益气养阴活血法治疗2型糖尿病合并慢性心力衰竭患者的疗效观察

Clinical Observation of Syndrome Differentiation Treatment of Type 2 Diabetes Mellitus with Chronic Heart Failure by Supplementing Qi,Nourishing Yin and Activating Blood

目的 探讨中医益气养阴活血法辨证治疗2型糖尿病(Type 2 diabetes, T2DM)合并慢性心力衰竭(Chronic heart failure, CHF)患者的临床疗效。方法 选取2021年1月—2022年1月期间唐山市中医医院内分泌一科收治的T2DM合并CHF患者102例作为研究对象,按随机数字表法分为对照组与治疗组,每组各51例。对照组给予常规西医治疗,治疗组在对照组基础上联合中医益气养阴活血法辨证治疗,均治疗12周。观察比较两组患者西医疗效、中医证候疗效、安全性及治疗前后血糖水平[空腹血糖(Fasting blood glucose, FPG)、餐后2 h血糖(Blood glucose 2 h after a meal, 2 h PG)、糖化血红蛋白(Glycosylated hemoglobin, HbAlc)]、心功能指标[6分钟步行试验距离(6 min walking test, 6MWT)、左室射血分数(Left ventricular ejection fraction, LVEF)、N末端B型脑钠肽前体(N-terminal B-type brain natriuretic peptide precursor, NT-pro BNP)]、生活质量评分[T2DM生活质量(Quality of life specific scale for diabetes patients, DSQL)、CHF生活质量(Minnesota Living with Heart Failure Questionnaire, MLHFQ)]变化。结果 临床疗效:治疗后治疗组西医疗效总有效率96.08%(49/51)高于对照组82.35%(42/51),差异有统计学意义(P<0.05);治疗组中医证候疗效总有效率92.16%(47/51)高于对照组68.63%(35/51),差异有统计学意义(P<0.05)。血糖水平:治疗后两组患者血糖FPG、2 h PG及HbAlc水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组血糖FPG、2 h PG及HbAlc水平均明显低于对照组,差异有统计学意义(P<0.05)。心功能指标:治疗后两组患者心功能6MWT、LVEF水平较治疗前升高,NT-pro BNP水平较治疗前降低,差异有统计学意义(P<0.05);且治疗组6MWT、LVEF水平高于对照组,NT-pro BNP水平低于对照组,差异有统计学意义(P<0.05)。生活质量:治疗后两组患者DSQL、MLHFQ评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组DSQL、MLHFQ评分均明显低于对照组,差异有统计学意义(P<0.05)。安全性:治疗期间,两组患者不良反应均为轻度或一过性,未影响治疗,且不良反应发生率组间比较,差异无统计学意义(P>0.05)。结论 中医益气养阴活血法辨证治疗T2DM合并CHF效果显著、安全性高,有利于控制患者血糖,改善心功能与生活质量。

Objective To examine the clinical efficacy of traditional Chinese medicine(TCM)therapy of supplementing Qi,nourishing Yin,and activating blood in the treatment of patients with type 2 diabetes mellitus(T2DM)complicated with chronic heart failure(CHF).Methods A total of 102 T2DM patients with CHF admitted to the Department of Endocrinology,Tangshan Hospital of Traditional Chinese Medicine from January 2021 to January 2022 were randomly divided into a control group and a treatment group by a random number table,with 51 in each group.The control group was treated with conventional Western medicine,while the treatment group received the TCM therapy in combination with conventional treatment.Both groups underwent treatment for 12 weeks.This paper compared the Western treatment outcomes,TCM syndrome treatment efficacy,safety,and changes in blood glucose[fasting blood glucose(FPG),blood glucose 2 hours after a meal(2 h PG),glycosylated hemoglobin(HbAlc)],cardiac function indicators[6-minute walking test distance(6MWT),left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP)],and quality of life scores[Diabetes-specific Quality of Life(DSQL),and Minnesota Living with Heart Failure Questionnaire(MLHFQ)]between the two groups.Results Clinical efficacy:The total effective rate of Western medicine treatment in the treatment group(96.08%,49/51)and the TCM syndrome treatment efficacy(92.16%,47/51)were higher than those in the control group(82.35%,42/51 and 68.63%,35/51,respectively)(P<0.05).Blood glucose:Both groups showed a decrease in FPG,2h PG,and HbAlc after treatment,with the treatment group exhibiting lower levels than the control group(P<0.05).Cardiac function indicators:Post-treatment 6MWT and LVEF increased while NT-proBNP decreased in both groups(P<0.05),with the treatment group having greater improvements than the control group.Quality of life:The scores of DSQL and MLHFQ decreased after treatment in both groups(P<0.05),and the treatment group scored lower than the control group(P<0.05).Safety:During treatment,all adverse reactions were mild or transient and did not affect the treatment.There was no significant difference in the incidence of adverse reactions between the groups(P>0.05).Conclusion The TCM method of supplementing Qi,nourishing Yin,and activating blood was an effective and safe treatment for T2DM patients with CHF,which helped to control blood sugar,improve cardiac function,and enhance the quality of life.