从肝郁脾虚论治代谢综合征51例临床观察

Effect of Liver-Soothing and Spleen-Strengthening Herbal Medicine for Metabolic Syndrome:An Observation of 51 Cases

【目的】观察疏肝健脾法为主的中药治疗代谢综合征的临床疗效。【方法】将93例代谢综合征患者随机分为治疗组(51例)和对照组(42例)。两组均给予相同的基础治疗,包括饮食控制和适当运动。治疗组在基础治疗的同时,给予疏肝健脾法为主的中药(主要由柴胡、白术、白芍、当归、茯苓、生地黄、黄芪、泽泻、薏苡仁、牡丹皮、山药、甘草等组成)治疗;对照组只采用基础治疗。两组均以3个月为1个疗程。观察两组临床疗效,以及治疗前后血压、体质量指数(BMI)、血糖、胰岛素及胰岛素敏感指数(ISI)、血脂水平的变化。【结果】治疗组痊愈23例,有效26例,无效2例,总有效率为96.08%;对照组痊愈12例,有效21例,无效9例,总有效率为78.57%;两组比较,治疗组疗效优于对照组(P<0.01)。在改善血压方面,治疗组治疗后收缩压和舒张压较治疗前均有显著性降低(P<0.05);而对照组治疗前后的收缩压和舒张压均无明显变化(P>0.05)。在改善BMI及血糖指标方面,两组治疗后患者的空腹血糖(FBG),餐后2小时血糖(2-HBG)、BMI均较治疗前有显著性降低(P<0.05),且治疗组对FBG的降低作用较对照组明显(P<0.05)。在改善胰岛素及ISI方面,两组治疗后患者的空腹胰岛素(FI)及餐后2小时胰岛素(2-HI)水平均较治疗前有显著性降低(P<0.05),但两组治疗后的ISI无明显变化(P>0.05)。在改善血脂水平方面,两组治疗后患者的总胆固醇(TC)、甘油三酯(TG)水平均较治疗前降低(P<0.05),高密度脂蛋白胆固醇(HDLC)水平升高(P<0.05);治疗组治疗后的低密度脂蛋白胆固醇(LDLC)水平有显著性降低(P<0.05),但对照组的降低作用不明显(P>0.05)。【结论】疏肝健脾法为主中药治疗代谢综合征具有较好疗效,不仅有调节血压、血脂和减肥作用,还能在一定程度上改善胰岛素抵抗,提高胰岛素敏感性。

Objective To observe the therapeutic effect of liver-soothing and spleen-strengthening herbal medicine for metabolic syndrome（MS）.Methods Ninety-three MS patients were randomized into group A（N=51）and group B（N=42）.The two groups received the basic treatment including dietary control and exercises.Group A received liver-soothing and spleen-strengthening herbal medicine（such as Radix Bupleuri,Rhizoma Atractylodis Macrocephalae,Radix Paeoniae Alba,Radix Angelicae Sinensis,Poria,Radix Rehmanniae,Radix Astragali,Rhizoma Alismatis,Semen Coicis,Cortex Moutan,Rhizoma Dioscoreae,Radix Glycyrrhizae,etc.）additionally.The treatment course lasted 3 months.After treatment,the therapeutic effect was evaluated,and the changes of blood pressure,body weight index（BWI）,blood glucose（BG）and insulin levels,insulin sensitivity index（ISI）,and the blood lipid levels were observed.Results After treatment,23 patients were cured,26 effective,2 ineffective,and the total effective rate was 96.08% in group A;in group B,12 were cured,21 effective,9 ineffective,and the total effective rate was 78.57%.The therapeutic effect in group A was better than that in group B（P〈0.01）.The systolic pressure and diastolic pressure were decreased in group A（P〈0.05 compared with those before treatment）,but remained unchanged in group B（P〉0.05）.Fasting BG,2-hour BG and BWI were decreased in the two groups（P〈0.05 compared with those before treatment）,and the decrease was obvious in group A compared with those in group B（P〈0.05）.Fasting insulin and 2-hour insulin levels were decreased in the two groups（P〈0.05 compared with those before treatment）,but the change of ISI was not obvious（P〉0.05）.Total cholesterol（TC）and triglyceride levels decreased,and high density lipoprotein cholesterol（HDLC）increased in the two groups（P〈0.05 compared with those before treatment）.The decrease of low density lipoprotein cholesterol（LDLC）was obvious in group A（P〈0.05）but not in group B（P〉0.05）.Conclusion Liver-soothing and spleen-strengthening herbal medicine exerts an effect for metabolic syndrome,not only decreasing blood pressure,blood lipid levels and body weight,but also improving insulin resistance and increasing ISI.