七味白术散对脾虚湿困型肥胖症患者糖脂代谢及肠道菌群的影响

Effects of Qiwei Baizhu Powder(七味白术散)on Glucose and Lipid Metabolism and Intestinal Flora in Obesity Patients of Spleen Deficiency and Dampness Disturbing Type

目的评价七味白术散治疗脾虚湿困型肥胖症的临床疗效。方法34例脾虚湿困型肥胖症患者随机分为治疗组(24例)与对照组(10例)。对照组患者给予指导生活方式、控制并规律饮食、适当运动锻炼干预;治疗组患者在对照组治疗基础上给予七味白术散口服,每日1剂。两组疗程均为3个月。比较两组治疗前后中医证候积分、体重指数(BMI)、血脂[包括甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]、糖代谢指标[包括空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)]以及肠道菌群分布变化。结果治疗组治疗后中医证候积分、BMI、FINS、HOMA-IR、FBG、TG均较治疗前明显降低,HDL明显升高(P<0.05或P<0.01),而对照组治疗前后各指标差异均无统计学意义(P>0.05)。肠道菌群结果显示,在门水平,治疗组治疗前后拟杆菌门增幅高于对照组拟杆菌门增幅(P<0.05),而厚壁菌门、变形杆菌门、放线菌门和梭形杆菌门两组间差异均无统计学意义(P>0.05)。在属水平,治疗组拟杆菌属、普雷沃菌属治疗后较治疗前有明显上升,拟普雷沃菌属较治疗前显著下降(P<0.05)。结论七味白术散可有效调节脾虚湿困型肥胖症患者肠道菌群分布,改善血糖、血脂代谢。

Objective To evaluate the clinical efficacy of Qiwei Baizhu Powder(七味白术散)in the treatment of obesity of spleen deficiency and dampness disturbing.Methods A total of 34 obese patients with spleen deficiency and dampness disturbing were randomly divided into a treatment group(24 cases)and a control group(10 cases).Patients in the control group were given guidance on lifestyle,controlled and regular diet,and appropriate exercise intervention;patients in the treatment group were additionally given Qiwei Baizhu Powder orally,1 dose per day.The course of treatment for both groups was 3 months.The scores of traditional Chinese medicine(TCM)syndromes,body mass index(BMI),blood lipids including triglycerides(TG),low-density lipoprotein(LDL)and high-density lipoprotein(HDL),glucose metabolism indicators including fasting blood glucose(FBG),fasting insulin(FINS),glycosylated hemoglobin A1c(HbA1c),insulin resistance index(HOMA-IR)and changes in the distribution of intestinal flora before and after treatment were compared.Results The scores of TCM syndromes,BMI,FINS,HOMA-IR,FBG,and TG in the treatment group were significantly lower than before treatment,and HDL was significantly increased(P<0.05 or P<0.01).There was no statistical difference in all indicators in the control group before and after treatment(P>0.05).The results of intestinal flora showed that at the phylum level,the increase of Bacteroides in the treatment group after treatment was higher than the that in the control group(P<0.05).There was no statistically significant difference between groups in Bacillus phylum Firmicutes,Proteobacteria,Actinomycetes and Fusiform(P>0.05).At the genus level,the Bacteroides and Prevotella in the treatment group increased significantly after treatment.Prevotella spp.was significantly decreased after treatment(P<0.05).Conclusion Qiwei Baizhu Powder can effectively regulate the distribution of intestinal flora in obese patients with spleen deficiency and dampness disturbing,and can improve blood sugar and blood lipid metabolism.