参芪玉荷方对伴糖尿病经他汀类单药治疗未达标的高胆固醇血症患者糖脂代谢、炎症反应及颈动脉内膜中层厚度的影响

Effect of Shenqi Yuhe decoction on glucose-lipid metabolism, inflammatory response and carotid intima-media thickness in patients with diabetes and untargeted hypercholesterolemia treated by statins

目的观察参芪玉荷方对伴糖尿病经他汀类单药治疗未达标的高胆固醇血症患者糖脂代谢、炎症反应及颈动脉内膜中层厚度(CIMI)的影响。方法将2017年4月—2018年12月在内蒙古医科大学附属医院诊治的糖尿病经他汀类单药治疗未达标的高胆固醇血症患者86例随机分为观察组和对照组,每组43例。对照组在原治疗方案中加用依折麦布治疗,观察组在对照组治疗基础上加用参芪玉荷方干预,2组疗程均为12周。记录2组治疗前后中医症状积分、糖脂代谢指标水平、炎性因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平、CIMI和斑块Crouse积分,统计2组中医症状治疗疗效及糖脂代谢达标率。结果与治疗前比较,2组治疗后各单项中医症状积分和总分及FPG、2hPG、HbA1c、TC、TG、LDL-C、hs-CRP、IL-6、IL-8、TNF-α水平和CIMI、斑块Crouse积分均明显降低(P均<0.05),HDL-C水平均明显增高(P均<0.05),治疗后观察组以上积分或指标改善情况均明显优于对照组(P均<0.05)。观察组治疗后中医证候治疗总有效率、血糖达标率与高胆固醇血症达标率分别为90.7%(39/43)、93.0%(40/43)和88.4%(38/43),对照组分别为67.4%(29/43)、72.1%(30/43)和67.4%(29/43),观察组均明显高于对照组(P均<0.05)。结论参芪玉荷方可显著减轻糖尿病经他汀类单药治疗未达标的高胆固醇血症患者临床症状,改善糖脂代谢紊乱,提高糖脂达标率,并能抑制炎症反应,改善颈动脉硬化。

Objective It is to observe the effects of Shenqi Yuhe decoction on glucose-lipid metabolism,inflammatory response,and carotid intima-media thickness(CIMI)in patients with diabetes and hypercholesterolemia who failed to meet the standard of target with statins.Methods 86 patients with diabetic hypercholesterolemia diagnosed and treated with statin monotherapy in the Affiliated Hospital of Inner Mongolia Medical University from April 2017 to March 2019 were randomly divided into observation group and control group,with 43 cases in each group.The control group was treated with ezetimibe based on the original treatment plan,and the observation group was treated with Shenqi Yuhe decoction on the basis of the treatment of the control group.Both groups were treated for 12 weeks.The TCM syndrome scores,levels of indexes of glucose and lipid metabolism,inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],CIMI and plaque Crouse score were recorded before and after treatment in the two groups,the efficacy of treatment of TCM syndromes and the target rate of glucose and lipid metabolism in the two groups were calculated.Results Compared with those before treatment,the scores of each item of TCM syndrome and total scores,the levels of FPG,2hPG,HbA1c,TC,TG,LDL-C,hs-CRP,IL-6,IL-8,TNF-αand the CIMI and plaque Crouse scores were significantly reduced(all P<0.05),and HDL-C levels were significantly increased in the two groups(all P<0.05).After treatment,the improvements of the scores or indexes in the observation group were significantly better than those in the control group(all P<0.05).The total effective rate of TCM syndrome,the target rate of blood glucose,and hypercholesterolemia were 90.7%(39/43),93.0%(40/43),and 88.4%(38/43)in the observation group,respectively.They were 67.4%(29/43),72.1%(30/43),and 67.4%(29/43)in the control group,and the rates in the observation group were significantly higher than those in the control group(all P<0.05).Conclusion Shenqi Yuhe Decoction can significantly reduce the clinical symptoms,improve glucose and lipid metabolism disorders,increase the rate of glucose and lipid compliance,and inhibit inflammation and improve carotid arteriosclerosis in diabetic patients with untargeted hypocholesterolemia treated with statin monotherapy.