连术消渴方联合二甲双胍对湿...者糖脂代谢及炎症因子的影响_文金谦.pdf

新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4收稿日期 2021-11-10修回日期 2022-12-01基金项目开封市科技计划项目（2103003）作者简介文金谦（1982-），男，主管检验师，E-mail：wjq1982_。通信作者闫镛（1962-），女，主任医师，E-mail：。连术消渴方联合二甲双胍对湿热互结兼瘀证肥胖2型糖尿病患者糖脂代谢及炎症因子的影响文金谦，金凯，魏光辉，徐伶俐，闫镛开封市中医院，河南 开封 475000摘要目的：观察连术消渴方联合二甲双胍治疗湿热互结兼瘀证肥胖 2 型糖尿病（T2DM）的疗效及对糖脂代谢、炎症因子的影响。方法：选取 66 例湿热互结兼瘀证 T2DM 患者，按随机数字表法分为对照组及观察组各 33 例。对照组给予二甲双胍治疗，观察组在对照组治疗基础上给予连术消渴方治疗。比较 2 组临床疗效及不良反应发生率，比较 2 组治疗前后中医证候积分、糖脂代谢 空腹血糖（FBG）、餐后 2 h 血糖（P2hBG）、血清总胆固醇（TC）、甘油三酯（TG）水平、炎症因子肿瘤坏死因子-（TNF-）、白细胞介素-6（IL-6），C-反应蛋白（CRP）水平的变化。结果：观察组临床疗效总有效率为 93.94%，对照组为75.76%，2 组比较，差异有统计学意义（P0.05）。治疗后，2 组口渴不欲饮、身重乏力、食欲不振、形体肥胖、肢体麻木刺痛、大便黏腻、小便短赤中医证候积分均较治疗前下降（P0.05），观察组中医证候各积分均低于对照组（P0.05）。治疗后，2 组 FBG、P2hBG、TC、TG 水平均较治疗前下降（P0.05），观察组上述 4 项水平均低于对照组（P0.05）。治疗后，2 组 TNF-、IL-6、CRP 水平均较治疗前下降（P0.05），观察组上述 3 项水平均低于对照组（P0.05）。结论：连术消渴方联合二甲双胍治疗湿热互结兼瘀证 T2DM 的疗效及安全性较好，可有效改善糖脂代谢，降低机体炎症因子水平，效果优于单一使用二甲双胍。关键词肥胖 2 型糖尿病；湿热互结兼瘀证；连术消渴方；二甲双胍；糖脂代谢；炎症因子中图分类号R587.2；R589.2文献标志码A文章编号0256-7415（2023）04-0063-06DOI：10.13457/ki.jncm.2023.04.014Effects of Lianzhu Xiaoke Prescription Combined with Metformin on Glucose andLipid Metabolism and Inflammatory Factors in Patients with Obesity Type 2 DiabetesMellitus with Dampness Blended with Heat and Blood Stasis SyndromeWEN Jinqian，JIN Kai，WEI Guanghui，XU Lingli，YAN YongAbstract：Objective：To observe the curative effect of Lianzhu Xiaoke Prescription combined withMetformin on obesity type 2 diabetes mellitus(T2DM)with dampness blended with heat and blood stasissyndrome and its effect on glucose and lipid metabolism and inflammatory factors.Methods：A total of66 patients with obesity T2DM with dampness blended with heat and blood stasis syndrome were selectedand divided into the control group and the observation group according to the random number tablemethod，with 33 cases in each group.The control group was treated with Metformin，and the observationgroup was additionally given Lianzhu Xiaoke Prescription based on the treatment of the control group.Theclinical effects and incidence of adverse reactions in the two groups were compared.Before and aftertreatment，the changes of traditional Chinese medicine(TCM)syndrome scores，levels of indexes of 63新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4糖尿病（DM）包括多种不同类型，其中以 2 型糖尿病（T2DM）最常见。目前临床上治疗 T2DM 常使用二甲双胍，其不仅可以降低患者血糖水平，而且可以减轻患者体质量，但是相关研究表明，二甲双胍长期使用会导致患者发生各种药物不良反应1。T2DM 归属于中医消渴范畴，主要是由于先天不足、饮食运动不合理、情志失常等所致的脾胃功能异常，肥胖则为胃强脾弱，其病机为本虚标实，治疗时需根据患者不同临床表现分为不同证型进行治疗2-3。本研究观察连术消渴方联合二甲双胍对湿热互结兼瘀证肥胖 2 型糖尿病患者糖脂代谢、炎症因子的影响，报道如下。