重视并提高中医药对糖尿病及其并发症的疗效

中医药治疗糖尿病（中医诊为消渴）已有数千年的历史,历代医书中记载了大量治疗消渴的中药及方剂,积累了丰富的经验。利用中医药的优势,积极有效预防并推迟糖尿病及其并发症的发生具有非常重要的意义。     

中医治疗糖尿病用药规律及效果分析

目的研究分析中医治疗糖尿病用药规律和效果。方法收集整理2010年1月至2014年3月经临床验证中医治疗糖尿病中具有良好治疗效果的患者120例,从总的治疗方法中提取出糖尿病用药中各类中药的使用次数、频率、比例等,分析中药治疗糖尿病的用药规律。结果在中药治疗糖尿病的过程中,出现频率最多的是黄芪,其次依次为茯苓、山药、天花粉、麦冬、白术、人参、山茱萸、泽泻、当归等。在治疗糖尿病所用的142种中药中,清热类的药物使用频率最高,其次是补气药、活血化瘀药、补阴药、利水渗湿药等。在收集的120例中医治疗糖尿病中具有良好治疗效果的患者中,治疗效果显著86例,占71.67%;在所有患者中治疗有效率最高为100.00%,治疗有效率最低为67.80%。结论中医治疗糖尿病主要是以益气养阴、清热为主,并加以祛痰;中医治疗糖尿病时,通常会使用补虚药、清热药和活血化瘀药等这几种类型的中药。     

哪些中药能降糖

现代药理研究证明,很多单味中药具有降糖作用.但中医药治疗糖尿病,与治疗其他疾病一样,其特点是重视患者的个体差异性和复方的使用.中医药治疗糖尿病的优势不仅在于降低血糖,更重要的是通过辨证论治的方法,采用综合措施改善症状,防治并发症,起到提高生活质量和延长寿命的作用.     

中药对糖尿病血管保护作用的研究进展

糖尿病的慢性并发症如血管并发症已成为糖尿病患者致残、死亡的重要原因,糖尿病发展过程中血管内皮细胞（vaseular endonthelial cell,VECs）功能损伤被认为是其并发症发生发展的共同病理基础。糖尿病时,高血糖、高血脂、胰岛素抵抗的存在及大量炎性因子的生成均为促进血管内皮功能不全的重要原因。现就中药对糖尿病血管保护作用的研究进展作一综述。     

健脾活血利湿清热法对糖尿病肾病大鼠血清转化生长因子-β_1和结缔组织生长因子的影响

<正>糖尿病肾病(DN)是糖尿病肾脏微血管并发症,是导致终末期肾病(ESRD)的主要原因之一。DN患者一旦出现持续性尿蛋白则病情不可逆转,因此,积极有效地治疗早中期DN尤为重要。中医药在早中期DN的治疗上具有显著优势[1-3],本研究临床实践中从脾论治,确立健脾活血燥湿清热法治疗DN,疗效明显,并在此基础上,精筛细选了有效方药芪术胶囊应用于临床,进行了大量基础研究工作,现报告如下。     

中医药治疗糖尿病肾病的研究进展

糖尿病肾病是糖尿病最严重、最常见的慢性并发症之一,近年来,通过临床及药理实验已经为其治疗找到了许多有效的手段,特别是中医药治疗取得了很大的进展,笔者查阅了近年来中医药治疗该病的相关文献,对糖尿病肾病的治疗从中药治疗、专方治疗、单味中药及其提取物治疗、中西医结合治疗等方面加以综述,并提出目前存在的问题和研究方向,以期更好地指导糖尿病肾病的防治。     

中药干预血脑屏障改善糖尿病认知功能障碍的研究进展

近年来糖尿病认知功能障碍作为一种糖尿病中枢神经系统并发症越来越受到人们的重视。糖尿病导致的中枢神经系统并发症常伴随着血脑屏障结构和功能的破坏。血脑屏障是中枢神经系统所特有的结构,对维持大脑内环境稳定以及分子转运起着重要作用。在糖尿病的病理发生发展过程中,高血糖、晚期糖基化终产物、炎性因子等诸多因素均可导致血脑屏障损伤,进而引起脑内神经元受损,从而导致认知功能障碍的发生。稳定血脑屏障可能成为治疗糖尿病认知功能障碍的主要策略之一,对血脑屏障改善糖尿病认知功能障碍以及相关中药的干预作用进行综述。     

