清肺泻肝汤治疗2型糖尿病合并非酒精性脂肪肝

Qinfei Xiegan Decoction in Treatment of Type 2 Diabetes with Non-alcoholic Fatty Liver

目的:探讨清肺泻肝汤治疗2型糖尿病(type 2 diabetes mellitus,T2DM)合并非酒精性脂肪肝的临床疗效及安全性。方法:200例T2DM合并非酒精性脂肪肝患者依照随机数字表法将患者分为对照组(100例)和观察组(100例)。对照组采用常规西药治疗,观察组在常规西药治疗基础上给予清肺泻肝汤治疗,两组均连续治疗2个月。治疗后比较两组患者临床疗效,两组患者治疗前后空腹血糖(fasting blood-glucose,FPG)、餐后2小时血糖(2-hour post-meal blood glucose,2hPG)、空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(insulin resistance index,HOMA-IR)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartate amino transferase,AST)、脂联素(adiponectin,APN)和C反应蛋白(C-reaction protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平及肠道肠球菌、肠杆菌、酵母菌、双歧杆菌、拟杆菌、乳杆菌数量,并比较两组患者治疗过程中不良反应的发生情况。结果:观察组有效率为92.00%(92/100),对照组为81.00%(81/100),两组比较,差异有统计学意义(χ^2=5.181,P=0.023)。两组患者治疗后FPG、2hPG、FINS及HOMA-IR水平均低于治疗前(P<0.05),同时观察组治疗后FPG、2hPG、FINS及HOMA-IR水平均明显低于对照组(P<0.05)。两组患者治疗后血清ALT、AST、CRP、TNF-α、IL-6水平明显低于治疗前(P<0.05),血清APN水平均明显高于治疗前(P<0.05),且观察组治疗后血清ALT、AST、CRP、TNF-α、IL-6水平均明显低于对照组(P<0.05),血清APN水平明显高于对照组(P<0.05)。两组治疗后肠球菌、肠杆菌、酵母菌数量均明显小于治疗前(P<0.05),双歧杆菌、拟杆菌、乳杆菌数量均明显高于治疗前(P<0.05),同时观察组治疗后肠球菌、肠杆菌、酵母菌数量均明显低于对照组(P<0.05),双歧杆菌、拟杆菌、乳杆菌数量均明显高于对照组(P<0.05)。结论:清肺泻肝汤治疗T2DM合并非酒精性脂肪肝临床疗效显著,能够调节血糖水平,改善胰岛素抵抗和肝功能,减轻炎症反应,调节肠道菌群,且安全性较好。

Objective:To explore the clinical efficacy and safety of Qingfei Xiegan Decoction in the treatment of type 2 diabetes mellitus(T2DM)combined with non-alcoholic fatty liver.Methods:200 patients with T2DM and non-alcoholic fatty liver were divided into a control group(100 cases)and an observation group(100 cases)according to the random number table method.The control group was treated with conventional Western medicine,and the observation group was given Qingfei Xiegan Decoction on the basis of conventional Western medicine treatment.Both groups were given continuous treatment for 2 months.After treatment,the clinical efficacy of the two groups of patients was compared.Before and after treatment,fasting blood-glucose(FPG),2-hour post-meal blood glucose(2hPG),fasting insulin(FINS),Insulin resistance index(HOMA-IR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),adiponectin(APN)And C-reaction protein(CRP),tumor necrosis factor-α(tumor necrosis factor-α,TNF-α),interleukin-6(interleukin-6,IL-6)levels and intestinal intestine Cocci,Enterobacteriaceae,Yeast,Bifidobacterium,Bacteroides,Lactobacillus,and compare the incidence of adverse reactions during treatment between the two groups of patients.Results:The effective rate was 92.00%(92/100)in the observation group and 81.00%(81/100)in the control group.The difference between the two groups was statistically significant(χ^2=5.181,P=0.023).The levels of FPG,2hPG,FINS and HOMA-IR after treatment in the two groups were significantly lower than that before treatment(P<0.05),and the levels of FPG,2hPG,FINS and HOMA-IR after treatment in the observation group were significantly lower than that of the control group(P<0.05).After treatment,the levels of serum ALT,AST,CRP,TNF-α,and IL-6 in the two groups were significantly lower than before treatment(P<0.05),and the level of serum APN was significantly higher than before treatment(P<0.05).The levels of serum ALT,AST,CRP,TNF-αand IL-6 were significantly lower than that of the control group(P<0.05),and the serum APN level was significantly higher than that of the control group(P<0.05).After treatment,the number of enterococci,enterobacteriaceae,and yeast were significantly less than before treatment(P<0.05),the number of bifidobacteria,Bacteroides,and lactobacilli were significantly higher than before treatment(P<0.05),while the observation group was treated.The number of enterococci,enterobacteriaceae and yeast were significantly lower than that of the control group(P<0.05),and the number of bifidobacteria,Bacteroides and lactobacilli were significantly higher than the control group(P<0.05).Conclusion:Qingfei Xiegan Decoction is effective in treating T2DM combined with non-alcoholic fatty liver.It can regulate blood sugar levels,improve insulin resistance and liver function,reduce inflammation,regulate intestinal flora,with adequate safety.