1临床资料1.1纳入标准所有 T2DM 患者均符合中国 2 型糖尿病防治指南（2020 年版）的相关诊断标准4，餐后随机血糖11.1 mmol/L 或空腹血糖（FBG）7.0 mmol/L或餐后 2 h 血糖（P2hBG）11.1 mmol/L；符合肥胖（中国成人超重和肥胖症预防与控制指南）的诊断标准5，男性腰围85 cm，女性腰围80 cm 或体质量指数（BMI）28；符合 中医临床诊疗术语国家标准（证候部分）6中湿热互结兼瘀证辨证标准（主症：口渴不欲饮、身重乏力、食欲不振、形体肥胖；次症：肢体麻木刺痛、大便黏腻、小便短爽；舌脉：舌暗红或有瘀斑，苔黄腻，脉滑数）；年龄2060 岁。1.2排除标准对本研究使用药物过敏；妊娠期、哺乳期妇女；合并恶性肿瘤；心、肝、肾功能不全。1.3一般资料选取 2021 年 212 月开封市中医院收治的 66 例肥胖 T2DM 患者，按随机数字表法分为观察组及对照组各 33 例。观察组男 17 例，女 16 例；年龄 4961 岁，平均（54.982.55）岁；病程 516 年，平均（10.542.39）年；BMI 2837，平均 31.522.48；高血压 8 例，高血脂 7 例。对照组男 15 例，女 18 例；年龄 4962 岁，平均（55.362.94）岁；病程 517 年，平均（11.252.87）年；BMI 2837，平均 31.382.63；高血压 6 例，高血脂 9 例。2 组一般资料比较，差异均无统计学意义（P0.05），具有可比性。所有患者均自愿参加、配合本研究，glucose and lipid metabolism，including fasting blood glucose(FBG)，2-hour postprandial blood glucose(P2hBG)，serum total cholesterol(TC)and triglyceride(TG)，and levels of inflammatory factors，includingtumor necrosis factor-(TNF-)，interleukin-6(IL-6)and C-reactive protein(CRP)，in both groups werecompared.Results：The total clinical effective rate was 93.94%in the observation group，higher than thatof 75.76%in the control group，the difference being significant(P0.05).After treatment，the TCMsyndrome scores of thirst without desire to drink，heavy body and fatigue，poor appetite，obesity，numbness and stabbing pain of limbs，sticky stool，and short voidiongs of reddish urine in both groupswere decreased when compared with those before treatment(P0.05)，and the above 7 scores in theobservation group were lower than those in the control group(P0.05).After treatment，the levels ofFBG，P2hBG，TC and TG in the two groups were decreased when compared with those before treatment(P0.05)，and the above four levels in the observation group were lower than those in the control group(P0.05).After treatment，the levels of TNF-，IL-6 and CRP in both groups were decreased whencompared with those before treatment(P0.05)，the above three levels in the observation group werelower than those in the control group(P0.05).Conclusion：With good safety，Lianzhu Xiaoke Prescriptioncombined with Metformin has a sound curative effect on obesity T2DM with dampness blended with heatand blood stasis syndrome，which can effectively improve the glucose and lipid metabolism and decreasethe levels of inflammatory factors，and the clinical effect is better than that of single Metformin.Keywords：Obesity type 2 diabetes mellitus；Dampness-heat binding and blood stasis syndrome；Lianshu Xiaoke Prescription；Metformin；Glucose and lipid metabolism；Inflammatory fac