清肺泻肝汤对代谢综合征慢性炎症和血管内皮功能的影响

Effect of Qingfei Xiegantang on Chronic Inflammation and Endothelial Function with Metabolic Syndrome

目的:探讨清肺泻肝汤治疗代谢综合征(MS)的临床疗效及对慢性炎症和血管内皮功能的影响作用。方法:将162例患者按随机数字表法分为对照组80例和观察组82例。两组均给予生活方式干预,并针对MS不同组分进行调脂、降压和降糖处理。观察组采用清肺泻肝汤加减治疗,1剂/d;对照组给予清肺泻肝汤安慰剂颗粒治疗。两组疗程均为4个月。测量治疗前后腰围(WC),身高、体质量和臀围,计算身体质量指数(BMI)和腰臀比(WHR);检测治疗前后高密度脂蛋白胆固醇(HDL-C),空腹血糖(FBG),负荷后2 h血糖(2 hPG),甘油三酯(TG),低密度脂蛋白胆固醇(LDL-C),糖化血红蛋白(HbA1c),总胆固醇(TC)和空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR),胰岛素敏感指数(InISI)和胰岛β细胞功能指数(HOMA-β);测量治疗前后收缩压(SBD),舒张压(DBP)水平;进行治疗前后朝医太阴人辨象症状评分;检测治疗前后一氧化氮(NO),肿瘤坏死因子-α(TNF-α),瘦素(LP),脂联素(ADP),白细胞介素-6(IL-6),内皮素-1(ET-1),内皮型一氧化氮合酶(eNOS)和诱导型一氧化氮合酶(iNOS)水平。结果:观察组患者体质量,BMI和WHR均明显低于对照组(P<0.05);观察组患者TG,TC,LDL-C均低于对照组(P<0.01),HDL-C高于对照组(P<0.01);观察组患者FBG,2 hPG,HbA1c,HOMA-IR均低于对照组(P<0.01),InISI和HOMA-β均高于对照组(P<0.01);观察组患者SBD,DBP水平和朝医太阴人辨象症状评分均低于对照组(P<0.01);观察组患者TNF-α,IL-6,ET-1,iNOS和LP水平均低于对照组(P<0.01),NO,eNOS和ADP水平均高于对照组(P<0.01);观察组患者BMI达标率为70.27%(52/74),高于对照组的53.42%(39/73)(χ^(2)=4.421,P<0.05);观察组患者血压达标率为95.95%(71/74),高于对照组的84.93%(62/73)(χ^(2)=5.171,P<0.05);观察组患者血脂达标率为87.84%(65/74),高于对照组的72.60%(53/73)(χ^(2)=5.386,P<0.05)。结论:清肺泻肝汤治疗太阴人MS患者,可有效调节MS患者肥胖、血压、血糖、血脂组分,减轻临床症状,改善IR,提高胰岛素敏感性和胰岛β细胞功能,并能减轻炎症反应、改善血管内皮功能。

Objective:To discuss the clinical efficacy of Qingfei Xiegantang on chronic inflammation and endothelial function of people of Taiyin constitution with metabolic syndrome(MS). Method: Patients(162 cases)were divided into control group(80 cases)and observation group(82 cases). Both groups got lifestyle intervention and treatment with lipid regulation,blood pressure reduction and hypoglycemia according to MS. Patients in observation group got Qingfei Xiegantang,1 dose/day. Patients in control group got placebo granules of Qingfei Xiegantang. The treatment lasted for 4 months. Before and after treatment,weight,height,waist(WC),hip,body mass index(BMI)and waist hip ratio(WHR)were calculated. Levels of triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1 c)and fasting insulin(FINS)were measured. Insulin resistance index(HOMA-IR),insulin sensitivity index(ISI)and islet beta cell function index(HOMA-β),systolic blood pressure(SBD),diastolic blood pressure(DBP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),leptin(LP),adiponectin(ADP),nitric oxide(NO),endothelin-1(ET-1),endothelial nitric oxide synthase(eNOS)and inducible nitric oxide synthase(iNOS)were detected and recorded. Then the safety was evaluated. Result: Levels of body mass,BMI,WHR,TG,TC,LDL-C,FBG,2 hPG,HbA1 c,HOMA-IR,SBD,DBP,TNF-α,IL-6,LP,ET-1 and iNOS were all lower than those in control group. Levels of HDL-C,InISI,HOMA-β,ADP,NO and eNOS were higher than those in control group(P<0.01). And score of syndrome differentiation of Taiyin people was lower than that in control group(P<0.01). The compliance rate of BMI in observation group was 70.27%(52/74),which was higher than 53.42%(39/73)in control group(χ^(2)=4.421,P<0.05). The compliance rate of blood pressure was 95.95%(71/74),was higher than 84.93%(62/73)in control group(χ^(2)=5.171,P<0.05). The compliance rate of blood fat was 87.84%(65/74),which was higher than 72.60%(53/73)(χ^(2)=5.386,P<0.05).Conclusion: Qingfei Xiegantang can regulate the obesity,blood pressure,blood glucose and blood lipid components of MS,relieve clinical symptoms,improve IR,insulin sensitivity and islet β cell function,reduce inflammatory reaction,and increase vascular endothelial function of people of taiyin constitution with metabolic Syndrome.