桂枝汤加减对糖尿病心脏自主神经病变患者中医证候疗效、炎症因子的影响

Effect of Modified Guizhi Decoction on TCM Syndrome Efficacy and Inflammatory Factors in Patients with Diabetic Cardiac Autonomic Nervous Disease

目的:观察桂枝汤加减对糖尿病心脏自主神经病变患者中医证候疗效及炎症因子的影响。方法:85例糖尿病心脏自主神经病变患者随机分为对照组(40例)和观察组(45例)。对照组给予常规甲钴胺片;观察组在对照组基础上给予桂枝汤加减方。观察两组患者治疗前后血糖指标:空腹血糖(fasting plasma glucose,FPG),餐后2小时血糖(2-hour postmeal blood glucose,2h PG),糖化血红蛋白(hemoglobin Alc,Hb AIc);心率变异性指标:正常心动周期的标准差:RR间期的标准差(SDNN)、相邻正常窦性心搏间期之差的平方根值(r MSSD)、相邻正常窦性心搏间期差值超过50 ms的个数占总窦性心搏数的百分率(PNN50)、心率变异的低频(LF)、心率变异的高频(HF)及LF/HF;炎症因子:白细胞介素-6(interleukin-6,IL-6),转化生长因子(transforming growth factor-β1,TGF-β1),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α);中医证候积分变化及中医证候疗效。结果:治疗前两组患者FPG、2h PG、Hb AIc比较,差异均无统计学意义(均P>0.05);与治疗前比较,两组患者FPG、2h PG、Hb AIc均显著下降(P<0.05)。治疗前两组患者SDNN、r MSSD、PNN50、LF、HF及LF/HF比较,差异均无统计学意义(P>0.05);观察组患者治疗后SDNN、r MSSD、PNN50、LF及HF均明显高于对照组,差异有统计学意义(P<0.05),而LF/HF低于对照组[(1.56±0.21)vs(2.89±0.23)](P<0.05)。治疗前两组患者IL-6、TGF-β1、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后两组患者IL-6水平显著低于治疗前(P<0.05);观察组治疗后IL-6、TGF-β1水平[(85.32±18.05)ng·L-1、(16.69±3.12)ng·L-1]明显高于对照组[(108.32±19.68)ng·L-1、(9.26±3.09)ng·L-1],而观察组TNF-α显著低于对照组[(10.02±3.52)vs(17.26±3.95)],两组比较,差异均有统计学意义(P<0.05)。治疗前两组患者中医证候积分比较,差异无统计学意义(P>0.05);两组治疗后均显著降低,且观察组中医证候积分[(12.32±7.12)分]低于对照组[(20.48±6.45)分],差异均有统计学意义(P<0.05)。观察组有效率高于对照组(88.89%vs 67.50%)(P<0.05)。结论:桂枝汤加减治疗糖尿病心脏自主神经病变疗效显著,可有效改善中医症状,提高心脏功能,降低血糖水平和炎症因子水平。

Objective： To observe the effect of modified Guizhi Decoction on the TCM syndrome efficacy and inflammatory factors in patients with diabetic heart autonomic neuropathy. Methods： 85 patients with diabetic heart autonomic neuropathy were randomly divided into control group（ 40 cases） and observation group（ 45 cases）. The control group was given conventional mecobalamin tablets; the observation group was given modified Guizhitang Decoction in addition to that of the control group. The following indexes before and after treatment were observed： the blood glucose parameters： fasting plasma glucose（ FPG）,2-hour post-meal blood glucose（ 2 h PG）,and hemoglobin Alc（ Hb AIc）; heart rate variability index： Standard deviation of the normal cardiac cycle：SDNN,r MSSD,PNN50,LF,HF,and LF/HF; inflammatory factors： interleukin-6（ IL-6）,transforming growth factor-β1,TGF-β1）,tumor necrosis factor-α（ TNF-α）; changes in TCM syndrome scores and efficacy of TCM syndromes. Results： There was no significant difference in FPG,2 h PG,and Hb AIc between the two groups before treatment（ all P〈0. 05）. Compared with that before treatment,FPG,2 h PG,and Hb AIc were significantly decreased in the two groups（ P〈0. 05）. There was no significant difference in SDNN,r MSSD,PNN50,LF,HF,and LF/HF between the two groups before treatment（ P〈0. 05）; SDNN,r MSSD,PNN50,LF,and HF in the observation group were significantly higher than that of the control group after treatment,the difference was statistically significant（ P〈0. 05）,while LF/HF was lower than that of the control group [（ 1. 56 ± 0. 21） vs（ 2. 89 ±0. 23） ]（ P〈0. 05）. There was no significant difference in the levels of IL-6,TGF-β1 and TNF-α between the two groups before treatment（ P〈0. 05）. After treatment,IL-6 levels in both groups were significantly lower than before treatment（ P〈0. 05）. After treatment,IL-6 and TGF-β1 levels in the observation group were significantly higher than those in the control group [（ 85. 32 ±18. 05） ng·L-1,（ 16. 69 ± 3. 12） ng·L-1][（ 108. 32 ± 19. 68） ng·L-1.（ 9. 26 ± 3. 09） ng·L-1],while TNF-α in the observation group was significantly lower than that in the control group [（ 10. 02 ± 3. 52） vs（ 17. 26 ± 3. 95） ]. There were significant differences between the two groups（ P〈0. 05）. There was no significant difference in TCM syndrome scores between the two groups before treatment（ P〈0. 05）. That of both groups were significantly lowered after treatment,and the TCM syndrome scores[（ 12. 32 ± 7. 12） points]of the observation group was significantly lower than that [（ 20. 48 ± 6. 45） points]of the control group（ P〈0. 05）. The clinical efficacy of the observation group was significantly better than that of the control group（ 88. 89% vs67. 50%）（ P〈0. 05）. Conclusion： Modified Guizhi Decoction has significant curative effect on diabetic autonomic neuropathy. It can effectively improve symptoms of traditional Chinese medicine,improve cardiac function,and reduce blood sugar level and inflammatory factor levels.