【作者】 谢宗瑾；

【导师】 汪悦； 王旭；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2013， 博士

【摘要】 目的：探讨中医学对糖耐量减低合并脂代谢紊乱的认识,采用糖脂清方治疗糖耐量减低合并脂代谢紊乱气阴两虚,痰瘀壅阻证。通过随机对照临床试验,观察糖脂清方对糖耐量减低合并脂代谢紊乱气阴两虚,痰瘀壅阻证的治疗效果,探讨其防治本病的机理。方法：采用随机对照的研究方法,将符合糖耐量减低合并脂代谢紊乱气阴两虚,痰瘀壅阻证诊断标准的患者60例,随机分为治疗组和对照组各30例。在生活方式干预和西药常规治疗的基础上,治疗组加用中药。3个月为一个疗程。治疗前后两组分别评价其临床症状、体征的变化,治疗前后血糖、糖化血红蛋白、体重、体重指数、腰围、臀围、腰臀比、胰岛素、胰岛素敏感指数、血脂指标,以及安全性指标。全部数据以SPSS15.0统计软件进行统计学分析。结果：治疗前两组的性别、年龄、病程等基线数据经统计学处理无显著性差异,有可比性(P>0.05)。①两组患者的中医证候积分治疗前后比较以及治疗后组间比较均有显著性差别。治疗组中医证候疗效总有效率达93.33%；对照组中医证候疗效有效率为50.00%。经统计学处理后治疗组显著优于对照组,具有统计学差异(P<0.01)。②肥胖相关指标方面,治疗后两组患者体重、BMI有所降低,与治疗前比较均有显著性差异(P<0.01)；治疗组体重改善较对照组有显著性差异(P<0.01),治疗组BMI改善较对照组有差异(P<0.05)；两组治疗后腰围、臀围、腰臀比与治疗前比较：治疗组的腰围和腰臀比均有显著性差异(P<0.01),治疗组在臀围及对照组在腰围、臀围、腰臀比方面无明显差异(P>0.05),治疗后治疗组与对照组腰围、腰臀比比较有差异(P<0.05)。③两组患者治疗后空腹血糖、餐后2小时血糖、糖化血红蛋白均明显降低,与治疗前比较均有显著性差异(P<0.01)；治疗组空腹血糖、餐后2小时血糖、糖化血红蛋白改善较对照组有显著性差异(P<0.01)。降糖效果分析,治疗组总有效率90.00%,对照组26.67%,治疗组总有效率优于对照组(P<0.01)。④治疗后治疗组患者空腹胰岛素有所降低、IAI指数有所升高,与治疗前比较均有显著性差异(P<0.01)；治疗前后对照组空腹胰岛素比较无明显差异(P>0.05),治疗后对照组IAI有所升高,与治疗前比较有差异(P<0.05)。治疗组空腹胰岛素、IAI的改善较对照组均有显著性差异(P<0.01)。⑤血脂指标方面,治疗组和对照组患者治疗后TG、TC、LDL-C水平下降,HDL-C水平升高,与治疗前比较均有显著性差异(P<0.01)。组间比较治疗组TG、TC、HDL-C水平改善均较对照组具有显著性差异(P<0.01),LDL-C水平改善均较对照组具有差异(P<0.05)。血脂疗效分析,治疗组总有效率93.33%,对照组33.33%,治疗组总有效率优于对照组(P<0.01)。⑥安全性指标：肝肾功能检查均在正常范围。两组均未见严重的不良反应。结论：从初步临床研究来看,糖脂清方治疗效果优于单纯西药治疗,中药治疗可改善糖耐量减低合并脂代谢紊乱患者的临床症状,改善肥胖相关指标,降低血糖、糖化血红蛋白,降低胰岛素,增加胰岛素敏感性,调节血脂,且安全、有效,具有广泛的应用前景,值得进一步深入研究。更多还原

【Abstract】 Purpose:To discuss the understanding of traditional Chinese medicine about impaired glucose tolarence combined with dyslipidemia by using prescription of tangzhiqing. To observe the therapeutic efficacy of this method in treating the syndrome of deficiency of both Qi and Yin with phlegm and blood stasis of impaired glucose tolarence combined with dyslipidemia and to investigate the mechanism of this method.Methods:A randomized, controlled trial was conducted.60patients with the syndrome of deficiency of both Qi and Yin with phlegm and blood stasis of impaired glucose tolarence combined with dyslipidemia were randomly classified into two groups. Besides the intervention of living behavior and western medicine, the patients of the treatment group (n=30) were treated by Chinese medicine while the patients of control group (n=30) were not. Three months was a course of treatment. The observed indexes included both change in the clinical symptoms and signs, FBG, PBG, HbAlC, weight, BMI, WC, HC, WHR, FINS, IAI, blood-fat and safety indexes. All data were analyzed by the SPSS15.0statistics software.Results:Before treatment, the gender, age, course of disease of the two groups had no differeces.①Both the treatment group and control group have significant difference on curative effect score between before and after treatment and the two groups. The total curative effect of treatment group was93.33%while total curative effect of control group was50,00%. The treatment group gained an advantage over the control group (P<0.01).②The weight, BMI of both groups and the WC, WHR of treatment group were decreased, compared with pre-treatment there is statistically significant (P<0.01). The WC, HC, WHR of control group and the HC of treatment group were not decreased after treatment(P>0.05). The descent of BMI, WC, WHR in treatment group had a statistically significant compared with control group(P<0.05). The treatment group had an advantage over the control group in weight(P<0.01).③The FBG, PBG, HbAlC of the two groups were decreased, compared with pre-treatment there is statistically significant (P<0.01). The total curative effect of treatment group is93.33%, which of control group is50.00%. And the treatment group had an advantage over the control group(P<0.01).④The FINS of the treatment group were decreased, the IAI were elevated, compared with pre-treatment there is statistically significant (P<0.01). The IAI of control group were elevated, compared with pre-treatment there is statistically significant (p<0.05) while the FINS didn’t (P>0.05). And the treatment group had an advantage over the control group(P<0.01).⑤The TG, TC, LDL-C of the two groups were decreased, the HDL-C of them were elevated, compared with pre-treatment there is a remarkable statistically significant (P<0.01). And the treatment group had an advantage over the control group in TG, TC, HDL-C(P<0.01). The curative effect of blood fat in treatment group reached93.33%, which was33.33%in control group. The curative effect of treatment group was better than that of control group(p<0.01).⑥Safety indicators: Liver and kidney function tests were in the normal range. Both groups were no severe adverse reactions.Conclusion:From the preliminary clinical research, the prescription of tangzhiqing can not only improve the clinical symptoms and insulin sensitivity, but also can reduce weight, blood glucose, lipid. It is safe and effective has a broad prospect of application. It is worth studying deeply and developing further.更多还原