酸甘化阴法对2型糖尿病患者胰岛素抵抗作用的研究

The Clinical Study on Effect of“Sour and Sweet Flavors Transforming into Yin”to Type 2 Diabetes Mellitus Patients

[目的]研究酸甘化阴法对2型糖尿病患者胰岛素抵抗的作用,并从调节脂联素(adiponectin,APN)及瘦素(leptin,LEP)角度探讨改善胰岛素抵抗的可能机制。[方法]采用随机、对照的方法,将60名患者分成治疗组和对照组,每组30人。在饮食、运动治疗的基础上,分别加用芪贞降糖颗粒和安慰剂,疗程3个月。观察治疗前后患者糖化血红蛋白(haemoglobin A1c,Hb A1c)、胰岛素抵抗指数(homeostasis model assessment-insulin resistant index,HOMA-IR)、APN、LEP的变化,并比较所有入组患者瘦素、脂联素与HOMA-IR的相关性,探讨芪贞降糖方酸甘化阴法对胰岛素抵抗(insulin resistant,IR)作用的可能机制。[结果]治疗组治疗后的Hb A1c、HOMA-IR较治疗前下降(P<0.05),LEP明显低于治疗前(P<0.01),而APN明显高于治疗前(P<0.01);对照组治疗后的APN高于治疗前(P<0.01)。而Hb A1c、HOMA-IR、LEP治疗前后比较差异无统计学意义(P>0.05),两组间治疗前后差值比较,治疗组降低Hb A1c、HOMA-IR优于对照组(P<0.05),且其升高APN、降低LEP的疗效明显强于对照组(P<0.01)。对所有入组患者的LEP、APN与Hb A1c、HOMA-IR、BMI进行相关性检测;APN与HOMA-IR呈负相关(P<0.05);LEP与HOMA-IR呈正相关(P<0.05)。[结论]芪贞降糖颗粒酸甘化阴法可显著改善2型糖尿病患者血糖及胰岛素抵抗,其作用机制可能是通过调节LEP、APN从而改善胰岛素抵抗及血糖水平。

[Objective]To treat type 2 diabetes mellitus patients by using ＂Sour and Sweet Flavors Transforming into Yin＂and discuss the mechanism of action to reduce insulin resistance by adjusting APN and LEP. [Methods] All 60 cases came from the endocrine clinics of Yue Yang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of TCM. They were divided into the treatment group and the control group on average.All cases were given the intervention of diet and movement. The period of treatment was three mouths. We detected the level of Hb A1 c, HOMA-IR, APN,LEP before and after treatment. Also we analyzed the correlation of APN, LEP and HOMA-IR. [Result] The levels of Hb A1 c, HOMA-IR were reduced esp. the LEP： and the level of APN was elevated in the treatment group（P〈0.01）. In the control group only the level of APN was elevated（P〈0.01）. The Hb A1 c,HOMA-IR and LEP had no statistical meaning between before and after treatment（P〈0.05）, Comparing the D-value of both groups before and after treatment, the reduction of HBa1 C, HOMA-IR of the treatment group was better than control group（ P〈0.05）, as well as the effects of raising APN and reducing LEP were better than control group（P〈0.01）. By making relative measurement to all patients＇ LEP, APN and HOMA-IR, BMI, the APN was in negative relation with HOMA-IR（P〈0.05）, LEP was in positive relation with HOMA-IR（P〈0.05）. [Conclusions] The comprehensive curative effect of＂Qizhen glucose-lowering decoction＂which based on＂Sour and Sweet Flavors Transforming into Yin＂was better than control group. The mechanism of action was reducing insulin resistance by adjusting APN and LEP.