补脏泻腑、益气养阴法针刺辅助治疗2型糖尿病气阴两虚证临床研究

Clinical study of acupuncture using the principle of invigorating viscera and purging fu,replenishing qi and nourishing yin for the type 2 diabetes mellitus patients with qi and yin deficiency

目的评价补脏泻腑、益气养阴法针刺辅助治疗T2DM气阴两虚证的疗效。方法将符合入选标准2019年1月1日-2020年12月31日安徽中医药大学第二附属医院T2DM气阴两虚证患者59例,按随机数字表法分为针刺组30例和对照组29例,对照组予以西医常规降糖治疗,针刺组在对照组基础上采用补脏泻腑、益气养阴法针刺治疗。2组均治疗4周。分别于治疗前后进行中医证候评分,采用ELISA法检测血清IL-6水平,免疫比浊法测血清CRP水平,分光光度法测定血清空腹血糖(FPG)、2 hPG、HbAlc及TC、TG、HDL-C、LDL-C水平,计算BMI,评价临床疗效。结果针刺组总有效率为96.7%(29/30)、对照组为75.9%(22/29),2组比较差异有统计学意义(χ^(2)=5.96,P<0.01)。针刺组治疗后倦怠乏力、口燥咽干、自汗盗汗、气短懒言评分均低于对照组(t值分别为6.02、4.31、4.34、3.63,P值均<0.01)。针刺组血清CRP水平治疗后21、48 d低于对照组(t值分别为-4.36、-3.75,P值均<0.01)、IL-6水平治疗后14、21、28 d低于对照组(t值分别为-2.92、-5.35、-8.71,P值均<0.01)。针刺组治疗后血清TC[(4.62±0.68)mmol/L比(5.56±0.72)mmol/L,t=5.16]、TG[(1.48±0.42)mmol/L比(2.12±0.89)mmol/L,t=3.55]、LDL-C[(2.48±0.84)mmol/L比(3.02±0.95)mmol/L,t=2.32]水平低于对照组(P<0.05),HDL-C[(1.39±0.27)mmol/L比(1.26±0.22)mmol/L,t=-2.02]水平高于对照组(P<0.05)。针刺组血清FPG水平治疗后21 d[(6.12±0.67)mmol/L比(6.57±0.61)mmol/L,t=-4.96]、28 d[(5.78±0.52)mmol/L比(6.49±0.58)mmol/L,t=-2.70]低于对照组(P<0.01),2 hPG水平治疗后14 d[(10.23±1.06)mmol/L比(11.76±1.34)mmol/L,t=-4.87]、21 d[(9.05±0.98)mmol/L比(10.53±1.24)mmol/L,t=-5.10]、28 d[(7.45±0.69)mmol/L比(9.31±0.78)mmol/L,t=-9.71]及HbA1c水平治疗后14 d[(7.93±0.86)%比(8.52±0.97)%,t=-2.47]、21 d[(7.63±0.85)%比(8.15±0.92)%,t=-2.26]、28 d[(6.47±0.51)%比(7.51±0.62)%,t=-7.05]低于对照组(P<0.01),BMI[(22.13±1.57)kg/m^(2)比(24.16±1.82)kg/m^(2),t=-4.59]治疗后28 d低于对照组(P<0.01)。结论补脏泻腑、益气养阴法针刺治疗可有效调节T2DM气阴两虚证患者糖脂代谢紊乱状态,改善中医核心证候及微炎症状态,协同降糖作用疗效确切。

Objective To evaluate the effect of acupuncture with invigorating viscera and purging fu,replenishing qi and nourishing yin for the T2DM patients with qi and yin deficiency syndrome.Methods A total of 59 patients who met the inclusion criteria from January 1,2019 to December 31,2020 in the Endocrinology Department of the Second Affiliated Hospital of Anhui University of Chinese Medicine were divided into the acupuncture group with 30 cases and a control group with 29 cases,according to the random number table method.The control group received conventional hypoglycemic treatment.And the acupuncture group was treated with acupuncture on the basis of the control group treatment.Both groups were treated for 4 weeks.TCM syndrome scores were performed before and after treatment,respectively.Serum IL-6 was measured by ELISA,serum CRP by immunoturbidimetry,and serum fasting blood glucose(FPG),2 hPG,HbAlc,TC,TG,HDL-C,LDL-C levels by spectrophotometry.The BMI,clinical effect rates were calculated.Results The total effective rate was 96.7%(29/30)in acupuncture group and 75.9%(22/29)in control group,and the difference was statistically significant(χ^(2)=5.96,P<0.01).After treatment,the scores of fatigue,dryness of mouth and pharynx,spontaneous sweating and night sweating,shortness of breath and lazy speech in acupuncture group were significantly lower than those in the control group(t values were 6.02,4.31,4.34,3.63,respectively,all Ps<0.01).The serum CRP level in acupuncture group was significantly lower than that of the control group at 21,48 d after treatment(t values were-4.36,-3.75,respectively,all Ps<0.01),and IL-6 level was significantly lower than that of the control group at 14,21,28 d after treatment(t values were-2.92,-5.35,-8.71,respectively,all Ps<0.01).After treatment,the serum TC[(4.62±0.68)mmol/L vs.(5.56±0.72)mmol/L,t=5.16],TG[(1.48±0.42)mmol/L vs.(2.12±0.89)mmol/L,t=3.55],LDL-C[(2.48±0.84)mmol/L vs.(3.02±0.95)mmol/L,t=2.32]in the acupuncture group were significantly lower than those in the control group(P<0.05),HDL-C[(1.39±0.27)mmol/L vs.(1.26±0.22)mmol/L,t=-2.02]in the acupuncture group was significantly higher than that of the control group(P<0.05).The serum FPG level at 21 d[(6.12±0.67)mmol/L vs.(6.57±0.61)mmol/L,t=-4.96],28 d[(5.78±0.52)mmol/L vs.(6.49±0.58)mmol/L,t=-2.70]in acupuncture group were significantly lower than those in the control group(P<0.01).The 2h PG level at 14 d after treatment[(10.23±1.06)mmol/L vs.(11.76±1.34)mmol/L,t=-4.87],21 d[(9.05±0.98)mmol/L vs.(10.53±1.24)mmol/L,t=-5.10],28 d[(7.45±0.69)mmol/L vs.(9.31±0.78)mmol/L,t=-9.71]in the acupuncture group were significantly lower than those in the control group(P<0.01),and HbA1c level were decreased 14 d[(7.93±0.86)%vs.(8.52±0.97)%,t=-2.47],21 d[(7.63±0.85)%vs.(8.15±0.92)%,t=-2.26],28 d[(6.47±0.51)%vs.(7.51±0.62)%,t=-7.05]significantly lower than those in the control group(P<0.01),BMI[(22.13±1.57)kg/m^(2)vs.(24.16±1.82)kg/m^(2),t=-4.59]28 d after treatment was significantly lower than that of the control group(P<0.01).Conclusion Acupuncture therapy of nourishing viscera and purging fu,nourishing qi and nourishing yin can regulate the disorder of glucose and lipid metabolism in patients with T2DM and syndrome of qi and yin deficiency.