益气养阴方对2型糖尿病合并动脉粥样硬化患者血清胆红素代谢及胰岛素抵抗影响的临床研究

The clinical research on Yiqi Yangyin recipe on serum bilirubin metabolism and insulin resistance in patients with type 2 diabetes mellitus combined with atherosclerosis

目的 观察益气养阴方对2型糖尿病(type 2 diabetes mellitus,T2DM)合并动脉粥样硬化(atherosclerosis,AS)患者血清胆红素代谢及胰岛素抵抗(insulin resistance,IR)水平的影响。方法 选取2018年10月至2019年9月上海中医药大学附属上海市中西医结合医院内分泌科门诊及住院部收治的T2DM伴AS患者64例,采用随机对照法分为观察组和对照组,每组32例。对照组予以常规治疗,观察组在对照组治疗基础上加用益气养阴方,疗程均为8周。观察中医临床证候总疗效、血清胆红素水平、稳态模型IR指数(homeostasis model assessment of insulin resistance,HOMA-IR)及空腹胰岛素(fasting insulin,FINS)变化。结果 治疗后,观察组血清总胆红素、血清结合胆红素水平较前升高,差异有统计学意义(P<0.001),且观察组改善优于对照组,差异有统计学意义(P<0.001)。在中医证候总疗效方面,两组差异有统计学意义(P<0.05)。观察组HOMA-IR及FINS较治疗前降低,差异有统计学意义(P<0.001),组间比较差异有统计学意义(P<0.001)。结论 益气养阴方可明显改善T2DM伴AS患者血清胆红素代谢及FINS和IR水平,反映了益气养阴方“消渴病”“气阴两虚”的基本病机,体现了“治病必求于本”的原则,为中医药防治T2DM伴AS提供了一个研究方向。

Objective To observe the effects of Yiqi Yangyin recipe on serum bilirubin metabolism and insulin resistance(IR) in patients with type 2 diabetes mellitus(T2DM) combined with atherosclerosis(AS).Methods A total of 64 T2DM patients combined with AS admitted to the outpatient and inpatient Department of Endocrinology,Shanghai University of Traditional Chinese and Western Medicine,Shanghai Traditional Chinese Medicine(TCM)-Integrated Hospital from October 2018 to September 2019 were selected and randomly divided into observation group and control group,with 32 cases in each group.The control group was treated with routine treatment,and the observation group was treated with Yiqi Yangyin recipe on the basis of routine treatment.The course of treatment was 8 weeks.The total curative effect of TCM clinical syndromes,serum bilirubin level,homeostasis model assessment of insulin resistance(HOMA-IR) and fasting insulin(FINS) were observed.Results After treatment,the levels of serum total bilirubin and serum conjugated bilirubin in the observation group were higher than those before treatment and the differences were statistically significant(P<0.001),and the improvement in the observation group was better than that in the control group,the difference was statistically significant(P<0.001).There was singnificant difference in the total curative effect of TCM clinical syndromes between the two groups(P<0.05).HOMA-IR and FINS in the observation group were significantly lower than those before treatment(P<0.001),and difference between the two groups was statistically significant(P<0.001).Conclusion Yiqi Yangyin recipe can significantly improve the metabolism of serum bilirubin and FINS and IR levels in patients with T2DM combined with AS,reflecting the basic pathogenesis of "consumptive thirst" and "deficiency of both Qi and Yin" in Yiqi Yangyin recipe,and embodying the principle of "treating diseases must be based on the principle" and providing a research direction for the prevention and treatment of T2DM combined with AS with TCM.