益气养阴活血中药对2型糖尿病一级亲属糖尿病预防的研究

Preventive Efficacy of Supplementing Qi and Nourishing Yin in Traditional Chinese Medicine on Nondiabetic First-degree Relatives of Patients with Type 2 Diabetes Mellitus

目的:观察益气养阴活血中药对2型糖尿病一级亲属糖尿病预防效果。方法:2型DM患者一级亲属(子代或同胞)共86例,随机分为中药干预组46例和对照组30例,观察时间为1年。所有观察对象均参加我院糖尿病俱乐部开展的宣传教育课程,根据个体情况制定饮食及运动方案。对照组每月进行电话随访,重复宣教饮食、运动干预的意义。中药干预组每月按时发放药物活血降糖饮。所有观察者在干预前和干预结束后进行OGTT(75g葡萄糖)取静脉血测定空腹血糖(FBG)和胰岛素(FINS),OGTT后2 h血糖(2hPG)和胰岛素(2hINS);计算稳态模型胰岛素抵抗指数(HOMA-IR)、β细胞功能指数(HOMA-β)和胰岛素敏感指数(ISI)和体重指数(BMI)。结果:(1)对照组和中药组干预后与干预前比较,空腹胰岛素、空腹血糖无明显变化(P>0.05);OGTT 2 h后血糖和胰岛素、BMI下降明显,差异有显著性(P<0.05)。(2)对照组干预后与干预前比较HOMA-IR降低,ISI升高,差异有显著性(P<0.05);HOMA-β无明显变化(P>0.05)。(3)中药干预组干预后与干预前比较HOMA-IR降低,HOMA-β和ISI升高,差异有显著性(P<0.05或0.01)。(4)干预后,中药组与对照组比较,HOMA-IR降低,HOMA-β和ISI升高,差异有显著性(P<0.05)。(5)观察期1 h结束,对照组糖耐量异常占23.3%。中药干预组占11.2%。2组干预后糖耐量异常转化率比较,差异无显著性(χ2=3.09,P>0.05)。结论:早期实施生活方式干预是预防糖尿病最基本的干预措施,养阴活血中药干预可恢复胰岛素敏感性,阻止和(或)修复β细胞的损伤,经济安全。

Objective： To study the preventive efficacy of traditional Chinese medicine with supplementing Qi, nourishing Yin and promoting blood circulation on nondiabetic first-degree relatives of patients with type 2 diabetes Mellitus. Methods： A total of 86 nondiabetic first-degree relatives of Type 2 DM patients with first-degree relatives （ offspring or fellow） were randomly divided into Chi- nese medicine intervention group （46 cases） and control group （30 cases） . All subjects were observed after 1 year of participation in public education programs, individualized dietary and exercise instruction delivered by our hospital diabetes club. Control group would be monthly telephoned foUow-up, repeated diet instructions and exercise intervention. Chinese medicine intervention group treated with Huoxuejiangtang Decoction monthly. Before and after interventions, both groups proceed OGTY （75g glucose）, FBG, FINS, 2hPG, 2bINS by blood test and calculated HOMA-IR, HOMA-13, ISI, BMI. Results ： （ 1 ） Both groups showed no significantly difference in FBG and FINS （P 〉 0. 05） . Chinese medicine intervention group got obvious lower 2hPBG, 2hPINS and BMI after interference than that of control group, the difference was statistically significant. （2） Control group got significantly lower HOMA-IR （P 〈 0.05 ） and higher ISI than of intervention group, and the difference was statistically significant （P 〈 0. 05） . No great difference in control group HOMA-β after interference （P 〉 0. 05） . （3） In Chinese medicine intervention group, HOMA-IR was significantly lower （P 〈 0. 05）, ISI and HOMA-βwere significantly higher （P 〈 0.05 D或 0.01 ） after interference. （4） After interference, HOMA-IR was lower, ISI and HOMA-β were higher in Chinese medicine intervention group than that of control group （P 〈 0. 05） . （5） After a year of observation, 23.3% cases was found abnormal glucose tolerance in control group, while only 11.2% in Chinese medicine intervention group. The conversion rate of abnormal glucose tolerance was not significantly different in both group （ X^2 = 3.09, P 〉 0. 05 ）. Conclusion： Early implementation of lifestyle interventions is essential to prevent diabetes, Chinese medicine of nourishing Yin and promoting blood circulation intervention could safely recover insulin sensitivity, blocking, and （or） repair β cell damage.