“调理脾胃”针刺对2型糖尿病患者阿司匹林抵抗的影响:随机对照研究

Effect of acupuncture for regulating spleen and stomach on aspirin resistance in patients with type 2 diabetes mellitus: a randomized controlled trial

目的:观察"调理脾胃"针刺对2型糖尿病患者阿司匹林抵抗(AR)的影响,并探讨其作用机制。方法:将68例2型糖尿病合并AR患者随机分为观察组和对照组,每组34例。在常规糖尿病治疗基础上,对照组予阿司匹林肠溶片口服,每次100 mg,每日1次,观察组在对照组基础上,加用"调理脾胃"针刺,穴取中脘、足三里、阴陵泉、合谷等,每日1次。两组均治疗1周为一疗程,共治疗4个疗程。分别于治疗前后观察两组患者血小板功能指标[血小板聚集率(PAG)、水杨酸浓度]、血管内皮功能指标[6-酮前列腺素F1α(6-keto-PGF1α)、血栓素B2(TXB2)及环氧合酶-2(COX-2)]、血糖[空腹血糖(FPG)、餐后2h静脉血糖(2hPG)、糖化血红蛋白(Hb A1c)]、胰岛素抵抗指数(HOMA-IR)、血脂指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]及中医症状总积分,于治疗后比较两组患者临床疗效及安全性,并于治疗后6个月随访心脑血管事件复发率。结果:治疗后,两组患者PAG、水杨酸浓度、TXB2、COX-2、FPG、2h PG、Hb Alc、HOMA-IR、LDL-C、TC、TG及中医症状总积分均较治疗前降低(P<0.01,P<0.05),6-keto-PGFlα、HDL-C均较治疗前升高(P<0.01,P<0.05),观察组以上指标较对照组改善更显著(P<0.01),观察组总有效率为91.2%(31/34),高于对照组的70.6%(24/34,P<0.05),两组均较安全,无明显不良反应,随访时,观察组心脑血管事件复发率为14.7%(5/34),低于对照组的29.4%(10/34,P<0.05)。结论:"调理脾胃"针刺联合阿司匹林肠溶片治疗可改善2型糖尿病患者的胰岛素抵抗,降低血糖、血脂及心脑血管事件复发率,可能与调节胰岛素抵抗、改善血管内皮功能有关,对阿司匹林抵抗的效果优于单纯阿司匹林肠溶片治疗。

Objective To observe the effect of acupuncture for regulating spleen and stomach on aspirin resistance in patients with type 2 diabetes mellitus(T2 DM) and explore the effect mechanism. Methods A total of 68 T2 DM patients complicated with aspirin resistance were randomized into an observation group and a control group, 34 cases in each one. On the base of the conventional treatment for diabetes, aspirin enteric-coated tablets were prescribed for oral administration,100 mg each time, once daily in the control group. In the observation group, on the basis of the treatment as the control group,acupuncture was used for regulating spleen and stomach at Zhongwan(CV 12), Zusanli(ST 36), Yinlingquan(SP 9), Hegu(LI 4),etc., once daily. The treatment for 1 week was as one course and 4 courses of treatment were required totally in two groups.Before and After treatment, the indexes of platelet function(platelet aggregation rate [PAG] and salicylic acid concentration),the indexes of vascular endothelial function(6-keone prostaglandin F1α[6-keto-PGF1α], thromin B2 [TXB2] and cyclooxysynthase-2 [COX-2]), blood glucose(fasting plasma glucose [FPG], 2 h plasma glucose [2 h PG] and glycosylated hemoglobin [Hb A1 c]), insulin resistance index(HOMA-IR), blood lipid indexes(total cholesterol [TC], triacylglycerol [TG],high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) and the total score of TCM symptoms were observed in the patients of two groups. Clinical therapeutic effect and safety was compared in the patients between the two groups after treatment and the recurrence rate of cardiocerebrovascular events was followed up 6 months after treatment. Results After treatment, PAG, salicylic acid concentration, TXB2, COX-2, FPG, 2 h PG, Hb A1 c,HOMA-IR, LDL-C, TC, TG and the total scores of TCM symptoms were all reduced as compared with those before treatment in the two groups(P<0.01, P<0.05), and 6-keto-PGF1αand HDL-C were increased as compared with those before treatment in the two groups(P<0.01, P<0.05). In comparison with the control group, the aforementioned indexes in the observation group were all improved significantly(P<0.01). The total effective rate was 91.2%(31/34) in the observation group, higher than 70.6%(24/34) in the control group(P < 0.05). In follow up visit, the recurrence rate of cardiocerebrovascular events was 14.7%(5/34) in the observation group, lower than 29.4%(10/34) in the control group(P<0.05). The therapies were safe and had no obvious adverse reactions in both two groups. Conclusion Acupuncture for regulating spleen and stomach combined with aspirin enteric-coated tablets relieve insulin resistance and reduces blood glucose and lipid as well as the recurrence rate of cardiocerebrovascular events in the patients with T2 DM, which is probably related to the regulation of insulin resistance and the improvement of vascular endothelial function. This combined therapy achieves the better effect on aspirin resistance as compared with simple aspirin enteric-coated tablets.