基于糖代谢和胰岛素抵抗评估益气养阴法治疗气阴两虚型2型糖尿病的疗效

Therapeutic Effect of Replenishing Qi and Nourishing Yin Methodon Type 2 Diabetes Mellitus with Deficiency of Both Qi and Yin Based on Glucose Metabolism and Insulin Resistance

目的分析益气养阴法治疗气阴两虚型2型糖尿病对患者糖代谢和胰岛素抵抗评估的影响。方法南京中医药大学附属南京市中西医结合医院2019年6月—2022年3月收治的90例气阴两虚型2型糖尿病患者随机分为胰岛素泵治疗组(45例)和益气养阴治疗组(45例)。益气养阴治疗组采用胰岛素泵强化治疗联合益气养阴法进行治疗,胰岛素泵治疗组单独进行胰岛素泵强化治疗,两组均治疗2周。统计两组治疗2周后的临床疗效及治疗期间不良反应发生情况,比较两组治疗前和治疗2周后中医证候积分、糖代谢情况、胰岛素抵抗情况。结果治疗2周后,益气养阴治疗组总有效率为91.11%(41/45),高于胰岛素泵治疗组[73.33%(33/45),P<0.05]。治疗2周后与治疗前比较,两组口燥咽干、倦怠乏力、失眠、自汗盗汗、五心烦热、气短懒言评分及血清空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖(postprandial 2-hour blood glucose,2 h PG)、糖化血红蛋白(glycated hemoglobin,HbA1c)、空腹胰岛素(fasting insulin,FINS)水平、胰岛素抵抗指数(Homa-IR)降低,益气养阴治疗组低于胰岛素泵治疗组(P<0.05),两组胰岛素敏感指数(insulin sensitivity index,ISI)、胰岛功能指数(Homa-islet)升高,益气养阴治疗组高于胰岛素泵治疗组(P<0.05)。治疗期间,益气养阴治疗组总不良反应发生率与胰岛素泵治疗组比较,差异无统计学意义(P>0.05)。结论气阴两虚型2型糖尿病患者采用益气养阴法进行治疗,可有效改善患者中医证候、糖代谢,降低患者机体胰岛素抵抗程度,具有较好的治疗效果。

Objective To analyze the effect of replenishing Qi and nourishing Yin method on glucose metabolism and insulin resistance in patients with type 2 diabetes mellitus with deficiency of both Qi and Yin.Methods From June 2019 to March 2022,90 patients with type 2 diabetes mellitus with Qi and Yin deficiency admitted to Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine were randomly divided intothe insulin pump treatment group(45 cases)and the replenishing Qi and nourishing Yin treatment group(45 cases).The replenishing Qi and nourishing Yin treatment group was treated with insulin pump intensive therapy combined with replenishing Qi and nourishing Yin method,while the insulin pump treatment group was treated with insulin pump intensive therapy alone.Both groups were treated for 2 weeks.The clinical efficacy after 2 weeks of treatment and the incidence of adverse reactions during treatment were statistically analyzed.The traditional Chinese medicine syndrome scores,glucose metabolism and insulin resistance before and after 2 weeks of treatment were compared between the two groups.Results After 2 weeks of treatment,the total effective rate of the replenishing Qi and nourishing Yin treatment groupwas higher than the insulin pump treatment group(P<0.05).After 2 weeks of treatment,compared with those before treatment,the dryness of mouth and throat,fatigue,insomnia,night sweats,fever of five nerves,shortness of breath and lazy speech score,serum fasting blood glucose(FPG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1c),fasting insulin(FINS)and insulin resistance index(HOMA-IR)decreased in the two groups,which in the replenishing Qi and nourishing Yin treatment group were lower than those in the insulin pump treatment group(P<0.05).The insulin sensitivity index(ISI)and islet function index(HOMA-islet)of the two groupsincreased,which in the replenishing Qi and nourishing Yin treatment group were higher than those in the insulin pump treatment group(P<0.05).During the treatment,the total incidence of adverse reactions in the replenishing Qi and nourishing Yin treatment group and the insulin pump treatment grouphad no significant difference(P>0.05).Conclusion The treatment of replenishing Qi and nourishing Yin method for patients with type 2 diabetes mellitus with deficiency of both Qi and Yin could effectively improve the traditional Chinese medicine syndrome and glucose metabolism,reduce the degree of insulin resistance,which had a good therapeutic effect.