祛湿降浊汤对代谢综合征患者胰岛功能干预作用随机对照研究

目的] 观察“分消走泄法”对代谢综合征患者胰岛功能的作用。方法] 随机选择2016年1月—2017年12月河北中医学院附属沧州中西医结合医院进行代谢综合征治疗患者200例进行临床研究。使用随机数字表法将患者分为观察组和对照组各100例。对照组患者给予常规的运动及饮食干预,常规治疗高血压、糖尿病、高血脂的药物,盐酸吡格列酮胶囊,30 mg,每日1次,口服,共计60 d。观察组在对照组治疗方案基础上增加中药汤剂祛湿降浊方。比较两组患者治疗前后相关指标、临床疗效、胰岛功能。分析胰岛功能变化情况与代谢综合征相关指标相关性。结果] 两组患者治疗前空腹血糖（FBG）、餐后2 h血糖（2 h PBG）、糖化血红蛋白（HbA1c）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、血清总胆固醇（TC）、收缩压（DBP）、舒张压（SBP）、体质量、腰围、体质量指数（BMI）水平无明显差异（P>0.05）,治疗后60d观察组患者HDL高于对照组,其余指标均低于对照组,且具有统计学差异（P<0.05）。从组内来看,两组患者治疗60 d后与治疗前相比各项指标均有改善,且组间差异显著（P<0.05）。观察组治疗总有效率为98.00%,明显高于对照组91.00%,且具有统计学差异（P<0.05）。两组患者治疗前胰岛素抵抗指数（HOMA2 IR）、胰岛素敏感指数（HOMA2 IS）及胰岛素分泌指数（HOMA2 IB）水平无明显差异（P>0.05）,治疗后各组患者与本组治疗前相比均明显改善,但观察组HOMA2 IR高于对照组,HOMA2 IS及HOMA2 IB低于对照组,且具有统计学差异（P<0.05）。使用Pearson相关性分析,观察胰岛功能变化情况与代谢综合征相关指标相关性,结果发现,HOMA2 IR与TG、HbA1c、体质量、腰围正相关,HOMA2 IS与HDL正相关,与HbA1c、体质量负相关,HOMA2 IB与TC负相关,其他指标无相关性。结论] 以“分消走泄法”为理论基础的祛湿降浊方对于代谢综合征的患者具有良好的临床疗效,不仅明显的提高了治疗的有效率,同时改善了患者的胰岛功能,具有重要的临床应用价值。

Randomized controlled study on the intervention effect of Qushi Jiangzhuo Decoction on islet function in patients with metabolic syndrome

Objective] To observe the effect of "Fenxiao Zouxie method" on the function of islets in patients with metabolic syndrome.Methods] From January 2016 to December 2017,200 patients with metabolic syndrome were randomly selected for clinical study. Patients were divided into observation group and control group with random number method. The patients in the control group were given routine exercise and diet intervention,conventional drugs for hypertension,diabetes and hyperlipidemia,pioglitazone hydrochloride capsule,30 mg,once a day,orally for 60 days. The observation group in the control group on the basis of the treatment plan to increase the traditional Chinese medicine decoction Qushi Jiangzhuo Decoction. Compared the two groups before and after treatment related indicators,clinical efficacy,islet function.Results] There was no significant difference in the levels of FBG,2 hPBG,HbA1c,TG,LDL,HDL,TC,DBP, SBP,body weight,waist circumference and BMI between the two groups before treatment(P>0.05). From the point of view of the group,after 60 days of treatment,each index of the two groups was improved compared with that before treatment,and the difference between two groups was significant (P<0.05). The total effective rate of the observation group was 98.00%,which was significantly higher than that of the control group (91.00%,P<0.05). There was no significant difference in the levels of HOMA2 IR,HOMA2 IS and HOMA2 IB between the two groups before treatment (P>0.05). After treatment,the levels of HOMA2 IR in the observation group were higher than those in the control group,and HOMA2 IS and HOMA2 IB were lower than those in the control group(P<0.05).Conclusion] Qushi Jiangzhuo Decoction based on the theory of "Fenxiao Zouxie method" has a good clinical effect on the patients with metabolic syndrome. It not only improves the efficiency of treatment,but also improves the islet function. It has an important clinical application value.