参芪复方对初诊2型糖尿病气阴两虚兼血瘀证患者肠道微生态的影响

Effect of Shenqi Compound Recipe on Intestinal Microecology of Patients with Qi and Yin Deficiency and Blood Stasis Syndrome Newly Diagnosed Type 2 Diabetes Mellitus

目的:观察参芪复方对初诊2型糖尿病(T2DM)气阴两虚兼血瘀证患者糖、脂代谢的影响,及对肠道微生态和血清促炎因子的干预效果。方法:将106例符合要求的患者采用随机按数字表法分为观察组54例及对照组52例,另择同期于该院体检中心40例健康志愿者作为健康对照组。对照组参照《中国2型糖尿病防治指南(2013年版)》,给予合理膳食、控制体质量、适量运动、限盐、控烟、限酒和心理平衡等生活方式干预。观察组在对照组治疗的基础上加用参芪复方内服,2次/d。两组疗程均为连续治疗8周。评价治疗前后空腹血糖(FBG),餐后2 h血糖(PBG),糖化血红蛋白(Hb A1c),胰岛素抵抗指数(HOMA-IR),总胆固醇(TC),甘油三脂(TG),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);检测治疗前后肠道菌群结构、数量;进行治疗后中医证候评分;检测治疗前后白细胞介素-1β(IL-1β),白细胞介素-6(IL-6),IL-8,肿瘤坏死因子-α(TNF-α)水平。结果:观察组FBG,PBG,Hb A1c,HOMA-IR水平均低于对照组(P <0. 05);观察组生成操作分类单元(OTU)高于对照组(P <0. 05);观察组拟杆菌属和克雷伯氏杆菌属丰度均高于对照组,放线菌属丰度明显低于对照组(P <0. 05);观察组患者TC,TG和LDL-C水平均较对照组低,HDL-C高于对照组(P <0. 05);观察组IL-1β,IL-6,IL-8和TNF-α水平均低于对照组(P <0. 01);经秩和检验,治疗后观察组疾病疗效优于对照组(Z=2. 134,P <0. 05)。结论:参芪复方能调节初诊T2DM(气阴两虚兼血瘀证)患者的血糖和血脂,改善IR,并可改善患者肠道微生态失衡状态,减轻非特异性炎症反应,有着较好的临床疗效。

Objective:To observe the effect of Shenqi compound recipe on glucose and lipid metabolism in patients with Qi and Yin deficiency and blood stasis syndrome newly diagnosed type 2 diabetes mellitus(T2DM),and its intervention effect on intestinal microecology and serum proinflammatory factors.Method:The106 eligible patients were divided into the observation group(54 cases)and the control group(52 cases)by random number table method.Another 40 healthy volunteers in physical examination center of the hospital during the same period were enrolled as health control group.On the basis of Guidelines for the Prevention and Treatment of Type 2 Diabetes in China(2013 edition),control group was provided lifestyle interventions,such as reasonable diet,weight control,moderate exercise,salt restriction,tobacco control,alcohol restriction and psychological balance.In addition to the therapy of the control group,the observation group was given Shengi compound for oral administration,2 times/days.Both groups were treated for 8 weeks.The fasting blood glucose(FBG),postprandial 2 h blood glucose(PBG),glycosylated hemoglobin(HbA1 c),homeostasis model assessment-insulin resistance index(HOMA-IR),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)before and after treatment were evaluated.The structure and quantity of intestinal flora before and after treatment were detected.The traditional Chinese medicine(TCM)symptom was scored.The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),IL-8,and tumor necrosis factor-α(TNF-α)were measured before and after treatment.Result:FBG,PBG,HbA1 c and HOMA-IR levels in observation group were lower than those in control group(P<0.05).The operational taxonomy unit(OUT)of observation group was higher than that of control group(P<0.05).The abundances of Bacteroides and Klebsiella in observation group were higher than those in control group,while actinomyces abundance was significantly lower than that in control group(P<0.05).TC,TG and LDL-C levels in observation group were lower than those in control group,while HDL-C was higher than that in control group(P<0.05).IL-1β,IL-6,IL-8 and TNF-αlevels in observation group were lower than those in control group(P<0.01).Rank-sum test showed that the efficacy on diseases of observation group was better than that of control group after treatment(Z=2.134,P<0.05).Conclusion:Shenqi compound can regulate blood glucose and blood lipid in patients with newly diagnosed T2DM(Qi and Yin deficiency and blood stasis syndrome),improve IR,intestinal microecology imbalance,and reduce non-specific inflammatory response,with a good clinical efficacy on intestinal microecology of patients with Qi and Yin deficiency and blood stasis syndrome newly diagnosed type 2 diabetes mellitus.