益气养阴活血通腑法对继发性磺脲类失效Ⅱ型糖尿病患者外周胰岛素抵抗的影响

Effect of Therapy With Supplementing Qi, Nourishing Yin, Promoting Blood Circulation and Relieving Constipa -tion by Purgation on Insulin Peripheral Resistance in Type 2 Diabetics with Second Failure to Sulfonyurea

目的:观察益气养阴活血通腑法对继发性磺脲类失效Ⅱ型糖尿病患者外周胰岛素抵抗的影响。方法:78例患者随机分为中药组和西药组,在原磺脲类降糖药剂量不变的情况下,中药组予益气养阴活血通腑方药的水煎剂治疗,西药组服二甲双胍治疗,疗程2个月。治疗前后作标准馒头餐试验,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(IAI)。结果:①中药组改善外周胰岛素抵抗疗效的总有效率为75.6%(其中逆转率为24.4%),降糖疗效的总有效率为73.2%,均与二甲双胍组的疗效相仿(P>0.05);但中药组证候的改善较为明显。②中药组的SI与IAI显著改善(P<0.05),而空腹胰岛素明显降低(P<0.05),但IRG无明显改善。结论:益气养阴活血通腑法可减轻继发性磺脲类失效Ⅱ型糖尿病患者的外周胰岛素抵抗。

Objective:To observe the effect of therapy with supplementing qi,nourishing yin,promoting blood circulation and relieving constipation by purgation on insulin peripheral resistance in type 2 diabetics with second failure to sulfonyurea . Methods:78 patients with type 2 diabetics of second failure to sulfonyurea were randomly divided into two groups . 41 cases were given orally decoction of drugs with supplementing qi,nourishing yin,promoting blood circulation and relieving constipation by purgation for 2 months. The efficacy was compared with that of 37 cases treated with metformin 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 chinese drugs group were 75.6% and 73.2%,which was equivalent to levels in the control group,but this recipe was more effective in relieving symptoms.(2)In Chinese drugs group, the insulin peripheral senstivity and insulin senstivity index were significantly increased (P<0.05), meanwhile the fasting blood serum insulin was reduced(P<0.05). Conclusions:It suggested that the treatment of methods for supplementing qi , nourishing yin,promoting blood circulation and relieving constipation by purgation might decrease insulin peripheral resistance in type 2 diabetics with second failure to sulfonyurea.