缺血性中风胰岛素抵抗与中医证型及治疗影响的临床研究

CLINICAL RESEARCH ON RELATIONSHIP BETWEEN INSULIN REAISTANCE IN ISCHEMIC APOPLESY AND TRADITIONAL CHINESE MEDICAL PATTERNS AND ITS CURATIVE EFFECTS

目的 :观察缺血性中风胰岛素抵抗与中医证型之间的关系及治疗的影响。方法 :选择脑梗死患者118例 ,分为气虚血瘀证组、风阳上扰证组、风痰阻络证组和单纯西医治疗组 ,均采取西医常规治疗 ,同时中医分型各组按中医辨证加用中药治疗 ,疗程20天 ;于治疗前、后采取清晨空腹静脉血检测胰岛素 (Ins)、血糖 (FBS) ,胰岛素抵抗用胰岛素敏感指数 (ISI)反映。结果 :所有病例均有不同程度的胰岛素抵抗 ,但以气虚血瘀证型患者胰岛素抵抗较严重 ,与各组比较P<0.01或P<0.05,各证型胰岛素抵抗程度排列次序为 :气虚血瘀证>风阳上扰证>风痰阻络证 ;经治疗后 ,加用中医辨证治疗各组胰岛素抵抗均有不同程度减轻 ,同时 ,空腹血糖及胰岛素释放亦降低 ,与西药组比较P<0.01或P<0.05;且治疗前、后比较气虚血瘀证有非常显著性差异 (P<0.01)。结论 :脑梗死患者气虚血瘀证型与胰岛素抵抗关系最为密切 ,加用中医辨证施治有显著减轻脑梗死患者胰岛素抵抗的作用。

Objective:To observe the relationship between the resistance of insulin in ischemic apoplexy and Traditional Chinese Medical(TCM)patterns,and the effects of different TCMpatterns on treatment for resistance of insulin.Methods:118cases of cerebral infarction were divided into the qi deficiency and the blood stasis group(32),the wind-yang group(28),the wind-phlegm group(28)and Western medicine group(30).Based on the Western medical routine treatment,the groups of TCM patterns were treated with Chinese medicine and herbs according to the syndrome differentiation for20days.Then the fasting insulin(Ins)and blood sugar(FBS)in venous blood were detected in the morning before and after the treatment,and the resistance of insulin was reflected by insulin sensitive index(ISI).Results:When compared to the normal group,the different degree of insulin resistance was found in all patients with ischmic aprolexy(P<0.05)while the qi deficiency and blood stasis group was more serious than the wind-yang group and the wind-phlegm group(P<0.01).After the treatment,the insulin resistance,FBS and Ins were improved in all groups.Moreover,better curative effects were found in TCMgroups than in Western medicine group,including ISI in each TCMpattern group(P<0.01or P<0.05),FBS and Ins in the qi deficiency and blood stasis group(P<0.05),and Ins in the wind-phlegm group(P<0.01).Conclusions:The resistance of insulin is very common in ischemic apoplexy,and the pattern of qi deficiency and blood stasis is the most serious type in all TCM patterns of this disease.And the resistance of insulin can be obviously lowered by adˉditional use of Chinese medicine and herbs according to the syndrome differentiation.