金匮肾气方治疗老年糖尿病疗效观察及对HPA轴的影响

Curative effect of Jingui Shenqi Prescription for Senile Diabetes and its Effect on HPA Axis

目的:观察在常规西药降糖的基础上联合金匮肾气方加减治疗老年糖尿病的临床疗效及其对下丘脑-垂体-肾上腺(HPA)轴的影响。方法:将老年糖尿病患者117例随机分为中药组67例,对照组50例。对照组采用常规西药降糖治疗,中药组在对照组的基础上予以金匮肾气方加减治疗,2组疗程均为3个月。观察比较2组治疗前后体质量指数(BMI)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、空腹胰岛素水平(FINS)、胰岛素敏感指数(ISI)情况,检测2组治疗前后血浆去甲肾上腺素(NE)、多巴胺(DA)、血清促肾上腺皮质激素(ACTH)、皮质醇(CORT)水平变化,并比较2组中医证候疗效。结果:中医证候疗效总有效率中药组为88.05%,对照组为62.00%,2组比较,差异有统计学意义(P<0.05)。与同组治疗前比较,中药组患者血清HbA1c、FBG、FINS及ISI指标明显改善(P<0.05),对照组FBG、ISI指标明显改善(P<0.05);与对照组治疗后比较,中药组患者BMI、HbA1c、FINS、ISI指标改善更显著(P<0.05)。与同组治疗前比较,中药组患者血清NE、DA、ACTH、CORT水平均明显改善(P<0.05),对照组仅CORT水平明显改善(P<0.05);与对照组治疗后比较,中药组血清NE、CORT水平改善更显著(P<0.05)。结论:在常规西药治疗的基础上,联合金匮肾气方加减治疗老年糖尿病疗效肯定。

Objective: To observe the clinical effect of modified Jingui Shenqi prescription based on routine western medicine for lowering blood glucose for senile diabetes and its effect on HPA axis. Methods:A total of 117 cases of senile patients with diabetes were randomly divided into the Chinese medicine group and the control group,67 and 50 cases in each group respectively. The control group was given routine western medicine for lowering blood glucose, and the Chinese medicine group was additionally given modified Jingui Shenqi prescription based on the treatment of the control group. Both groups were treated for three months. Body Mass Index(BMI),the levels of glycosylated hemoglobinA1 c(HbA1 c),fasting blood glucose(FBG) and fasting insulin(FINS), as well as Insulin Sensitivity Index(ISI) before and after treatment were observed and compared between the two groups;the changes in levels of norepinephrine(NE) and dopamine(DA) in plasma,and adrenocorticotropic hormone(ACTH) and cortisol(CORT) in serum before and after treatment were detected in the two groups;the clinical effect of Chinese medicine syndromes was compared between the two groups. Results:The clinical total effective rate of Chinese medicine syndromes was 88.05% in the Chinese medicine group and 62.00% in the control group,the difference being significant(P<0.05). When compared with those in the same group before treatment, the levels of HbA1 c,FBG and FINS in serum and ISI in the Chinese medicine group were significantly improved(P<0.05);the levels of FBG and ISI in the control group were significantly improved(P<0.05). When compared with that in the control group after treatment,the improvement of levels of BMI,HbA1 c,FINS and ISI in the Chinese medicine group was more significant(P<0.05). When compared with those that in the same group before treatment,the levels of NE,DA,ACTH and CORT in serum in the Chinese medicine group were significantly improved(P<0.05);in the control group, only the level of CORT in the control group was significantly improved(P<0.05). When compared with that in the control group after treatment, the improvement of levels of NE and CORT in serum in the Chinese medicine group was more significant(P<0.05). Conclusion:Based on routine western medicine, modified Jingui Shenqi prescription has significant curative effect in treating senile diabetes.