【摘要】：目的:在中醫(yī)學(xué)辨證論治理論的指導(dǎo)下,探討中藥復(fù)方制劑降糖增敏湯聯(lián)合二甲雙胍片對(duì)老年2型糖尿病胰島素抵抗(脾虛濕盛證)的治療作用,并對(duì)降糖增敏湯的配伍特點(diǎn)及藥理作用機(jī)制進(jìn)行初步探討。方法:于我院保健科住院患者中選取符合標(biāo)準(zhǔn)的老年2型糖尿病胰島素抵抗(脾虛濕盛證)患者65例,隨機(jī)分為治療組32例,對(duì)照組33例。兩組患者均給予糖尿病基礎(chǔ)規(guī)范治療(醫(yī)學(xué)營(yíng)養(yǎng)飲食、運(yùn)動(dòng)、血糖監(jiān)測(cè)和糖尿病教育),對(duì)照組給予西藥二甲雙胍片口服,治療組在口服二甲雙胍片的同時(shí)加用自擬中藥降糖增敏湯治療。以4周為1個(gè)療程,共治療3個(gè)療程。治療前后分別測(cè)定患者血糖、空腹胰島素、血脂、血流變、C反應(yīng)蛋白,計(jì)算胰島素抵抗指數(shù)、胰島素敏感指數(shù)、胰島素β細(xì)胞功能指數(shù)、體重指數(shù),并觀察兩組治療前后中醫(yī)癥狀積分的改變情況。所得數(shù)據(jù)分別采用t檢驗(yàn)、X2檢驗(yàn)及秩和檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:經(jīng)過3個(gè)療程的治療,治療組總有效率為86.67%,對(duì)照組總有效率為66.67%,治療組患者血糖、血脂、血流變及空腹胰島素、C反應(yīng)蛋白指標(biāo)值較治療前均明顯改善,與治療前相比結(jié)果有極顯著性差異(P0.01),且療效優(yōu)于對(duì)照組(P0.05或P0.01)。治療后治療組患者胰島素抵抗指數(shù)較前降低,胰島素敏感指數(shù)明顯提高,組內(nèi)比較有極顯著性差異(P0.01),且療效優(yōu)于對(duì)照組(P0.01);治療后治療組患者胰島β細(xì)胞功能指數(shù)較治療前明顯升高,組內(nèi)比較有極顯著性差異(P0.01),但與對(duì)照組療效相當(dāng)(P0.05)。結(jié)論:中藥降糖增敏湯在二甲雙胍片療效基礎(chǔ)上可顯著改善老年2型糖尿病胰島素抵抗(脾虛濕盛證)患者的糖脂代謝、血液粘稠度及炎癥狀態(tài),提高胰島素敏感性,改善胰島素抵抗?fàn)顟B(tài),療效確切;但在改善胰島β細(xì)胞功能方面無明顯優(yōu)勢(shì)。
[Abstract]:Objective: to explore the therapeutic effect of Jiangtang Zengmin decoction combined with metformin tablet on insulin resistance (spleen deficiency and dampness syndrome) in elderly type 2 diabetes mellitus under the guidance of TCM theory of syndrome differentiation and treatment. The compatibility characteristics and pharmacological mechanism of Jiangtang Zengmin decoction were discussed. Methods: 65 elderly type 2 diabetic patients with insulin resistance (spleen deficiency and dampness syndrome) were randomly divided into treatment group (n = 32) and control group (n = 33). The patients in both groups were given basic standard treatment for diabetes (medical nutrition diet, exercise, blood glucose monitoring and diabetes education), while the control group was given metformin tablets orally. The treatment group was treated with Jiangtang Zengmin decoction at the same time as metformin tablets. 4 weeks as a course of treatment, a total of 3 courses of treatment. Blood glucose, fasting insulin, blood lipid, hemorheological C-reactive protein, insulin resistance index, insulin sensitivity index, insulin 尾 cell function index, body mass index were measured before and after treatment. The changes of TCM symptom score before and after treatment were observed. The data were analyzed by t test X 2 test and rank sum test respectively. Results: after three courses of treatment, the total effective rate was 86.67 in the treatment group and 66.67 in the control group. The blood glucose, blood lipid, blood rheology and fasting insulin C-reactive protein index were significantly improved in the treatment group. Compared with the results before treatment, there was a significant difference (P0.01), and the curative effect was better than the control group (P0.05 or P0.01). After treatment, the insulin resistance index of the patients in the treatment group was lower than that of the former, and the insulin sensitivity index was obviously increased. Compared with the control group (P0.01), the islet 尾 cell function index in the treatment group was significantly higher than that before treatment (P0.01), but the curative effect was similar to that in the control group (P0.05). Conclusion: Jiangtang Zengmin decoction can significantly improve glucose and lipid metabolism, blood viscosity and inflammatory state in elderly type 2 diabetes mellitus patients with insulin resistance (spleen deficiency and dampness syndrome) on the basis of metformin tablets, and improve insulin sensitivity. The effect of improving insulin resistance is definite, but there is no obvious advantage in improving the function of islet 尾-cells.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1

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