加减二陈汤联合十二经流注针刺治疗2型糖尿病合并非酒精性脂肪性肝病痰湿内蕴证临床观察

Clinical observation of modified Erchen decoction combined with twelve-channel injection acupuncture in treating phlegm-dampness accumulation syndrome of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease

目的:探究加减二陈汤联合十二经流注针刺治疗2型糖尿病合并非酒精性脂肪性肝病痰湿内蕴证的临床疗效。方法:选取2020年10月―2021年12月日照市中医医院收治的2型糖尿病合并非酒精性脂肪性肝病痰湿内蕴证患者60例,随机分为治疗组(30例)和对照组(30例),对照组口服多烯磷脂酰胆碱胶囊与盐酸二甲双胍片治疗,治疗组在此治疗基础上再予口服加减二陈汤,并于巳时(9点)针刺大都穴、三阴交穴、足三里穴、商丘穴、阴陵泉穴、地机穴、丰隆穴、水分穴等穴位,隔日1次。治疗8周后观察并比较两组患者的临床疗效、血脂[三酰甘油(Triglycerides,TG)、总胆固醇(Total Cholesterol,TC)、低密度脂蛋白胆固醇(Low-density Lipoprotein Cholesterol,LDL-C)]水平、空腹血糖(Glucose,GLU)、餐后2 h血糖(2 h Postprandial Blood Glucose,2 h PG)、糖化血红蛋白(Glycosylated Hemoglobin,Hb A1c)、空腹胰岛素(Fasting Insulin,FINS)、胰岛素抵抗指数(Homa Insulin-resistance,HOMA-IR)、肝功能指标[丙氨酸氨基转移酶(Alanine Transaminase,ALT)、天门冬氨酸氨基转移酶(Aspartate Aminotransferase,AST)]水平、脂联素、肝脏影像学表现及不良反应发生情况等。结果:治疗组的总有效率为93.3%,与对照组的80.0%相比差异有统计学意义(P<0.05);治疗后两组的TG、TC、LDL-C、ALT、AST、GLU、2 h PG、Hb A1c、FINS、HOMA-IR水平显著下降,脂联素明显升高,且治疗组变化更为显著,差异具有统计学意义(P <0.05);未发现与加减二陈汤口服有关的不良反应。结论:在降脂降糖的基础治疗上,采用加减二陈汤联合十二经流注针刺治疗2型糖尿病合并非酒精性脂肪性肝病痰湿内蕴证患者,可以更有效地控制血脂与血糖水平,并可保护肝功能,提高胰岛素敏感性,调节脂代谢,临床疗效确切,使用安全。

Objective:To explore the clinical efficacy of modified Erchen decoction(加减二陈汤)combined with twelve-channel injection acupuncture in the treatment of phlegm-dampness accumulation syndrome of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease.Methods:A total of 60 patients with phlegm-dampness accumulation syndrome of type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease admitted to Rizhao Hospital of Traditional Chinese Medicine from October 2020 to December 2021 were randomly divided into the treatment group(30 cases)and the control group(30 cases).The control group was treated with polyene phosphatidylcholine capsule and metformin tablet orally,and the treatment group was treated with modified Erchen decoction on the basis of the treatment in the control group.Acupoints such as Dadu point(SP2),Sanyinjiao point(SP6),Zusanli point(ST36),Shangqiu point(SP5),Yinlingquan point(SP9),Diji point(SP8),Fenglong point(ST40)and Shuifen point(RN9)were needled at 9 am(9:00 am)every other day.After 8 weeks of treatment,the clinical efficacy,the levels of blood lipids[triglyceride(TG),cholesterol(TC),low density lipoprotein(LDL)],blood glucose before meals,and blood glucose at 2 hours after meals in the two groups were observed and compared.Glycosylated hemoglobin(HbA1c),fasting insulin(FINS),insulin resistance index(HOMA-IR),liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)]levels,adiponectin(APN),liver imaging findings and the incidence of adverse reactions were compared.Results:The total effective rate in the treatment group was 93.3%,which was significantly different from that in the control group(80.0%)(P<0.05).After treatment,the levels of TG,TC,LDL-C,ALT,AST,GLU,2 h PG,HbA1c,FINS and HOMA-IR in the two groups were significantly decreased,while APN was significantly increased,and the changes were more significant in the treatment group,the differences were statistically significant(P<0.05).No adverse reactions related to oral administration of Modified Erchen decoction were found.Conclusion:In addition to the basic treatment of lowering lipid and glucose,modified Erchen decoction combined with twelve-meridian injection acupuncture can more effectively control blood lipid and blood glucose levels,protect liver function,improve insulin sensitivity and regulate lipid metabolism in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease with phlegm-dampness accumulation syndrome,which has definite clinical efficacy and is safe in application.