活血降糖饮联合二甲双胍对2型糖尿病胰岛素抵抗患者糖脂代谢及脂肪因子的影响

Effects of Huoxue Jiangtang Yin Combined with Metformin on Glucose and Lipid Metabolism and Fat Factors in Type 2 Diabetes Patients with Insulin Resistance

【目的】探讨自拟方活血降糖饮联合二甲双胍对2型糖尿病胰岛素抵抗(insulin resistance,IR)患者糖脂代谢及脂肪因子的影响。【方法】将84例2型糖尿病患者随机分为对照组和试验组各42例。2组均给予糖尿病饮食控制、运动疗法、禁烟酒及心理疏导等基础治疗,对照组同时给予二甲双胍治疗,试验组在对照组治疗基础上加用活血降糖饮(由黄芪、生地黄、丹参、太子参、五味子、麦冬、山药、黄精、牡丹皮、大黄、红花、桃仁等组成)治疗,疗程均为20周。观察2组患者治疗前后空腹血糖(FPG)、餐后2h血糖(2h PG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDC-C)]、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、分泌型卷曲相关蛋白5(SFRP5)水平。【结果】治疗后,2组FPG、2h PG、Hb A1c、BMI、FINS、TC、TG、LDC-C、HOMA-IR、TNF-α、IL-6水平均较治疗前显著下降(P<0.01或P<0.05),SFRP5水平均较治疗前显著增高(P<0.05),且试验组对各项指标的改善作用均优于对照组,差异均有统计学意义(P<0.01或P<0.05)。【结论】活血降糖饮联合二甲双胍不仅可以控制体质量,调节2型糖尿病患者的糖脂代谢,还可以通过影响IL-6、TNF-α、SFRP5等脂肪因子从而改善胰岛素抵抗。

Objective To investigate the effects of the decoction of Huoxue Jiangtang Yin （HJY） combined with metformin on glucose and lipid metabolism and fat factors in type 2 diabetes patients with insulin resistance （ IR）. Methods A total of 84 type 2 diabetes patients with IR were randomly assigned to experiment group and control group, 42 cases in each group. Both groups were given the basic treatment of controlling diet, exercise therapy, banning from smoking and alcohol, and psychological therapy. Additionally, the control group was given metformin orally, and the experiment group was given oral use of metformin and the decoction of HJY （ mainly composed of Radix Astragalie, Rhizoma Rehmanniae, Radix Salviae Miltiorrhizae, Radix Pseudostellariae, Fructus Schisandrae, Radix Ophiopogonis, Radix Dioscoreae, Rhizoma Polygonati, Cortex Moutan, Radix et Rhizoma Rhei, Flos Carthami, and Semen Persicae）. The treatment for both groups covered 20 weeks for a course of treatment. Before and after the treatment, we observed the indexes of fasting plasma glucose （FPG）, 2-h postprandial plasma glucose （2hPG）, glycosylated hemoglobin （HbA1c）, fasting insulin （ FINS） , homeostasis model assessment of insulin resistance （ HOMA-IR） , body mass index （ BMI） , blood lipid of total cholesterol （ TC） , triglyceride （ TG） and low density lipoprotein cholesterol （ LDL-C） , interleukin 6 （ IL -6） , tumor necrosis factor alpha （ TNF-α） , and secreted frizzled related protein 5 （ SFRP5）. Results After treatment, FPG, 2hPG, HbA1c, BMI, FINS, TC, TG, LDL-C, HOMA-IR, TNF-α and IL -6 levels were all decreased （P〈0.05 or P〈0.01）, and SFRP5 level was increased （P〈0.05） in both groups compared with those before treatment. The improvement of the indexes in the experiment group was superior to that in the control group （ P〈0.05 or P〈0.01） Conclusion HJY combined with metformin has an effect on controlling body weight, regulating the glucose and lipid metabolism, and improving IR through regulating fat factors of IL-6, TNF-α and SFRP5 in type 2 diabetes patients with IR.