中医治疗33例糖尿病腹泻的临床疗效分析

目的分析观察使用中医药对糖尿病腹泻患者进行治疗的临床效果。方法使用随机抽样的方法选取了在2008年1月至2012年1月在我院就诊并确诊为糖尿病腹泻患者的临床资料,将这些患者随机分成对照组和治疗组,平均每个组33例。治疗组患者使用中药进行治疗,对照组使用盐酸黄连素进行治疗。对两组患者的治疗效果、并发症和不良反应等现象进行比较分析。结果数据分析表明,采取中医治疗糖尿病腹泻的临床效果要比对照组治疗效果好,具有显著的统计学差异(P<0.05),两组患者在进行治疗的过程中均没有严重的并发症和不良反应的现象出现。结论采取中医药来对患者进行治疗临床效果较好,治疗过程中也没有特殊的额外并发症和不良反应的情况发生,可以在临床中进行推广和使用。     

儿童睡眠障碍中医药研究综述

儿童睡眠障碍(SD)的病因主要分为外邪侵犯的外因和脏腑失和及情志所伤的内因;病机主要在于阴阳、营卫失衡,且与脏腑功能失调及特殊体质相关。对治疗儿童SD的临床常用中药的实验研究、中医药对症诊疗思路和用药情况以及中医外治法进行了综述。     

早期糖尿病肾病的清热祛湿化瘀通络法治疗体会

糖尿病肾病(DN)是糖尿病的主要微血管并发症之一。是导致糖尿病患者死亡的主要原因。糖尿病患者一旦发生肾脏的损伤,就会出现持续尿蛋白且病情无法逆转,逐渐恶化直到病患末期,最终发展为肾功能衰竭[1]。据欧、美、日本的统计资料表明,目前DN已越升为终末期肾病(ESRD)的首位原因,占35%左右。因此,对早期DN的诊断和治疗显得尤为重要。本文运用清热祛湿、     

中药来源醛糖还原酶抑制剂的研究进展

醛糖还原酶抑制剂是治疗糖尿病并发症的重要药物之一,可通过抑制体内高血糖状态下被激活的多元醇通路中醛糖还原酶的活性而减少山梨醇的蓄积,预防和延缓糖尿病及其并发症的发生发展。中药来源的醛糖还原酶抑制剂来源更加广泛,显示了良好的应用前景。综述了2010—2020年报道的来源于中药的醛糖还原酶抑制剂及其在改善糖尿病并发症症状等方面取得的研究进展,主要包括生物碱类、黄酮类、酚酸类、皂苷类、多糖类,以及中药提取物,以期为新药研发提供依据。     

Dysfunction of endothelial progenitor cells under diabetic conditions and its underlying mechanisms

Cardiovascular complications have been major concerns in the treatment of diabetes, and up to 80% of all deaths in diabetic patients are linked to cardiovascular problems. Impaired angiogenesis is one of the most serious symptoms associated with diabetes, resulting in delayed wound healing and lower limb amputation. Endothelial progenitor cells (EPCs), a subpopulation of adult stem cells, are recruited from bone marrow to the injured vessel to promote endothelial regeneration and neovascularization, playing an important role in angiogenesis. Interestingly, several clinical studies have showed that the number of recruited EPCs is reduced and their function is decreased under diabetic conditions, implying that diabetic EPC dysfunction may contribute to defective angiogenesis and resultant cardiovascular complications in diabetes. To recover the functional abilities of diabetic EPCs and to address possible application of EPC cell therapy to diabetic patients, some studies provided explanations for diabetic EPC dysfunction including increased oxidative stress, involvement of the inflammatory response, alteration in the nitric oxide pathway and reduced signals for EPC recruitment. This review discusses clinical evidence of impairment of EPC functions under diabetic conditions and the suggested mechanisms for diabetic EPC dysfunction.     

