参芪地黄汤联合沙格列汀治疗降糖不佳2型糖尿病患者的临床研究

Clinical Study on Shenqi Dihuang Decoction Combined with Saxagliptin in the Treatment of Type 2 Diabetes with Poor Hypoglycemic Effect

目的在沙格列汀治疗基础上,应用参芪地黄汤辅助治疗降糖不佳2型糖尿病(T2DM),探究其临床疗效及对患者胰岛细胞功能及氧化应激指标的影响。方法选取2017年1月至2020年1月我院收治且口服2种或3种降糖药物疗效不佳的T2DM患者170例,依据随机数字表简单随机分为对照组与观察组,各85例。在原有治疗方案基础上,对照组给予沙格列汀5 mg,口服,1次/天;观察组则在对照组基础上,另给予参芪地黄汤,1剂/天。2周为1疗程,两组均持续治疗6疗程。比较两组临床疗效、中医证候积分变化、血糖水平、胰岛细胞功能指标[胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、氧化应激指标水平变化。结果相较于对照组,观察组总有效率(92.94%vs 78.82%)明显更高(P<0.05)。治疗后,相较于对照组,观察组口干多饮、易饥多食、气短乏力证候积分均明显更低(P<0.05);FPG、2hPG、HbA1c均明显更低(P<0.05)。治疗2疗程、4疗程、6疗程,相较于对照组,观察组HOMA-β变化量、HOMA-IR变化量均明显更高(P<0.05)。治疗6疗程,相较于对照组,观察组超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSHPX)均明显更高,丙二醛(MDA)、活性氧类物质(ROS)均明显更低(P<0.05)。结论相较于沙格列汀治单独用药治疗,应用参芪地黄汤辅助沙格列汀治疗口服多种降糖药物效果不佳T2DM疗效更为显著,可有效改善体征并缓解症状,降低血糖水平、改善胰岛细胞功能、降低胰岛素抵抗,有效减轻氧化应激损伤。

Objective On the basis of saxagliptin treatment,to apply Shenqi Dihuang Decoction to assist in the treatment of type 2 diabetes mellitus(T2 DM)with poor hypoglycemic effect,and to explore its clinical efficacy and its effect on the function of pancreatic islet cells and oxidative stress indicators.Methods A total of 170 patients with T2 DM who were admitted to our hospital from January 2017 to January 2020 who had poor efficacy of oral 2 or 3 hypoglycemic drugs were selected and randomly divided into control group and observation group,with 85 cases in each group.On the basis of the original treatment plan,the control group was given saxagliptin 5 mg orally,once a day;the observation group was given Shenqi Dihuang Decoction on the basis of the control group,1 dose/day.2 weeks is a course of treatment,and both groups have continued treatment for 6 courses.The clinical efficacy,changes in TCM syndrome scores,blood sugar levels,islet cell function indexes[isletβcell function index(HOMA-β),insulin resistance index(HOMA-IR)],and oxidative stress index levels were compared between the two groups.Results Compared with the control group,the total effective rate of the observation group(92.94%vs 78.82%)was significantly higher(P<0.05).After treatment,compared with the control group,the scores of dry mouth and polydipsia,hunger and polyphagia,shortness of breath and fatigue in the observation group were significantly lower(P<0.05);FPG,2 hPG,and HbA1 c were significantly lower(P<0.05).Compared with the control group,the changes of HOMA-βand HOMA-IR in the observation group were significantly higher(P<0.05).Compared with the control group,the observation group had significantly higher superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px),and significantly lower malondialdehyde(MDA)and reactive oxygen species(ROS)(P<0.05).Conclusion Compared with saxagliptin treatment alone,the application of Shenqi Dihuang Decoction to assist saxagliptin in the treatment of multiple oral hypoglycemic drugs with less effectiveness in the treatment of T2 DM,which can effectively improve signs and relieve symptoms,reduce blood sugar levels,improve the function of islet cells,reduce insulin resistance,and effectively reduce oxidative stress damage.