消渴通冠方对2型糖尿病合并冠心病老年患者胰岛功能及预后影响的观察研究

Effect of Xiaoke Tongguan recipe on islet function and prognosis of elderly patients with type 2 diabetes mellitus complicated with coronary heart disease

目的探讨消渴通冠方辅助治疗老年2型糖尿病合并冠心病患者对其胰岛功能保护及预后影响。方法选取上海市静安区市北医院2020年11月—2022年9月接诊的老年2型糖尿病合并冠心病患者150例为本次的研究对象,将150例研究对象按随机数字表法将其随机分为观察组和对照组,每组75例,后期对照组脱落3例,实际入组147例。对照组予以甘精胰岛素进行治疗,观察组在对照组基础上予以消渴通冠方辅助治疗8周。对比2组治疗后的临床疗效、胰岛素敏感指数(IAI)、胰岛素分泌指数(HOMA-β)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、糖脂代谢餐后2 h血糖(2 hPG)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、氧化应激指标丙二醛(MDA)、血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、心脏不良事件发生情况。结果观察组临床总有效率高于对照组(93.33%vs 76.39%)(P<0.05);观察组IAI、HbA1c及HOMA-IR低于对照组,而OMA-β高于对照组(P<0.05);观察组糖脂代谢2 hPG、FPG、TG及TC水平均低于对照组(P<0.05);观察组MDA水平低于对照组,而GSH-Px及SOD水平均高于对照组(P<0.05);随访6个月,观察组急性冠脉综合征发生率、不稳定性心绞痛发生率及靶血管重建发生率均低于对照组[(8.00%vs 19.44%)、(5.33%vs 16.67%)、(5.33%vs 20.83%)](P<0.05)。结论消渴通冠方辅治老年2型糖尿病合并冠心病患者,不仅可以改善患者的胰岛素功能和糖脂代谢,还能降低患者体内氧化应激反应,缓解临床症状,提高预后效果。

Objective To investigate the effect of Xiaoke Tongguan recipe on the protection of pancreatic islet function and prognosis of elderly patients with type 2 diabetes mellitus complicated with coronary heart disease.Methods 150 elderly patients with type 2 diabetes mellitus complicated with coronary heart disease who were admitted to Shibei Hospital in Jing an District from November 2020 to September 2022 were selected as the research subjects.They were randomly divided into observation group and control group according to the random number table method,with 75 cases in each group.In the later stage,3 cases fell out in the control group,and 147 ones were actually enrolled.The control group was treated with insulin glargine,and the observation group was treated with Xiaoke Tongguan recipe for 8 weeks on the basis of control group.The clinical efficacy,insulin sensitivity index(IAI),insulin secretion index(HOMA-β),glycated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),glucose and lipid metabolism at 2 h after meals(2hPG),fasting blood glucose(FPG),total cholesterol(TC),triacylglycerol(TG),oxidative stress indexes[malondialdehyde(MDA),serum glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)],and cardiac adverse events were compared between the two groups.Results The total effective rate of the observation group was higher than that of the control group(93.33%vs 76.39%)(P<0.05).The levels of IAI,HbA1c and HOMA-IR of the observation group were lower than those of the control group,while the level of OMA-βwas higher than that of the control group(P<0.05).The levels of 2hPG,FPG,TG and TC of the observation group were lower than those of the control group(P<0.05).The level of MDA of the observation group was lower than that of the control group,but the levels of GSH-Px and SOD were higher than those of the control group(P<0.05).During the 6-month follow-up period,the incidence of acute coronary syndrome,unstable angina pectoris,and target vessel reconstruction in the observation group were lower than those in the control group[(8.00%vs 19.44%),(5.33%vs 16.67%),(5.33%vs 20.83%)](P<0.05).Conclusion When used in the adjuvant treatment of elderly patients with type 2 diabetes mellitus complicated with coronary heart disease,Xiaoke Tongguan recipe can not only improve the islet function and glucose and lipid metabolism,but also reduce the oxidative stress response,alleviate clinical symptoms and improve the prognosis of patients.