芪贞颗粒“异病同治”治疗气虚型2型糖尿病及腹型肥胖的临床研究

Clinical study on Qizhen granules for treating type 2 diabetes mellitus of Qi deficiency type and abdominal obesity with concept of"treating different diseases with same method"

目的从“异病同治”的角度研究芪贞颗粒对气虚型2型糖尿病(type 2 diabetes mellitus,T2DM)及腹型肥胖患者的临床疗效。方法纳入2018年1月至2019年12月就诊于上海中医药大学附属岳阳中西医结合医院内分泌科住院部和门诊的气虚型T2DM及腹型肥胖患者各60例,采用随机对照的方法将两类患者分成观察组及对照组,每组30例。T2DM组在饮食、运动治疗及原有降糖方案基础上,其观察组及对照组分别加用芪贞颗粒及对照药物;腹型肥胖组在饮食、运动治疗基础上,其观察组及对照组分别加用芪贞颗粒及对照药物。疗程均为12周。观察气虚型T2DM组治疗前后糖代谢指标、腹型肥胖组形体学指标及两类患者稳态模型胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)变化。结果治疗后,T2DM观察组空腹血糖、2 h餐后血糖、糖化血红蛋白较治疗前明显下降(P<0.01),且观察组优于对照组,差异均有统计学意义(P<0.05)。腹型肥胖观察组体质量指数、腰围、腰臀比较治疗前明显改善(P<0.01),且观察组优于对照组,差异均有统计学意义(P<0.01)。两类患者观察组HOMA-IR均显著下降(P<0.01),且观察组优于对照组,差异均有统计学意义(P<0.05)。两类患者观察组中医证候疗效均优于对应的对照组,差异均有统计学意义(P<0.01)。结论对于气虚型T2DM及腹型肥胖患者,芪贞颗粒可通过“异病同治”,且可能是“益气”的方式来改善胰岛素抵抗,进而改善患者病症。

Objective To study the clinical effects of Qizhen granules on patients with type 2 diabetes mellitus(T2DM)of Qi deficiency type and abdominal obesity with concept of"treating different diseases with same method".Methods A total of 60 patients with T2DM of Qi deficiency type and 60 patients with abdominal obesity were included in the inpatient and outpatient departments of endocrinology,Yueyang hospital of integrated traditional Chinese and western medicine,Shanghai university of traditional Chinese medicine(TCM)from January 2018 to December 2019.The two types of patients were randomly divided into observation group and control group,with 30 cases in each group.On the basis of diet,exercise therapy and maintaining the original hypoglycemic regimen in T2DM group,Qizhen granules and control drug were added to the observation group and control group respectively.On the basis of diet and exercise therapy,the observation group and the control group were treated with Qizhen granules and control drug respectively.The course of treatment was 12 weeks.The indexes of saccharometabolism in T2DM group and the physique in abdominal obesity group were observed before and after treatment.The homeostasis model assessment of insulin resistance(HOMA-IR)was compared between the two groups of patients.Results After treatment,fasting blood glucose,2-hour postprandial blood glucose and glycosylated hemoglobin in the T2DM observation group were significantly lower than those in the T2DM control group(P<0.01).And the observation group was better than the control group,the difference was statistically significant(P<0.05).The body mass index,waist circumference and waist hip of the abdominal obesity observation group were significantly improved compared with those before treatment(P<0.01),and the observation group was better than the control group(P<0.01).HOMA-IR in the two groups decreased significantly(P<0.01),And the observation group was better than the control group,the difference was statistically significant(P<0.05).The curative effect of TCM syndromes in the observation group was better than that in the corresponding control group,and the difference was statistically significant(P<0.01).Conclusion Qizhen granules can treat different diseases at the same time for patients with T2DM of syndrome of Qi deficiency and abdominal obesity with concept of"treating different diseases with same method",and it may improve IR and symptoms by supplementing Qi.