益气化痰活血法改善超重/肥胖2型糖尿病患者糖脂代谢紊乱及肥胖抑制素的临床观察

Clinical Observation on Method of Supplementing Qi,Resolving Phlegm and Activating Blood Circulationin Improving Disorder of Glucose and Lipid Metabolism and Obestatin in Overweight/Obese of Type 2 Diabetes Mellitus Patients

目的:观察益气化痰活血法对气虚痰瘀型超重/肥胖2型糖尿病糖脂代谢及肥胖抑制素的影响,并探讨其作用机制。方法:86例超重/肥胖2型糖尿患者随机分为治疗组和对照组,各43例,治疗组采用益气化痰活血中药+基础治疗,对照组采用安慰剂+基础治疗;治疗前后分别检测空腹血糖、餐后2 h血糖、空腹胰岛素、糖化血红蛋白、血脂、肥胖抑制素(obestatin),安全性指标(三大常规、肝肾功能),计算胰岛素抵抗指数(HOMA-IR),并详细观察患者症状、体征的变化以及药物的毒副反应。结果:治疗后治疗组中医疗效优于对照组(P<0.05),可以明显改善少气乏力/懒言、口干不多饮、肢体麻木或刺痛等症状;治疗后与对照组比较,治疗组体质量指数、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数明显下降(P<0.05),obestatin明显升高(P<0.05),治疗组胆固醇、低密度脂蛋白显著下降(P<0.01),高密度脂蛋白显著升高(P<0.01);两组治疗后空腹血糖、甘油三酯比较差异无统计学意义。结论:益气化痰活血法可以改善治疗组患者糖脂代谢紊乱、胰岛素抵抗,提升obestatin水平,这可能是益气化痰活血中药复方发挥作用的途径之一。

Objective： To observe the effect of method of Supplementing Qi,Resolving Phlegm and Promoting Blood Circulation on glucose and lipid metabolism and obestatin in obesity type 2 diabetes mellitus,and investigate its action mechanism. Method： The 86 cases of overweight / obese patients with type 2 diabetes were randomly divided into treatment group and control group,each consisting of 43 cases. Patients in treatment group received traditional Chinese medicine（ supplementing Qi,resolving phlegm and activating blood circulation） ＋basic therapy,and patients in control group received placebo ＋ basic therapy. Both before and after treatment,the fasting blood glucose,postprandial 2 h plasma glucose,fastinginsulin,glycosylated hemoglobin,blood lipids,obestatin,safety indexes（ three routine tests,liver and kidney function） were detected; the insulin resistance indexes（ HOMA-IR） were calculated,and changes in symptoms,signs and drug adverse reactions were observed in detail. Result： The curative effect of traditional Chinese medicine in treatment group was better than that in control group after treatment（ P〈0. 05）,and it can significantly improve the shortness of breath and fatigue / lazy words,drying mouth and polydipsia,limbs numbness or tingling,and other symptoms. After treatment,the body mass index,2 h postprandial blood glucose,glycosylated hemoglobin,and insulin resistance index in treatment group were lower than those in control group（ P〈0. 05）,while the level of obestatin was higher than that in control group（ P〈0. 05）; the levels of cholesterol and low density lipoprotein in treatment group were significantly lower than those in control group（ P〈0. 01）,while the level of high density lipoprotein was significantly higher than that in control group（ P〈0. 01）; there were no statistically significant differences in fasting blood glucose and triglyceride between two groups after the treatment. Conclusion： The method of Supplementing Qi,Resolving Phlegm and Promoting Blood Circulation can improve glucose and lipid metabolism disorder,insulin resistance and obestatin level in treatment group, which may be one of the active ways for Chinese herbal compound of supplementing Qi,resolving phlegm and activating blood circulation.