清肝泻心法及滋阴润燥法治疗2型糖尿病的临床研究

Clinical study with the method of purging liver and the heart fire,nourishing yin and moistering arid on patients with type 2 diabetes

目的:探讨清肝泻心法、滋阴润燥法及两法合用对2型糖尿病的影响,分别评价其改善胰岛素抵抗及治疗2型糖尿病的疗效差异。方法:120例患者随机分为4组,每组各30例,第1组采用清肝泻心法及滋阴润燥法治疗,第2组为清肝泻心法组,第3组为滋阴润燥法组,第4组采用罗格列酮4mg/d口服,均治疗1个月。用ELISA法检测并比较治疗前后4组的血清抵抗素、脂联素、瘦素、肿瘤坏死因子-α、白介素-6水平并同时检测并比较治疗前后4组的血压、血糖、血脂、胰岛素抵抗水平。结果:4组治疗后均能降低血糖(P<0.01),但4组间差值比较无差异性(P>0.05)。第1及第4组均能降低血脂、FINS,升高了胰岛索敏感性指数,4组间差值比较第1及第4组明显优于第2及第3组(P<0.01)。第1、2、3组均能改善中医临床症状,但第1组作用最好,优于其他各组(P<0.01),第4组则无明显改善(P>0.05)。4组治疗后均能降低CRP(P<0.01或P<0.05)。第1、2、4组瘦素、肿痛坏死因子-α、白介素-6水平下降(P<0.01或P<0.05),第3组上述指标则无差异性改变。第1、4组抵抗素水平明显降低、脂联素水平升高(P<0.01或P<0.05),而第2、3组上述指标则无差异性改变(P>0.05)。4组间上述6项指标比较均显示第1、4组差异性明显(P<0.01),而第2组与第3组组间比较在降低C反应蛋白、瘦素、肿瘤坏死因子-α、白介素-6水平方面,第2组优于第3组有差异性(P<0.01或P<0.05)。结论:清肝泻心滋阴润燥法能有效改善2型糖尿病的胰岛素抵抗,减轻患者临床症状,其作用机理可能与调节脂肪细胞及炎症因子的产生,抑制炎症反应有关。

AIM ： To investigate the clinical effect of the treatment of the method of purging liver and the heart fire or nourishing yin and moistering arid, and that of both of them being used together in treating type 2 diabetes mellius, at the same time to evaluate differences of them of improving insulin resistance one by one. METHODS ： 120 patients with type 2 diabetes were randomly divided into four groups with 30 cases each. They were treated with the method of purging liver and the heart fire （ group 2）, with the methods of nourishing yin and moistering arid （group 3 ） ,both of the two methods （group 1 ） ,the drugs of rosiglitazone 4 mg a day （group 4）, each for 1 month. The serum level of resistin,adiponectin,Leptin,TNF-α,CRP,IL-6 were measured of the four groups before and after the treatment by ELISA method, and blood pressure, blood sugar, lipid as well as insulin resistance levels were measured before and after treatment too. RESULTS： After treatment, Four groups could reduce blood sugar, no significant difference was observed between the four groups （P 〉 0.05 ）. group 1 and group 4 could significantly re- duce the level of lipid,FINS, increase the level of IAI （P 〈0.01 ）, but the group 2 and group 3 affection were not significant （P 〉0.05 ）. After treatment, the clinical symptom score dropped in group 1,2,3 （P 〈 0.01 or P 〈 0.05）, no significant difference was observed in group 4, and it was the lowest in the group 1 in the four groups （P 〈0.01）. At the same time, serum levels of CRP decreased in four groups, serum levels of Leptin,TNF-α,IL- 6 decreased in group 1,2,4 （P 〈 0.01 or P 〈 0.05 ）, no difference was observed in group 3 （ P 〉 0.05 ） ; serum levels of resistin decreased and adiponectin increased in group 1,4 （P 〈 0.01 or P 〈 0.05 ）, no difference was ob- served in group 2,3 （P 〉0.05）. More significant difference was observed in group 1,4 between the four groups about the serum level of resistin,adiponectin,Leptin,TNF-α,CRP,IL-6 （P 〈0.01 ）. And between the group 2 and group 3, the serum level of CRP,Leptin,TNF-α,IL-6 in group 2 were reduced more than group 3, there was differ- ence was observed between the two groups （P 〈 0.01 or P 〈 0.05 ）. CONCLUSION： The method of purging liver and the heart fire, nourishing yin and moistering arid can improve insulin resistance and alleviate clinical symptoms of Type 2 diabetes mellitus patients, the mechanism may be related to its actions in regulating the production of in- flammatory cytokines and inhibiting inflammatory reaction.