降浊合剂治疗气虚痰浊型糖耐量异常患者的疗效及对肠道菌群的影响

Therapeutic effect of Jiangzhuo Mixture on qi deficiency and phlegm turbidity type patients with impaired glucose tolerance and its effect on intestinal flora

目的:观察降浊合剂治疗气虚痰浊型糖耐量异常(IGT)患者的疗效,探讨其对肠道菌群的影响。方法:随机选取2018年1月至12月宁波市中医院内分泌科门诊的40例气虚痰浊型IGT患者,按随机数字表法,分为治疗组与对照组,并选取20名体检中心的健康人为健康对照组,治疗组予以饮食运动基础上服用降浊合剂,对照组予饮食运动治疗,于治疗前后提取粪便菌群基因组DNA,通过构建粪便菌群的细菌通用16S rRNA基因克隆文库分析患者肠道菌群变化,所有患者均连续治疗4周,检测空腹血糖(FPG)等指标及肠道菌群变化。结果:降糖疗效上:治疗组患者FPG和空腹胰岛素水平显著降低(P<0.05),空腹胰岛素敏感指数较治疗前显著升高(P<0.05),对照组经过饮食运动干预,餐后血糖较干预前显著升高(P<0.05)。治疗组IGT患者甘油三酯、低密度脂蛋白水平较治疗前显著降低(P<0.05),且与对照组比较,差异有统计学意义(P<0.05)。菌群结构上:在目分类水平上,治疗组乳杆菌目的丰度较对照组显著升高,普雷沃氏菌科的丰度在治疗后显著降低;在属水平上,普雷沃氏菌属丰度在治疗后较对照组显著下降(P<0.01),双歧杆菌属、乳杆菌属的丰度显著升高(P<0.05)。结论:降浊合剂能有效改善气虚痰浊型IGT患者的糖、脂代谢及肠道菌群紊乱状态,恢复肠道微生态平衡,临床上治疗IGT有较显著的疗效。

Objective:To observe the curative effect of Jiangzhuo Mixture(JM)on qi deficiency and phlegm turbidity type patients with impaired glucose tolerance(IGT),and to explore its effect on intestinal flora.Methods:Randomly select 40 IGT patients with qi deficiency and phlegm turbidity who admitted to the Endocrine Clinic of Ningbo Municipal Hospital of Traditional Chinese Medicine from January to December 2018,and divide them into treatment group and control group according to random number table method,then select another 20 healthy people in the Physical Examination Center as healthy control group.The treatment group was treated with JM on the basis of diet and exercise while the control group was treated with diet and exercise therapy.Extract the genomic DNA of fecal flora before and after treatment,and analyzed the changes of intestinal flora in patients by constructing a universal 16S rRNA gene cloning library of fecal flora.All patients were treated continuously for four weeks,and tested the changes of fasting plasma glucose(FPG),etc,and intestinal flora.Results:In terms of hypoglycemic effect:the FPG and fasting insulin levels in the treatment group were significantly lower(P<0.05),and the fasting insulin sensitivity index was significantly higher than that before treatment(P<0.05),the postprandial blood glucose of the control group was significantly higher than that before intervention(P<0.05).The triglyceride and low-density lipoprotein levels of IGT patients in treatment group are significantly lower than those before treatment(P<0.05),and there are significant differences between the treatment group and the control group(P<0.05).In terms of flora structure:the abundance of Lactobacillus in the treatment group was significantly higher than that in the control group,and the abundance of prevotellaceae was significantly lower after treatment;at the generic level,the abundance of Prevotella was significantly lower than that in the control group after treatment(P<0.01),and the abundance of Bifidobacterium and Lactobacillus was significantly higher.Conclusion:JM can effectively improve the disorder of glucose metabolism in IGT patients with qi deficiency and phlegm turbidity.It has the effect of significantly improving fasting plasma glucose,fasting insulin,and fasting insulin sensitivity index,as well as the function of regulating lipid metabolism,improving intestinal flora disorders,and restoring intestinal microecological balance.Therefore,it has a significant clinical effect on the treatment of IGT in clinic.