针药并用治疗气阴两虚兼瘀型糖尿病性勃起功能障碍的疗效观察及对血管内皮功能及相关生长因子的影响

Therapeutic observation of acupuncture combined with medication for diabetic erectile dysfunction due to dual deficiency of Qi and Yin complicated by stasis and its effects on vascular endothelial function and related growth factors

目的 观察针刺联合益气养阴活血方治疗气阴两虚兼瘀型糖尿病性勃起功能障碍的临床疗效及对血管内皮功能及相关生长因子的影响。方法 将90例气阴两虚兼瘀型糖尿病性勃起功能障碍患者随机分为治疗组和对照组,每组45例。对照组予糖尿病基础治疗及他达拉非片口服治疗,治疗组在对照组基础上采用针刺联合益气养阴活血方。比较两组国际勃起功能指数-5(international index of erectile function-5, IIEF-5)评分和中医证候积分变化,比较两组血清内皮素-1(endothelin-1, ET-1)、血管紧张素-Ⅱ(angiotensin Ⅱ, Ang-Ⅱ)、一氧化氮(nitric oxide, NO)和血管活性肠肽(vasoactive intestinal peptide, VIP)含量变化,比较两组血清内皮生长因子(vascular endothelial growth factor, VEGF)、转化生长因子-β(transforming growth factor-β, TGF-β)、成纤维细胞生长因子-21(fibroblast growth factor 21, FGF-21)和胰岛素样生长因子-1(insulin-like growth factor 1, IGF-1)含量变化,并比较两组临床疗效。结果 治疗后,两组IIEF-5评分高于治疗前(P<0.05),对照组勃起无力、腰膝酸软、阴部刺痛及中医证候积分总分低于治疗前(P<0.05),治疗组中医证候各项积分及总分低于治疗前(P<0.05);且治疗组IIEF-5评分高于对照组(P<0.05),治疗组中医证候各项积分及总分低于对照组(P<0.05)。治疗后,两组血清ET-1和AngⅡ低于治疗前,NO和VIP高于治疗前(P<0.05);且治疗组血清ET-1和AngⅡ低于对照组,NO和VIP高于对照组(P<0.05)。治疗后,两组血清VEGF和IGF-1高于治疗前,TGF-β和FGF-21低于治疗前(P<0.05);且治疗组血清VEGF和IGF-1高于对照组,TGF-β和FGF-21低于对照组(P<0.05)。治疗组总有效率为90.7%,高于对照组的73.8%(P<0.05)。结论 在西药治疗的基础上,针刺联合益气养阴活血方能够改善气阴两虚兼瘀型糖尿病性勃起功能障碍患者临床症状,提高治疗效果,可能与改善血管内皮功能、调节相关生长因子有关。

Objective To observe the clinical efficacy of acupuncture plus Yi Qi Yang Yin Huo Xue Fang in treating diabetic erectile dysfunction(DED)due to dual deficiency of Qi and Yin complicated by stasis and the effects on vascular endothelial function and related growth factors.Method Ninety patients with DED due to dual deficiency of Qi and Yin complicated by stasis were randomized into a treatment group and a control group,with 45 cases in each group.The control group received oral Tadalafil tablets,and the treatment group additionally received acupuncture plus Yi Qi Yang Yin Huo Xue Fang. Changes in the following items were compared: the international index of erectile function-5 (IIEF-5) score, the symptom score of traditional Chinese medicine (TCM), and serum contents of endothelin-1 (ET-1), angiotensin Ⅱ (Ang-Ⅱ), nitric oxide (NO), vasoactive intestinal peptide (VIP), vascular endothelial growth factor (VEGF), transforming growth factor-b (TGF-b), fibroblast growth factor 21 (FGF-21), and insulin-like growth factor 1 (IGF-1). The clinical efficacy was also compared between the two groups. Result After the treatment, the IIEF-5 score increased in both groups (P<0.05), the scores of erectile weakness, soreness in the lower back and knees, and stinging pain in the genitals, and the TCM symptom general score dropped in the control group (P<0.05), the TCM symptom component and total scores dropped in the treatment group (P<0.05);the IIEF-5 score was higher in the treatment group than in the control group (P<0.05), and the TCM symptom component and total scores were lower in the treatment group than in the control group (P<0.05). After the intervention, the serum ET-1 and AngⅡ contents dropped, and the NO and VIP contents increased in both groups (P<0.05);the serum ET-1 and AngⅡ contents were lower in the treatment group than in the control group, and the NO and VIP contents were higher in the treatment group (P<0.05). After the treatment, the serum VEGF and IGF-1 contents increased, and the TGF-b and FGF-21 contents dropped in the two groups (P<0.05);the serum VEGF and IGF-1 contents in the treatment group were higher than those in the control group, and the TGF-b and FGF-21 contents were lower in the treatment group (P<0.05). The total effective rate was 90.7% in the treatment group, higher than 73.8% in the control group (P<0.05). Conclusion Based on the Western pharmaceutical treatment, acupuncture plus Yi Qi Yang Yin Huo Xue Fang can improve clinical symptoms and enhance efficacy in treating patients with DED due to dual deficiency of Qi and Yin complicated by stasis. This may be associated with improving vascular endothelial function and regulating pertinent growth factors.