六味地黄丸联合二甲双胍对乙型糖尿病阴虚内热证患者疗效及血管内皮功能的影响

目的研究六味地黄丸联合二甲双胍治疗2型糖尿病阴虚内热证疗效及对患者血管内皮功能的影响。方法选择2015年6月—2017年1月期间收治的150例阴虚内热证2型糖尿病患者,将其随机分为对照组和治疗组各75例,对照组患者采用二甲双胍治疗,0.5 g,口服,2次/d。治疗组联合六味地黄丸制成的汤剂治疗,水煎400 ml,分早晚各200 ml服用,4周为1个疗程,连续治疗3个疗程后,比较两组患者治疗前后血清空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、一氧化氮(NO)、内皮素-1(ET-1)、中医证候评分、不良反应发生率等情况,评价其临床疗效。结果治疗后两组患者血清FPG、2hPG、HbA1c与治疗前比较均降低(P<0.05),且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清FINS、HOMA-IR与治疗前比较均降低(P<0.05),且治疗组均低于对照组(P<0.05)。治疗后两组患者血清NO升高、ET-1降低,与治疗前比较,差异有统计学意义(P<0.05),且治疗组NO高于对照组,ET-1低于对照组,两组比较差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分与治疗前比较均减低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后对照组有效率为80.00%,治疗组有效率为92.00%,两组比较差异有统计学意义(χ^2=4.485,P=0.034)。治疗后对照组不良反应发生率为14.67%,治疗组不良反应发生率为6.67%,两组不良反应发生率比较,差异无统计学意义(χ^2=2.519,P=0.113)。结论采用六味地黄丸联合二甲双胍治疗2型糖尿病阴虚内热证患者,疗效显著,能有效控制患者血糖水平,改善胰岛素抵抗和血管内皮功能,从而缓解临床症状,安全可靠,值得临床推广。

Efficacy of Liuwei Dihuang Pills combined with metformin on type 2 diabetes mellitus differentiated by yin deficiency with internal heat and its effect on vascular endothelial function

Objective To investigate the effect of Liuwei Dihuang Pills combined with metformin on type 2 diabetes mellitus differentiated by yin deficiency with internal heat and its effect on vascular endothelial function.Methods A total of 150 patients with type 2 diabetes mellitus differentiated by yin deficiency with internal heat admitted to our hospital from June,2015 to January,2017 were included and randomized into the control group and the treatment group(75 patients per group).The control group was given metformin orally for 0.5 g,twice daily.The treatment group was additionally given decoction of Liuwei Dihuang Pill for 200 ml,twice daily(400 ml per day).The treatment lasted for three courses(4 weeks as one course).Fasting plasma glucose(FPG),2-h plasma glucose(2h PG),Hemoglobin A1c(HbA1c),fasting insulin(FINS),Homeostatic Model Assessment of Insulin Resistance(HOMA-IR),nitric oxide(NO),Endothelin-1(ET-1),TCM syndrome score,incidence of adverse reactions were compared between the two groups after treatment to evaluate the effect.Results After treatment,serum FPG,2h PG,and HbA1c in both groups decreased(P<0.05),and the levels in the treatment group were lower than in the control group,with significance(P<0.05);serum FINS and HOMA-IR in both groups decreased(P<0.05),and the levels in the treatment group were lower than in the control group,with significance(P<0.05);the level of NO increased and the level of ET-1 decreased in both groups with significance(P<0.05),and the improvement in the treatment group was more significant than in the control group,with significant difference(P<0.05);the TCM syndrome score in both groups decreased,and the score in the treatment group was lower than in the control group(P<0.05).The total effective rate was 80.00%in the control group and 92.00%in the treatment group,with significant difference(χ^2=4.485,P=0.034).The incidence of adverse reactions was 14.67%in the control group and 6.67%in the treatment group,without significant difference(χ^2=2.519,P=0.113).Conclusion For type 2 diabetes mellitus,Liuwei Dihuang Pills combined with metformin can effectively control the blood glucose level,improve insulin resistance and vascular endothelial function to relieve symptoms,with safety and a significant effect,which is worthy of clinical application.