中西医结合治疗代谢综合征60例疗效观察

Effect of Integrated Chinese and Western Medicine Therapy for MS: A Report of 60 Cases

目的 :观察疏肝化浊汤联合西医常规疗法治疗代谢综合征的疗效。方法 :将120例代谢综合征痰浊郁阻证患者随机分为西医组和中西医结合组各60例。西医组除生活方式干预外,根据患者的具体情况采用马来酸依那普利片、胰岛素、阿托伐他汀钙片来治疗,中西医结合组在西医组治疗基础上加用疏肝化浊汤治疗,2组疗程均为4月。检测2组患者治疗前后的空腹血糖(FBG)、餐后2 h血糖(P2h BG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)水平,计算胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR);测量体质量、腰围和臀围,计算腰臀比(WHR)和体质量指数(BMI);检测甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;并进行痰浊郁阻证评分。结果:治疗后,2组FBG、P2h BG、Hb A1c、FINS、HOMA-IR均较治疗前下降(P<0.01),ISI均较治疗前上升(P<0.01);中西医结合组Hb A1c、FINS、HOMA-IR水平均低于西医组(P<0.01),ISI高于西医组(P<0.01),2组间FBG和P2h BG比较,差异均无统计学意义(P>0.05)。2组体质量、腰围、WHR和BMI均较治疗前下降(P<0.01);中西医结合组体质量、腰围、WHR和BMI均低于西医组(P<0.05)。2组TC、TG、LDL-C水平均较治疗前下降(P<0.01),HDL-C水平均较治疗前升高(P<0.01);中西医结合组TG、TC、LDL-C水平均低于西医组(P<0.01),HDL-C水平高于西医组(P<0.01)。2组痰浊郁阻证评分均较治疗前下降(P<0.01),中西医结合组痰浊郁阻证评分低于西医组(P<0.01)。结论 :在西医降糖、调脂、降压等干预的基础上加用疏肝化浊汤治疗,能进一步调节代谢综合征患者的糖脂代谢,提高机体的胰岛素敏感性,改善胰岛素抵抗,改善中医证候,有助于防治心血管疾病和延缓糖尿病的发生、发展。

Objective： To observe the curative effect of Shugan Huazhuo tang combined with routine western medicine in treating metabolic syndrome （MS）. Methods. Selected 120 MS patients with phlegm stasis syndrome and divided them into the western medicine group and the integrated Chinese and western medicine group being 60 cases in each. Except for intervention in life style, the western group was given enalapril maleate tablets, insulin and atorvastatin calcium tablets according to actual conditions of patients. The integrated Chinese and western medicine group was given Shugan Huazhuo tang based on the treatment of the western medicine group. Treatment of the two groups both lasted for four months. Detected levels of fasting blood glucose（FBG）, two hour postprandial blood glucose（P2hBG）, Hemoglobin Al Glycosylated（HbAlc）, fasting insulin（FINS）, counted insulin sensitivity index （ISI）, insulin resistance index （HOMA-IR）; tested weight, waist circumference and hip circumference, and counted waist-hip ratio（WHR） and body mass index （BMI）; detected levels of triglyceride （TG）, total cholesterol （TC）, high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（LDL-C）, and evaluated phlegm stasissyndromescore. Results： After treatment, FBG, P2hBG, HbAlc, FINS and HOMA-IR of the two groups were all lower than those before treatment（P 〈 0.01）, ISI was higher than that before treatment （P 〈 0.01）. Levels of HbAlc, FINS and HOMA-IR of the integrated Chinese and western medicine group were all lower than those of the western medicine group （P 〈 0.01）, ISI of the integrated Chinese and western medicine group was higher than that of the western medicine group （P 〈 0.01）. Comparing FBG and P2hBG of the two groups, the difference was not significant （P 〉0.05） . Weight, waist circumference, WHR and BMI of the two groups were all lower than those before treatment （P〈0.01）. Weight, waist circumference, WHR and BMI of the integrated Chinese and western medicine group were all lower than those of the western medicine group（P 〈 0.05）. Levels of TC, TG and LDL-C of the two groups were all lower than those before treatment（P 〈 0.01）, HDL-C levels of the two groups were higher than those before treatment （P 〈 0.01）. Levels of TC, TG and LDL-C of the integrated Chinese and western medicine group were all lower than those of the western medicine group（P 〈 0.01）, HDL-C levels of the integrated Chinese and western medicine group were higher than those of the western medicine group （P 〈 0.01）. Phlegm stasis syndrome scores of the two groups were lower than those before treatment （P 〈 0.01）, and the scores of the integrated Chinese and western medicine group were lower than those of the western medicine group （P 〈 0.01）. Conclusion： Based on the intervention of western medicine for reducing blood glucose and blood pressure, and regulating blood lipid, application of Shugan Huazhuo tang can further improve glucose, lipid metabolism, insulin sensitivity of the body, promote insulin resistance and Chinese medicine symptom, which can help control cardiovascular disease and delay the incidence and development of diabetes mellitus.