隔药灸联合调胃承气汤对脾虚湿困型糖尿病胃轻瘫疗效观察

Efficacy observation of herb-partitioned moxibustion combined with Tiao Wei Cheng Qi Tang for diabetic gastroparesis due to spleen deficiency with dampness pattern

目的观察隔药灸联合调胃承气汤治疗脾虚湿困型糖尿病胃轻瘫的临床疗效。方法将94例脾虚湿困型糖尿病胃轻瘫患者随机分为治疗组和对照组,每组47例。治疗组采用隔药灸联合调胃承气汤治疗,对照组采用单纯调胃承气汤治疗。检测两组治疗前后胃泌素-17(gastrin-17,G-17)、生长素释放肽(ghrelin)、血管活性肠肽(vasoactive intestinal peptide,VIP)、胃动素(motilin,MTL)、胆囊收缩素(cholecystokinin,CCK)、胃蛋白酶原(pepsinogen,PG)Ⅰ、PGⅡ、空腹血糖(fasting plasma glucose,FPG)、丙二醛(malondialdehyde,MDA)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、超氧化物歧化酶(superoxide dismutase,SOD)和活性氧(reactive oxygen species,ROS)水平,测量患者胃窦收缩幅度、胃窦收缩频率和胃排空率,给予患者胃轻瘫主要症状指数(gastroparesis cardinal symptom index,GCSI)、尼平消化不良生活质量指数(Nepean dyspepsia life quality index,NDLQI)及症状指数(Nepean dyspepsia symptom index,NDSI)评价,观察两组患者临床疗效。结果两组治疗后VIP、CCK、ROS、MDA、FPG水平及GCSI、NDSI评分均较同组治疗前显著下降,G-17、ghrelin、MTL、PGⅠ、PGⅡ、SOD、GSH-Px水平及NDLQI评分均显著上升,胃窦收缩幅度、胃窦收缩频率、胃排空率均较同组治疗前显著升高,差异均具有统计学意义(P<0.05)。治疗组治疗后VIP、CCK、ROS、MDA、FPG水平及GCSI、NDSI评分明显低于对照组,G-17、ghrelin、MTL、PGⅠ、PGⅡ、SOD和GSH-Px水平及胃窦收缩幅度、胃窦收缩频率、胃排空率和NDLQI评分均明显高于对照组,差异均具有统计学意义(P<0.05)。治疗组总有效率为95.7%,明显高于对照组的83.0%(P<0.05)。结论隔药灸联合调胃承气汤对脾虚湿困型糖尿病胃轻瘫疗效确切,可提升患者胃动力,改善胃黏膜功能,降低氧化应激及血糖水平,促进胃肠收缩,改善其临床症状和生活质量。

Objective To observe the clinical efficacy of treating diabetic gastroparesis due to spleen deficiency with dampness pattern with herb-partitioned moxibustion plus Tiao Wei Cheng Qi Tang.Method Ninety-four patients with diabetic gastroparesis due to spleen deficiency with dampness pattern were randomly allocated to a treatment group and a control group,with 47 cases in each group.The treatment group received herb-partitioned moxibustion plus Tiao Wei Cheng Qi Tang,and the control group only received Tiao Wei Cheng Qi Tang.Before and after the treatment,the levels of gastrin-17(G-17),ghrelin,vasoactive intestinal peptide(VIP),motilin(MTL),cholecystokinin(CCK),pepsinogen(PG)Ⅰ,PGⅡ,fasting plasma glucose(FPG),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),and reactive oxygen species(ROS)were detected;the gastric antrum contraction amplitude and frequency and gastric emptying rate were measured;the gastroparesis cardinal symptom index(GCSI),Nepean dyspepsia life quality index(NDLQI),and Nepean dyspepsia symptom index(NDSI)were assessed.The clinical efficacy was also observed for the two groups.Result After the treatment,the levels of VIP,CCK,ROS,MDA,and FPG,and the GCSI and NDSI scores decreased notably in both groups;the levels of G-17,ghrelin,MTL,PGⅠ,PGⅡ,SOD,and GSH-Px and the NDLQI score increased significantly;the gastric antrum contraction amplitude and frequency and gastric emptying rate accelerated compared with those before the treatment in each group;the differences were all statistically significant(P<0.05).After the intervention,the levels of VIP,CCK,ROS,MDA,and FPG and the GCSI and NDSI scores were lower in the treatment group than in the control group;the levels of G-17,ghrelin,MTL,PGⅠ,PGⅡ,SOD,and GSH-Px,gastric antrum contraction amplitude and frequency,gastric emptying rate,and the NDLQI score were higher in the treatment group than in the control group;the between-group differences were statistically significant(P<0.05).The total effective rate was 95.7%,markedly higher than 83.0%in the control group(P<0.05).Conclusion Herb-partitioned moxibustion plus Tiao Wei Cheng Qi Tang is effective in treating diabetic gastroparesis due to spleen deficiency with dampness pattern;this method can accelerate gastric motility,improve gastric mucosal function,lower oxidative stress and blood glucose levels,boost gastrointestinal contraction,and improve clinical symptoms and quality of life.