益气养阴活血通腑法治疗2型糖尿病磺脲类药继发性失效的临床观察

Clinical Observation on Effect of Yiqi Yangyin Huoxue Tongfu Principle in Treating Diabetes Mellitus Type 2 of Secondary Failure to Sulfonylurea Agents

目的观察益气养阴活血通腑法治疗 2型糖尿病磺脲类药继发性失效 (SFS)的疗效。方法 4 0例患者随机分为两组 ,两组均在原磺脲类药剂量不变的情况下 ,中药组加服益气养阴活血通腑汤剂治疗 ,西药组加服罗格列酮治疗。观察治疗前后外周血胰岛素敏感度 (SI)、胰岛素释放率 (IRG)、胰岛素敏感性指数(ISI)、肿瘤坏死因子α(TNFα)、内皮素 1(ET 1)、6 酮 前列腺素F1α(6 keto PGF1α)和血栓素B2 (TXB2 )等指标的变化。结果 (1)中药组降糖的总有效率为 71 4 % ,改善外周胰岛素抵抗的总有效率为 76 2 % ,与西药组相仿。 (2 )中药组SI与ISI显著改善 (P <0 0 5 ) ,IRG无明显改善。 (3)中药组TNFα、ET 1、TXB2 明显下降 (P <0 0 5或P <0 0 1)。结论益气养阴活血通腑法可减轻SFS患者的外周胰岛素抵抗 ,抑制TNFα 。

ObjectiveTo observe the effect of Yiqi Yangyin Huoxue Tongfu (YYHT) principle in treating diabetes mellitus type 2 of secondary failure to sulfonylurea agents. MethodsForty patients were randomly divided into two groups, based on the unchanged previous treatment of sulfonylurea agents, Chinese decoction prescribed according to YYHT principle was given to the treated group and rosiglitazone was given to the control group. Changes of insulin sensitivity (SI), insulin response to glucose (IRG), insulin sensitive index (ISI), tumor necrosis factor-α (TNF-α), endothelin-1 (ET-1), 6-keto-prostaglandin F 1α (6-keto-PGF 1α ) and thromboxane B 2 (TXB 2) were observed. ResultsThe total effective rate in the treated group was 71 4%, that on improving peripheral insulin resistance was 76 2%, the two parameters were similar to those in the control group. In the treated group, SI, ISI were significantly improved, and TNF-α, ET-1 and TXB 2 significantly lowered, but no change of IRR was found. ConclusionApplication of YYHT principle in treating patients with diabetes mellitus type 2 of secondary failure to sulfonylurea agents could alleviate the peripheral resistance to insulin, inhibit TNF-α, and protect the vascular endothelial cells.