【作者】 黄淑敏；

【导师】 王旭；

【作者基本信息】 南京中医药大学 ， 中西医结合临床， 2013， 博士

【摘要】 目的：探讨中医学对老年糖尿病合并高血压的认识,通过临床研究,观察导师经验方滋阴潜阳化瘀方改善老年糖尿病合并高血压患者症状、体征、血糖、血压、体质量指数、糖化血红蛋白、血脂、血液流变学、胰岛素抵抗指数和胰岛p细胞功能指数等方面的影响,评价其临床疗效和安全性,探讨其防治本病的机理,为临床应用提供客观依据。方法：采用随机平行对照的研究方法,将符合老年糖尿病合并高血压阴虚阳亢夹瘀证诊断标准的患者,随机分为治疗组和对照组。在常规西药降糖降压的基础上,治疗组加用中药滋阴潜阳化瘀方水煎剂每日1剂,4周为1个疗程,观察3个疗程。治疗前后两组分别评价其症状、体征、血糖、血压、体重指数、糖化血红蛋白、血脂、胰岛素抵抗指数和胰岛p细胞功能指数、血液流变学等指标,以及患者的不良反应、依从性。全部数据以SPSS17.0统计软件进行统计学分析。结果：确诊并纳入的老年糖尿病合并高血压阴虚阳亢夹瘀证患者60例(治疗组30例,对照组30例),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,具有可比性。①对症状体征的改善作用：治疗组患者治疗后症状有明显改善,总有效率93.33%；对照组总有效率66.67%。治疗组中医症状改善情况优于对照组(P<0.01)。②降糖降压效果：治疗组与对照组患者血糖、血压、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)；治疗组治疗后空腹血糖改善较对照组有显著差异(P<0.01),治疗组餐后血糖、糖化血红蛋白、血压改善较对照组有差异(P<0.05)。③调脂效果：治疗组患者TC、TG、LDL-C与治疗前比较均下降(P<0.01),HDL-C与治疗前比较升高(P<0.01)；对照组患者TC水平下降(P<0.01),HDL-C水平升高(P<0.01),但TG、LDL-C与治疗前比较无明显差异。组间比较TC、HDL-C的改善情况两组无明显差异。④血液流变学：治疗组治疗后全血粘度(高切、中切、低切)、血浆粘度较治疗前均下降(P<0.05),对照组全血粘度(中切)和血浆粘度较治疗前均下降(P<0.05),但血浆粘度(高切、低切)治疗前后无差异。组间比较治疗组全血粘度(中切)的下降幅度较对照组有显著差异(P<0.01),但血浆粘度的下降水平两组无明显差异(P>0.05)。两组红细胞压积治疗前后均无明显变化。⑤治疗前后两组空腹胰岛素、HOMA2-IR及HOMA2-%B指数：治疗后两组患者空腹胰岛素、HOMA2-IR均有所降低,治疗后两组患者HOMA2-%B指数有所升高,与治疗前比较均有显著性差异(P<0.01);治疗组空腹胰岛素、HOMA2-IR及HOMA2-%B的改善较对照组均有显著性差异(P<0.01)。⑥安全性指标：肝肾功能检查均在正常范围。两组均未见不良反应。结论：从初步临床研究来看,滋阴潜阳化瘀方合用西药治疗效果优于单纯西药治疗。导师经验方治疗既可改善老年糖尿病合并高血压患者的临床症状,降低血糖、血压,调节血脂,还能改善血液流变学、胰岛素抵抗指数和胰岛p细胞功能指数,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 nodular goite, using Removing Phlegm and Activating Blood Circulation to Eliminating Goiter Decoction to interfere in the Syndrom of Turbid Phlegm and Blood Stasis.To observe the therapeutic efficacy of this decoction in treating the Syndrom of Turbid Phlegm and Blood Stasis.Methods:A randomized, controlled trial was conducted60patients with nodular goite were randomly classified into two groups.On the basic of modern medicine, the patients of treated group (n=30) were treated by Chinese medicine while the patients of controlled group (n=30) were not.Six months was a course of treatment.The observed indexes included both curative effect indexes, such as clinic symptoms, Thyroid morphology, serum the thyroid spectrum, thyroglobulin, IL-6, TNF-a, hemorheology,and safety indexes,such as routine urine,blood and stool test,ECG,the function of live and kidney and harmful reaction.The complete data carries on statistics analysis by the SPSS15.0statistics software.Results:Confirmed and incorporated in the elderly diabetic patients with Yin deficiency and Yang hyperactivity clip stasis in60cases of hypertension (treatment30cases in the control group of30cases), treated the first two courses in gender, age group, baseline data, such as statistical analysis no significant differences in comparability.①on the symptoms and signs of improvement:the treatment group patients symptoms improved markedly after treatment, total effective rate93.33%;66.67%total effective rate of the control group. Symptoms treatment groups improved conditions better than the control group (P<0.01).②hypoglycemic effects: the treatment group and the control group patients with blood glucose, blood pressure, glycosylated hemoglobin are significantly reduced, compared with before treatment showed a significant difference (P<0.01); the treatment group after treatment fasting glucose to upgrade the standard of significant differences in the control group (P<0.01), postprandial blood glucose, glycosylated hemoglobin, blood pressure treatment group improved compared with the control group difference (P<0.05).③the lipid effects:treatment in patients with TC, TG, reduced LDL-C compared with before treatment (P<0.01), HDL-C rise compared with before treatment (P<0.01); the control group patients with TC levels (P<0.01), elevated HDL-C levels (P<0.01), but the TG, LDL-C are not significantly different compared with before treatment. Group TC, HDL-C improve the situation between the two groups are not significantly different.④blood rheological learn:treatment group treatment Hou full blood stick degrees (Gauche, and in the cut, and low cut), and plasma stick degrees more treatment Qian are declined (P<0.05), against group full blood stick degrees (in the cut) and plasma stick degrees more treatment qian are declined (P<0.05), but plasma stick degrees (Gauche, and low cut) treatment before and after no differences. group between comparison treatment group full blood stick degrees (in the cut) of declined range more against group has significantly differences (P<0.01), but plasma stick degrees of declined level two group no obviously differences (P>0.05). Two sets of hematocrit without obvious changes before and after treatment.⑤fasting insulin and two sets of HOMA2-IR and HOMA2-%B before and after treatment index:fasting insulin and HOMA2-IR are two groups of patients after treatment has been reduced, two groups of patients after treatment HOMA2-%B expected to rise, compared with before treatment had significant differences (P<0.01); improvement in fasting insulin, HOMA2-IR, and HOMA2-%B treatment groups compared with the control group there were significant differences (P<0.01).⑥Security indices:liver and kidney function tests are in the normal range. Both groups had no adverse reaction.Conclusion:Judging from preliminary clinical study, of nourishing yin and Yang and blood stasis treated by Western medicine combined with Western medicine treatment more effective than simple. Instructor experience treatment can improve the clinical symptoms of elderly patients with diabetes mellitus combined with hypertension, lower blood sugar, blood pressure, blood lipid, can improve blood rheology in pancreatic islet beta cell function, insulin resistance index and indices, and safe, effective, and has a broad prospect, deserve further in-depth study.更多还原