三黄降糖方对Ⅱ型糖尿病患者外周胰岛素抵抗的影响

Effect of Sanhuang Jiangtang Recipe on Insulin Peripheral Resistance in Type Ⅱ Diabetics

目的：观察三黄降糖方（即加味桃核承气汤）对Ⅱ型糖尿病患者外周胰岛素抵抗的影响。方法：９５例Ⅱ型糖尿病患者随机分为中药组和西药组，中药组以三黄降糖方的水煎剂和片剂同时使用；西药组用美吡达治疗。两组疗程均为４～６个月，治疗前后进行标准馒头餐试验，并计算外周胰岛素敏感度（ＳＩ）、胰岛素释放率（ＩＲＧ）及胰岛素敏感性指数。结果：（１）中药组改善外周胰岛素抵抗疗效的总有效率为７９．２％（其中逆转率２６．４％），降糖疗效的总有效率为８０．１％，与西药组的疗效相当（Ｐ＞０．０５）；但中药组的气虚证候及瘀血征象的改善较为明显。（２）中药组的ＳＩ明显增加，胰岛素敏感性指数（ＩＡＩ）显著改善（Ｐ＜０．０５和Ｐ＜０．０１），而空腹胰岛素及其面积明显降低（Ｐ＜０．０５），但ＩＲＧ无明显改善。（３）中药组的血糖降低与ＳＩ、ＩＡＩ的改变呈明显负相关（ｒ＝－０．７７和－０．４２，Ｐ＜０．０１和Ｐ＜０．０５），而与胰岛素面积的改变无相关性（ｒ＝０．１２７，Ｐ＞０．０５）。结论：三黄降糖方治疗Ⅱ型糖尿病可能通过降低高胰岛素血症、增强机体对胰岛素的敏感性的胰外作用途径，达到减轻外周胰岛素抵抗的治疗目的。

Objective: To observe the effect of Sanhuang Jiangtang recipe (SHJT)on insulin Peripheral resistance in type Ⅱ diabetics. Methods: Ninety-five patients with type Ⅱ diabetics were randomly divided into two groups. Fiftythree cases of SHJT group were given orally decoction and tablets of SHJT for 4 - 6 months. The efficacy was compared with that of 42 cases treated with Glipizide as the control. Before and after treatment standard steamed bread meal test was performed to measure the insulin peripheral sensitivity, insulin release to glucose and insulin sensitivity index. Results: (1)The total effective rates of improving insulin peripheral resistance and reducing blood sugar in SHJT group were 79. 2 % and 80. 1 %, which was equivalent to levels in the control group, but SHJT recipe was more effective in relieving symptoms of Qi deficiency and signs of blood stasis. (2) In SHJT group, the insulin peripheral sensitivity and insulin sensitivity index were significantly increased (P < 0. 05 and P < 0. 01 ), meanwhile the fasting blood sugar and blood sugar area were reduced (P < 0. 05 ), but the chang insulin release to glucose was blunted. (3)The lowering of blood sugar in SHJT group was significantly negative correlated with the changing of degree of insulin peripheral sensitivity and index of insulin sensitivity (P < 0.01 and P < 0. 05), but cot with that of insulin area. Conclusions:It suggested that the treatment of SHJT recipe Aught decrease insulin peripheral resistance (partial reversal) by means of reducing hyperinsulinemia and improving insulin sensitivity.