of the prescription on the patients with impaired hearing, and to provide a train of thought and method for the prevention and treatment of diabetes hearing loss. Method: According to the criteria for the level of deafness published by the International Organization for Standardization (ISO) in 1964, 308 cases (416 ears) of type 2 diabetes mellitus (NIDDM) with deafness were selected from October,2012 to November,2015 at the Second Affiliated Hospital of the People's Hospital of the Affiliated Hospital of Hebei Medical University. Of the patients with mild deafness,72 ears,120 ears with moderate deafness,132 ears with moderate to severe deafness,60 ears with severe deafness,32 ears with deep deafness,236 ears of one-sided deafness and 180 ears of bilateral deafness,46 ears of patients with sudden deafness and 370 ears of patients with sudden deafness. The above-mentioned patients were randomly divided into the treatment group and the control group according to the condition group: the treatment group (the kidney-tonifying traditional Chinese medicine group)170 cases (220 ears), the male 73 cases, the female 97 cases, the age 36-69 years, the average age of 50.6 years, the course of the disease 1-10 years, the average 4.6 years. 138 (196 ears) of the control group (196 ears),67 males and 71 females, aged 34 to 67, had an average of 49.8 years, and the course of the disease ranged from 1 to 9 years, with an average of 4.3 years. There was no statistical difference between the two groups (P0.05). The other two groups are excluded from the medical history of drug-induced deafness, brain trauma, noise deafness, and other toxic diseases. The diagnostic criteria were met by the World Health Organization (WHO) as the NIDDM standard. The dialectical type is based on the guiding principle of the clinical study of the treatment of diabetes (diabetes) by the new drug (traditional Chinese medicine). Deafness classification is the standard of hearing loss published by the International Organization for Standardization (ISO) in 1964. The results are as follows: after the treatment, the hearing is gradually restored, the tinnitus is gradually reduced, the full-frequency auditory threshold curve is gradually recovered to the normal range or similar to the healthy side, and the whole-frequency auditory threshold curve is more than 30 days before the treatment, or enters the practical auditory zone, and the subjective symptom is improved; Progress: The multi-frequency recovery of the auditory threshold curve is up to 15-30 d B, and the subjective symptoms are also improved; the majority of the frequency of the auditory threshold curve is less than 15 d B before the treatment, whether the subjective symptom is improved or not. In the treatment group,170 cases (220 ears) were treated with the traditional Chinese medicine for tonifying the kidney. In the control group,132 patients with diabetes and deafness were treated with gliclazide tablets and the treatment of the conventional deafness drugs. The effects of two groups of pre-and post-treatment hearing, fasting blood glucose (FBG),2-hour postprandial blood glucose (PBG) and 24-hour urine glucose were observed, and the changes of blood platelet function, superoxide dismutase (SOD) and lipid peroxide (LPO) were observed. Results: The total effective rate of the two groups was 57.7% after treatment and 28.5% in the control group, and there was a significant difference between the two groups (P0.05). The two groups of FBG, PBG, and 24h were treated with two groups of fasting blood glucose (FBG) before and after treatment. After 2 h postprandial blood glucose (PBG) and 24 h urine glucose level and pre-treatment, the blood glucose (PBG) and 24h urine glucose were significantly better than those in the control group (P 0.01). There was no significant difference between the two groups of fasting blood glucose (FBG) (P0.05). in that control group, the platelet adhesion rate, the platelet aggregation rate, the superoxide dismutase (SOD), the platelet aggregation rate, the platelet aggregation rate, the superoxide dismutase (SOD), The lipid peroxide (LPO) of the control group was better than that of the control group (P0.05). Conclusion:1. The traditional Chinese medicine prescription can improve the hearing of the patients with impaired hearing, improve the activity of the superoxide dismutase and improve the main symptoms of the patients with impaired hearing. In ord to reduce that aggregation of the platelet and the content of the lipid peroxide, and the curative effect is superior to that of the conventional control group, the study provides a good idea and a method for preventing and treating the diabetic deafness by combination of the traditional Chinese and western medicine.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1;R259

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