益气养阴活血中药治疗2型糖尿病合并脂肪肝46例临床观察

Clinical Observation on 46 Cases of Type 2 Diabetes Mellitus Complicated with Fatty Liver Treated by Yiqi Yangyin and Huoxue Herbal Medicines

目的从胰岛素和瘦素的角度分析2型糖尿病合并脂肪肝(DFL)的发病机制,并探讨益气养阴活血中药对该病的疗效。方法收集196例2型糖尿病患者进行回顾性研究,非合并脂肪肝的100例患者归为对照组,合并脂肪肝的96例病例归为实验组,两组患者进行血糖、血脂检查,胰岛素抵抗分析,并考察血清瘦素(leptin)及可溶性瘦素受体(SLR)水平。另外,将96例实验组随机分成基础治疗组(50例)和中药治疗组(46例),均接受基础治疗(饮食体重控制、加强运动并使用口服降糖药物调节血糖),中药治疗组在基础治疗之外加以益气养阴活血中药组方治疗,疗程为3个月,治疗前后进行肝脏B超检查、胰岛素抵抗分析,并考察leptin及SLR的改变情况。结果实验组与对照组治疗前比较,胰岛素抵抗指数血清瘦素及可溶性瘦素受体(-HOM A-IR)、leptin及SLR差异有统计学意义(P<0.01)。实验组中,血甘油三酯(TG)与HOM A-IR、L eptin均呈正相关(P<0.01),leptin和HOM A-IR呈正相关(P<0.01),SLR和HOM A-IR呈负相关(P<0.01)。基础治疗组和中药治疗组在治疗前脂肪肝分度差异无统计学意义(P>0.05),治疗后两组的脂肪肝分度得以不同程度逆转,但仅中药治疗组呈显著逆转(P<0.01)。两个治疗组在治疗前HOM A-IR、leptin和SLR差异无统计学意义,治疗后各指标有不同程度的改善,但中药治疗组改善更明显。结论益气养阴活血法中药组方对胰岛素抵抗和瘦素异常有显著改善作用,这可能是益气养阴活血法治疗2型糖尿病并发脂肪肝的机制之一。

Objective To analyze the pathogenesis of diabetic fatty liver（DFL） from the abnormality of leptin level and insulin resistance to discuss the therapeutic effect of Yiqi Yangyin Huoxue（Reinforcing qi,replenishing yin,and activating blood） herbal medicines.Methods Totally 196 patients with type 2 diabetes mellitus were selected for retrospective study.Those 100 patients who had not developed to fatty liver were attributed to the control group,while those 96 who had already developed to fatty liver attributed to the test group.Blood sugar,fat,insulin resistance and level of serum leptin and soluble leptin receptor（SLR） were observed in all subjects.In addition,96 patients of the test group,which was subdivided randomly into basic treatment group（50 patients） and Chinese medicine treatment group（46 patients）,and they were all given the basic treatment including diet control,body weight control,exercise,and oral taking hypoglycemic agents,while the Chinese medicine treatment group was prescribed the herbal medicines for reinforcing qi,replenishing yin,and activating blood additionally.The course of treatment was 3 months.Before and after treatment,the liver ultrasound of B type examination,analysis on insulin resistance and determination of serum leptin and SLR were applied.Results There was significant difference in HOMA-IR,leptin and SLR between the test group and the control group before treatment（P0.01）.In the test group,triglyceride（TG） was positively correlated with HOMA-IR and leptin level（P0.01）,leptin level was positively correlated with HOMA-IR（P0.01）.However,SLR level was negatively correlated with HOMA-IR（P0.01）.There was no significant difference in the DFL degree between the basic treatment group and Chinese medicine treatment group before treatment （P0.05）,and the DFL degree of the two groups was reversed to different degrees after the 3-month treatment,wherein,the DFL degree of the Chinese medicine treatment group was significantly improved（P0.01）.There was no significant difference in HOMA-IR,leptin and SLR level between the two groups before treatment（P0.05）.After the 3-month treatment,all indices of the two groups were improved to different degrees,however,those of the Chinese treatment group were improved more significantly.Conclusion The Chinese herbal medicines for reinforcing qi,replenishing yin,and activating blood are effective in improving insulin resistance and the abnormality of serum leptin and SLR level.This is possibly one of the mechanisms of the Yiqi Yangyin Huoxue therapy for DFL.