2型糖尿病湿热困脾证合并血脂紊乱胰岛功能变化及其影响因素分析

目的探讨2型糖尿病湿热困脾证合并血脂紊乱患者胰岛功能变化及其影响因素。方法选择2020年1月—2020年12月医院收治的2型糖尿病湿热困脾证患者100例,根据美国ATPIII评估标准将其分为血脂紊乱组62例与血脂正常组38例。比较各组SF-36积分、胰岛素分泌功能(Homeostasis model assessment-β,HOMA-β)、胰岛素抵抗水平(Homeostasis model assessment-IR,HOMA-IR)、胰岛素敏感指数(Insulin sensitivity index,ISI)、空腹C肽和空腹胰岛素。应用单因素和多因素分析法研究血脂异常的相关因素。结果高甘油三酯组与混合型高脂组空腹胰岛素水平显著高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组空腹C肽水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。混合型高脂组与高甘油三酯组的ISI水平低于高胆固醇组(P<0.05)。高甘油三酯组HOMA-β水平明显高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组及混合型高脂组HOMA-IR水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。两组患者在躯体疼痛、整体健康、活力、社会功能和精神健康维度方面比较,差异有统计学意义(P<0.01)。多因素Logistic分析显示,喜食油腻、吸烟史、腰围和空腹胰岛素是2型糖尿病湿热困脾证患者血脂异常的危险因素,有氧运动是2型糖尿病湿热困脾证患者血脂异常的保护因素(P<0.05)。结论不同血脂紊乱类型对胰岛功能的影响并不相同,应针对相关因素积极预防,降低胰岛分泌负担,促使胰岛功能恢复。

基于GC-TOF/MS代谢组学技术探讨藿香正气滴丸干预湿困脾胃型大鼠的作用机制

目的通过基于气相色谱-飞行时间质谱联用(GC-TOF/MS)技术的代谢组学方法探讨藿香正气滴丸干预湿困脾胃型大鼠的作用机制。方法将雄性SD大鼠随机分为正常组、模型组和藿香正气滴丸组(1 g·kg^(-1))。采用综合物理模型复制方法结合饮食失节制备湿困脾胃大鼠模型。灌胃给药,每日1次,连续给药10 d。观察大鼠宏观体征和行为学指标(体质量、体长、尾长、腹围指数与自主活动次数)。利用GC-TOF/MS方法对大鼠血清和尿液代谢组进行分析,鉴定与湿困脾胃相关的潜在生物标志物,分析藿香正气滴丸干预湿困脾胃型大鼠的代谢通路。结果与正常组比较,模型组大鼠的体质量、体长、尾长、自主活动次数明显减少(P<0.05),腹围指数明显升高(P<0.05)。与模型组比较,藿香正气滴丸组大鼠的体质量、体长、自主活动次数明显增加(P<0.05),腹围指数明显降低(P<0.05)。在大鼠血清、尿液中分别鉴定了38、44个与湿困脾胃相关的潜在生物标志物。藿香正气滴丸对模型大鼠的血清和尿液代谢表型能产生有效的干预,并能使血清、尿液中的17、13个潜在生物标志物水平显著回调,共涉及7条代谢通路。结论藿香正气滴丸对湿困脾胃型大鼠的干预机制可能与调节色氨酸代谢、组氨酸代谢、谷氨酸-谷氨酰胺代谢、能量代谢及肠道菌群等有关。

Ultrastructure Characteristics of Different Chinese Medicine Syndromes of Helicobacter pylori-Correlated Gastric Diseases

