黄芪葛根汤治疗老年糖尿病疗效观察及对胰岛素抵抗的影响

Observation of Huangqi Gegen Tang for Senile Diabetes and Its Effect on Insulin Resistance

目的:观察黄芪葛根汤治疗老年糖尿病的临床疗效及对胰岛素抵抗(IR)的影响。方法:将中医辨证为血瘀脉络和气阴两虚证的老年的糖尿病患者120例随机分为2组,对照组60例常规服用盐酸二甲双胍、格列吡嗪控释片治疗,试验组60例在对照组的基础上加用黄芪葛根汤治疗;检测治疗前后空腹血糖(FBG)、餐后2h血糖(P2hBG)、空腹胰岛素(FINS),观察胰岛素抵抗指数(HOMA-IR)和胰岛素的感敏指数(ISI)的变化,评定证候积分变化及临床疗效。结果:临床疗效总有效率试验组为95.0%,对照组为75.0%,2组比较,差异有统计学意义(P<0.05)。胰岛素抵抗总有效率试验组为85.0%,对照组为55.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组患者主症积分、次症积分及总积分均较治疗前明显降低(P<0.05),且试验组各项积分均低于对照组(P<0.05)。治疗后,2组患者血清FIN、FBG和P2hBG水平均较治疗前显著下降(P<0.05),且试验组各项指标水平均低于对照组(P<0.05)。治疗后,试验组患者HOMA-IR降低、ISI升高,与治疗前及对照组治疗后比较,差异均有统计学意义(P<0.05)。对照组患者HOMA-IR、ISI治疗前后变化不大(P>0.05)。结论:黄芪葛根汤可明显改善老年糖尿病患者的临床症状和胰岛素抵抗情况,值得临床推广应用。

Objective:To observe the clinical effect of Huangqi Gegen tang on senile diabetes and its effect on insulin resistance(IR). Methods: A total of 120 cases of senile patients with diabetes with blood stasis in the collaterals and dual deficiency of qi and yin syndrome were randomly divided into two groups, 60 cases in each group. The control group was routinely treated with metformin hydrochloride and glipizide extended-release tablets, and the experiment group was additionally treated with Huangqi Gegen tang based on the treatment of the control group. The fasting blood glucose(FBG),postprandial 2 h blood glucose(P2 hBG)and fasting insulin(FINS) before and after treatment were detected;the changes of homeostatic model assessment for insulin resistance(HOMA-IR) and insulin acuity index(IAI) were observed;the changes of syndrome scores and the clinical effect were evaluated. Results: The total clinical effective rate was 95.0% in the experiment group and 75.0% in the control group, the difference being significant(P < 0.05). The total effective rate for insulin resistance was 85.0% in the experiment group and 55.0%in the control group, the difference being significant(P < 0.05). After treatment, the scores of main symptoms as well as secondary symptoms and the total scores in the two groups were significantly deceased when compared with those before treatment(P < 0.05), and the scores in the experiment group were lower than those in the control group(P < 0.05). After treatment, the levels of FIN, FBG and P2 h BG in serum in the two groups were significantly decreased when compared with those before treatment(P < 0.05), and the levels in the experiment group were lower than those in the control group(P < 0.05). After treatment, when compared with those before treatment and in the control group after treatment respectively, HOMA-IR in the experiment group was decreased while IAI was increased, differences being significant(P < 0.05). There was no significant difference being found in the comparison of the changes of HOMA-IR and IAI in the control group before and after treatment(P >0.05). Conclusion: Huangqi Gegen tang can significantly reduce clinical symptoms and improve IR of patients with senile diabetes,which is worthy of clinical promotion and application.