黄连温胆汤联合西格列汀治疗老年T2DM的效果及对患者炎症水平的影响

Effect of Huanglian Wendan Tang combined with sitagliptin in the treatment of elderly T2DM patients and its impact on inflammation levels in patients

目的探究黄连温胆汤联合西格列汀治疗老年2型糖尿病(T2DM)效果及对患者炎症水平的影响。方法回顾性分析2020年5月至2023年5月鹿邑县人民医院收治的108例老年T2DM患者的临床资料,按照治疗方案不同分为对照组52例和研究组56例。对照组患者予以常规生活方式干预联合西格列汀治疗,研究组患者在对照组治疗的基础上加用黄连温胆汤,两组患者均连续治疗8周。治疗8周后,比较两组患者的治疗效果,以及治疗前后的糖脂代谢相关指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)]、胰岛素相关指标[胰岛素敏感指数(ISI)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、炎症因子水平[肿瘤坏死因子(TNF-α)、白细胞介素(IL)-6、IL-10]和血清核因子-κB(NF-κB)m RNA和Toll样受体4(TLR4)m RNA表达水平,同时比较两组患者治疗期间的药物不良反应情况。结果研究组患者的治疗总有效率为85.71%,明显高于对照组的67.31%,差异有统计学意义(P<0.05);治疗前,两组患者的糖脂代谢相关指标比较差异无统计学意义(P>0.05),治疗8周后,两组患者的糖脂代谢相关指标较治疗前均降低,且研究组患者的FPG、2 h PG、LDL-C、TC分别为(5.89±1.32)mmoL/L、(10.21±2.30)mmoL/L、(2.83±0.57)mmoL/L、(4.62±0.61)mmoL/L,明显低于对照组的(7.22±1.44)mmoL/L、(12.32±2.25)mmoL/L、(3.22±0.49)mmoL/L、(5.01±0.47)mmoL/L,差异均有统计学意义(P<0.05);治疗前,两组患者的ISI、HOMA-β及HOMA-IR水平比较差异均无统计学意义(P>0.05),治疗8周后,两组患者的ISI、HOMA-β水平较治疗前均升高,而HOMA-IR较治疗前均降低,且研究组患者的ISI、HOMA-β水平明显高于对照组,HOMA-IR水平明显低于对照组,差异均有统计学意义(P<0.05);治疗前,两组患者的TNF-α、IL-6、IL-10及NF-κB m RNA及TLR4 m RNA表达水平比较差异均无统计学意义(P>0.05),治疗8周后,两组患者的TNF-α、IL-6及NF-κB mRNA及TLR4 mRNA表达水平较治疗前均降低,而IL-10水平较治疗前均升高,且研究组患者的TNF-α、IL-6及NF-κB mRNA及TLR4 mRNA表达水平明显低于对照组,IL-10水平明显高于对照组,差异均有统计学意义(P<0.05);治疗期间对照组患者药物不良反应发生率为7.69%,略高于研究组的7.14%,但差异无统计学意义(P>0.05)。结论黄连温胆汤联合西格列汀治疗老年T2DM的效果显著,能有效改善患者糖脂代谢水平及胰岛素抵抗情况,减轻患者炎症反应,其作用机制可能与调控机体TLR4/NF-κB通路表达有关。

Objective To explore the effect of Huanglian Wendan Decoction combined with sitagliptin in the treatment of elderly patients with type 2 diabetes mellitus(T2DM)and its influence on the level of inflammation.Methods A retrospective analysis was conducted on the medical records of 108 elderly T2DM patients admitted to the People's Hospital of Luyi from May 2020 to May 2023.The patients were divided into a control group of 52 cases and a study group of 56 cases according to different treatment plans.Patients in the control group received routine lifestyle intervention combined with sitagliptin treatment,while those in the study group received Huanglian Wendan Tang in addition to the treatment in the control group.Both groups of patients were treated continuously for 8 weeks.After 8 weeks of treatment,the therapeutic effects between the two groups of patients were compared,as well as the glucose and lipid metabolism-related indicators(fasting blood glucose,FPG;2-hour postprandial blood glucose,2 hPG;low-density lipoprotein cholesterol,LDL-C;total cholesterol,TC),insulin related indicators(insulin sensitivity index,ISI;pancreatic beta cell function index,HOMA-β;homeostasis assessment insulin resistance index,HOMA-IR),inflammatory factor levels(tumor necrosis factor alpha,TNF-α;interleukin-6,IL;IL-10),serum nuclear factor kappa B(NF-κB)mRNA,and Toll like receptor 4(TLR4)mRNA expression before and after 8 weeks of treatment.The adverse drug reactions during treatment were compared between the two groups of patients.Results The total effective rate of the study group was 85.71%,which was significantly higher than the control group's 67.31%(P<0.05).Before treatment,there was no statistically significant difference in the glucose and lipid metabolism-related indicators between the two groups(P>0.05).After treatment,the glucose and lipid metabolism-related indicators in both groups decreased compared with those before treatment;the FPG,2 hPG,LDL-C,and TC in the study group were(5.89±1.32)mmol/L,(10.21±2.30)mmol/L,(2.83±0.57)mmol/L,and(4.62±0.61)mmol/L,respectively,which were significantly lower than(7.22±1.44)mmol/L,(12.32±2.25)mmol/L,(3.22±0.49)mmol/L,and(5.01±0.47)mmol/L in the control group;the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the levels of ISI,HOMA-β,and HOMA-IR between the two groups(P>0.05).After treatment,the levels of ISI and HOMA-βin both groups increased compared with those before treatment,while HOMA-IR decreased;the levels of ISI and HOMA-βin the study group were significantly higher than those in the control group,while the levels of HOMA-IR were significantly lower than those in the control group;the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the expression levels of TNF-α,IL-6,IL-10,NF-κB mRNA,and TLR4 mRNA between the two groups(P>0.05).After treatment,the expression levels of TNF-α,IL-6,NF-κB mRNA,and TLR4 mRNA in both groups decreased compared with those before treatment,while IL-10 levels increased compared with those before treatment;the expression levels of TNF-α,IL-6,NF-κB mRNA,and TLR4 mRNA in the study group were significantly lower than those in the control group,while IL-10 levels were significantly higher than those in the control group;the differences were statistically significant(P<0.05).The incidence of adverse drug reactions in the control group during treatment was 7.69%,which was slightly higher than 7.14%in the study group(P>0.05).Conclusion The combination of Huanglian Wendan Tang and sitagliptin has a significant effect in the treatment of elderly patients with type 2 diabetes mellitus,which can effectively improve the levels of glucose and lipid metabolism and insulin resistance in patients,alleviate inflammatory reactions,and may be related to the regulation of TLR4/NF-κB pathway expression in the body.