健脾益气通络汤治疗脾虚血瘀型2型糖尿病合并非酒精性脂肪肝疗效及对血清脂联素的影响

Therapeutic effect of Jianpi Yiqi Tongluo decoction on type 2 diabetes mellitus with non-alcoholic fatty liver of type of spleen deficiency and blood stasis and its effect on serum adiponectin

目的探讨健脾益气通络汤治疗脾虚血瘀型2型糖尿病合并非酒精性脂肪肝患者的疗效及对血清脂联素(APN)的影响。方法选取2020年3—12月于河北中医学院第一附属医院内分泌科住院的脾虚血瘀型2型糖尿病合并非酒精性脂肪肝患者80例,采用随机数表法将其分为对照组40例和治疗组40例,2组患者均在生活方式干预基础上给予降糖、降压、降脂等对症治疗,治疗组在此基础上加用健脾益气通络汤口服,2组患者均治疗12周。观察2组治疗前后中医症状积分以及空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、游离脂肪酸(FFA)、APN、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平的变化,比较2组总体治疗效果,记录治疗过程中患者不良反应发生情况。结果2组患者治疗后血清HOMA-IR、HbA1c、TG、LDL-C、FFA水平均较治疗前降低,治疗组各指标明显低于对照组,差异均有统计学意义(P均<0.05);对照组治疗后中医症状积分及血清APN、TNF-ɑ、IL-6水平均变化不明显(P均>0.05),治疗组治疗后中医症状评分及血清TNF-ɑ、IL-6水平均低于治疗前及同期对照组,血清APN水平明显高于治疗前及同期对照组,差异均有统计学意义(P均<0.05)。对照组总有效率为65.8%(25/38),治疗组为94.9%(37/39),治疗组总有效率明显高于对照组(P<0.05);2组整个用药过程中均未见严重不良反应。结论健脾益气通络汤能够改善脾虚血瘀型2型糖尿病合并非酒精性脂肪肝患者肝脏脂肪变程度,缓解患者的临床症状,这一作用可能与提高血清APN水平,减少炎症因子的释放,从而减轻胰岛素抵抗,增加脂肪氧化,抑制FFA生成,改善糖脂代谢相关。

Objective It is to investigate the curative effect of Jianpi Yiqi Tongluo decoction in the treatment of type 2 diabetes mellitus with non-alcoholic fatty liver of type of spleen deficiency and blood stasis and its effect on serum adiponectin(APN).Methods Eighty patients with type 2 diabetes mellitus with non-alcoholic fatty liver of type of spleen deficiency and blood stasis who were hospitalized in the department of endocrinology of the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine from March to December 2020 were selected and divided into a control group of 40 cases and a treatment group of 40 cases by random number table method.The patients in both groups were given symptomatic treatments such as hypoglycemic,hypotensive,and hypolipidemic treatment on the basis of lifestyle intervention.The treatment group was additionally given Jianpi Yiqi Tongluo decoction orally,both groups were treated for 12 weeks.The traditional Chinese medicine symptom scores,and the levels of fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index(HOMA-IR),glycosylated hemoglobin(HbA1c),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),free fatty acids(FFA),APN,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)before and after treatment were observed in the two groups,the overall treatment effect of the two groups were compared,and the occurrence of adverse effects of patients during the treatment process was recorded.Results The levels of serum HOMA-IR,HbA1c,TG,LDL-C,and FFA after treatment were lower than those before treatment in the two groups,and each index in the treatment group was significantly lower than that in the control group,and the differences were all statistically significant(all P<0.05);after treatment,the traditional Chinese medicine symptom score,levels of serum APN,TNF-αand IL-6 in the control group did not change significantly(all P>0.05),the traditional Chinese medicine symptom score and levels of serum TNF-αand IL-6 in the treatment group were lower than those before treatment and in the control group at the same period,and the serum APN level was significantly higher than those before treatment and in the control group at the same period,and the differences were all statistically significant(all P<0.05).The total effective rate was 65.8%(25/38)in the control group and 94.9%(37/39)in the treatment group,the total effective rate in the treatment group was significantly higher than that in the control group(P<0.05).There were no serious adverse reactions in the two groups during the entire medication process.Conclusion Jianpi Yiqi Tongluo decoction can improve the degree of hepatic steatosis,relieve the clinical symptoms of patients type 2 diabetes mellitus with non-alcoholic fatty liver of type of spleen deficiency and blood stasis.This effect may be related to increasing serum APN and reducing the release of inflammatory factors,thereby reducing insulin resistance,increasing fat oxidation,inhibiting FFA production,and improving glucose and lipid metabolism.