加味黄芪桂枝五物汤治疗老年2型糖尿病下肢血管病变临床研究

Efficacy of modified decoction of five drugs containing Astragalus Root and Cassia Twig on lower limb vasculopathy of type 2 diabetes mellitus in the elderly

目的 探讨加味黄芪桂枝五物汤对老年2型糖尿病下肢血管病变患者糖脂代谢、神经功能的影响及可能作用机制。方法 选取2019年3月—2021年3月就诊于陕西中医药大学第二附属医院的150例老年糖尿病下肢血管病变患者,随机分为对照组和研究组各75例。对照组给予常规西医治疗,研究组在对照组治疗基础上给予加味黄芪桂枝五物汤治疗,2组患者均连续治疗3个月。观察2组患者治疗前后血清糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、炎症相关指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、氧化应激相关指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、氧化型低密度脂蛋白(Ox-LDL)]、疾病进展相关指标[内脏脂肪特异性丝氨酸蛋白酶抑制剂(Vaspin)、视黄醇结合蛋白4(RBP4)]及左胫神经、右胫神经传导速度。结果 治疗后,2组患者FPG、2hPG、HbAlc及血清TC、TG、LDL-C、CRP、IL-6、TNF-α、MDA、Ox-LDL、RBP4水平均明显降低(P均<0.05),血清HDL-C、SOD、Vaspin水平均明显升高(P均<0.05),左胫神经、右胫神经运动神经传导速度与感觉神经传导速度均明显加快(P均<0.05),且研究组上述各项指标改善情况均明显优于对照组(P均<0.05)。结论 加味黄芪桂枝五物汤可以有效调节老年糖尿病下肢血管病变患者机体糖脂代谢,改善神经功能,可能与其抗炎、抗氧化应激、保护血管作用有关。

Objective It is to explore the effects of modified decoction of five drugs containing Astragalus Root and Cassia Twig on glucose and lipid metabolism,nerve function and its possible mechanism of action in elderly patients with type 2 diabetes mellitus with lower limb vasculopathy.Methods A total of 150 cases of elderly patients with diabetic lower limb vasculopathy treated in the Second Affiliated Hospital of Shaanxi University of Chinese Medicine from March 2019 to March 2021 were selected and randomly divided into control group and the study group,with 75 cases in each group.The control group was treated with conventional western medicine,and the study group was treated with modified decoction of five drugs containing Astragalus Root and Cassia Twig on the basis of the treatment of the control group,and the patients in both groups were treated continuously for 3 months.The serum glucose and lipid metabolism indexes[fasting plasma glucose(FPG),postprandial 2 h glucose(2hPG),glycosylated hemoglobin(HbAlc),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],inflammation-related indexes[C reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],oxidative stress-related markers[superoxide dismutase(SOD),malondialdehyde(MDA),oxidized low-density lipoprotein(Ox-LDL)],and disease progression-related markers[visceral fat-specific serine protease inhibitor(Vaspin),retinol binding protein 4(RBP4)]and nerve conduction velocity of left and right tibial nervea of patients of the two groups were observed before and after treatment.Results After treatment,the levels of FPG,2hPG,HbAlc,and serum levels of TC,TG,LDL-C,CRP,IL-6,TNF-α,MDA,Ox-LDL,and RBP4 were significantly reduced,and serum levels of HDL-C,SOD,and Vaspin were significantly increased(all P<0.05),the motor nerve conduction velocity and sensory nerve conduction velocity of left and right tibial nerves were significantly accelerated in the patients of the two groups(all P<0.05),and the improvements of the above indexes in the study group were significantly better than those in the control group(all P<0.05).Conclusion Modified decoction of five drugs containing Astragalus Root and Cassia Twig can effectively regulate the glucose and lipid metabolism and improve the neurological function of elderly patients with diabetic lower limb vasculopathy,which may be related to its anti-inflammatory,anti-oxidative stress,and vascular protection effects.