Objective: To explore the ultrastructure characteristics of patients with dampness-heat of Pi(Spleen)-Wei(Stomach) syndrome(DHPW) and Pi-qi deficiency syndrome(PQD), both of which are Helicobacter pylori(Hp)-correlated gastric diseases(HPCG), and implicate a helpful hint for the clinical microcosmic syndrome differentiation. Methods: Fourteen gastric mucosa samples from 6 chronic gastritis(CG) and 6 active peptic ulcer(including 8 DHPW, 4 PQD) as well as 2 healthy volunteers were collected and tested for Hp infection. The ultrastructure of gastric mucosa was observed under the transmission electron microscope(TEM). Results: Among 14 gastric mucosa samples, 8 of them were Hp positive(6 DHPW and 2 PQD), which were all accordance with the results screened by supermicro-pathological method. Under TEM, the normal gastric mucosa, with tidy microvilli and abundant in mucus granules, mitochondria and rough endoplasmic reticulum distributed evenly, and with smooth nucleus membrane. But in those specimens of DHPW with Hp infection, microvilli were presented with burr shape. Especially, those samples from dampnessheat syndrome with predominant heat type(DHSH) patients were more obvious, with microvilli damaged, mitochondria concentrated and distributed in disorder, secretory tubule extended. In dampness-heat syndrome with predominant dampness type(DHSD) patients, mucus granules aggregated obviously, mitochondria swelled and blurred, and rough endoplasmic reticulum crowded. For 2 samples of DHPW without Hp infection, their microvilli were intact, with mitochondria increased and gathered but well-distributed, and secretory tubule extended mildly. In 2 PQD patients with Hp positive, the specimens of microvilli were sparse, and their mucus granules and mitochondria were decreased, with fractured crests and vacuole, secretory tubules extension to nucleus membrane, and rough endoplasmic reticulum extension in a pool-like way, and nucleus condensed. The 2 samples from PQD patients without Hp infection were characterized with intact microvilli, decreased mitochondria, fractured crest and extended rough endoplasmic reticulum in a pool-like way. Conclusion: It is obvious different in ultrastructure of DHPW and PQD patients under TEM, which may give a helpful hint for the microcosmic syndrome differentiation of HPCG.

健胰祛湿降糖方治疗肥胖型2型糖尿病脾虚湿困证临床研究

目的:观察健胰祛湿降糖方治疗肥胖型2型糖尿病脾虚湿困证的临床疗效。方法:选取2020年1月至2021年1月在上饶市广丰区中医院内分泌科进行治疗的肥胖型2型糖尿病脾虚湿困证患者100例,随机分为对照组和治疗组,每组各50例。对照组采用饮食和运动疗法加二甲双胍肠溶片治疗,治疗组在对照组治疗的基础上采用健胰祛湿降糖方治疗,4周为1个疗程,共治疗3个疗程。比较两组患者治疗前后血糖水平、胃肠激素水平、胰岛素抵抗与分泌情况、中医证候积分等。结果:两组患者治疗后血糖水平均降低,且治疗组低于对照组,差异有统计学意义(P<0.05)。两组患者治疗后胃肠激素含量均升高,且治疗组高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后胰岛素抵抗指数降低,胰岛素分泌指数升高,且组间比较,差异有统计学意义(P<0.05)。两组患者治疗后中医证候积分均降低,且治疗组低于对照组,差异有统计学意义(P<0.05)。结论:健胰祛湿降糖方治疗肥胖型2型糖尿病脾虚湿困证,可以改善患者症状,降低血糖,提高胃肠激素含量。

中西医结合治疗Ⅱ型糖尿病湿热困脾证的临床观察

目的探讨中西医结合治疗Ⅱ型糖尿病的临床疗效及安全性。方法将80例Ⅱ型糖尿病患者用随机数字表分为治疗组42例,对照组38例。2组均予相同的基础治疗及相应的降糖、降血压、抗凝、改善心脑血液循环治疗。对照组加用盐酸吡格列酮胶囊30 mg,口服,日1次;治疗组加用中药水煎剂,日1剂。结果2组总有效率有非常显著性差异。治疗组降低体重指数、控制血糖,降低胆固醇、升高高密度脂蛋白疗效优于对照组,特别是治疗微量白蛋白尿明显优于对照组,有非常显著性意义。结论中西医结合治疗Ⅱ型糖尿病湿热困脾证疗效显著、安全、稳定。