Berberine in type 2 diabetes therapy: a new perspective for an old antidiarrheal drug?

Type 2 diabetes mellitus (T2DM) and dysglycemia (impaired glucose tolerance and/or impaired fasting glucose) are increasingly contributing to the global burden of disease. Despite the continued introduction of hypoglycemic drugs, intervention in diabetes and its related complications remains a major global medical problem. Traditional Chinese medicine offers a number of potential candidates for developing hypoglycemic drugs. Berberine (BER), an isoquinoline alkaloid extract, has been commonly used as an oral drug to treat gastroenteritis and diarrhea for more than 1400 years. Although the antidiabetic effect of berberine has been noted in diabetic patients and demonstrated diabetic animal models in the last decade, its use is not yet accepted in the general medical community, for two reasons: its mechanism of action remains to be determined, and its bioavailability is low. Therefore, characterization of its mechanism of action and enhancement of its bioavailability are most important and the subject of current investigations. Recent studies have also revealed beneficial effects of berberine on diabetic complications. In this review the antidiabetic mechanism of action of berberine, its effect on diabetic complications, and efforts to improve its bioavailability are summarized. These studies may lead to its wider use for the treatment of type 2 diabetes mellitus and its complications.     

Peripheral origin exosomal microRNAs aggravate glymphatic system dysfunction in diabetic cognitive impairment

Cognitive dysfunction is one of the common central nervous systems (CNS) complications of diabetes mellitus, which seriously affects the quality of life of patients and results in a huge economic burden. The glymphatic system dysfunction mediated by aquaporin-4 (AQP4) loss or redistribution in perivascular astrocyte endfeet plays a crucial role in diabetes-induced cognitive impairment (DCI). However, the mechanism of AQP4 loss or redistribution in the diabetic states remains unclear. Accumulating evidence suggests that peripheral insulin resistance target tissues and CNS communication affect brain homeostasis and that exosomal miRNAs are key mediators. Glucose and lipid metabolism disorder is an important pathological feature of diabetes mellitus, and skeletal muscle, liver and adipose tissue are the key target insulin resistance organs. In this review, the changes in exosomal miRNAs induced by peripheral metabolism disorders in diabetes mellitus were systematically reviewed. We focused on exosomal miRNAs that could induce low AQP4 expression and redistribution in perivascular astrocyte endfeet, which could provide an interorgan communication pathway to illustrate the pathogenesis of DCI. Furthermore, the mechanisms of exosome secretion from peripheral insulin resistance target tissue and absorption to the CNS were summarized, which will be beneficial for proposing novel and feasible strategies to optimize DCI prevention and/or treatment in diabetic patients.     

Advanced glycation end products and diabetic complications

Diabetic complications are major cause of morbidity and mortality in patients with diabetes. While the precise pathogenic mechanism(s) underlying conditions such as diabetic retinopathy, diabetic nephropathy and increased risk of atherosclerosis remain ill-defined, it is clear that hyperglycaemia is a primary factor that initiates and promotes complications. Formation of advanced glycation end products (AGEs) correlate with glycaemic control, and these reactive adducts form on DNA, lipids and proteins where they represent pathophysiological modifications that precipitate dysfunction at a cellular and molecular level. Many of these adducts form rapidly during diabetes and promote progression of a raft of diabetes-related complications. Recent evidence also suggests an important interaction with other pathogenic mechanisms activated within the diabetic milieu. This review outlines the nature of AGE formation in biological systems and highlights accumulative evidence that implicates these adducts in diabetic complications. As more therapeutic agents are developed to inhibit AGE formation or limit their pathogenic influence during chronic diabetes, it is becoming clear that these anti-AGE strategies have an important role to play in the treatment of diabetic patients.     

Advanced glycation end products and diabetic complications

Diabetic complications are major cause of morbidity and mortality in patients with diabetes. While the precise pathogenic mechanism(s) underlying conditions such as diabetic retinopathy, diabetic nephropathy and increased risk of atherosclerosis remain ill-defined, it is clear that hyperglycaemia is a primary factor that initiates and promotes complications. Formation of advanced glycation end products (AGEs) correlate with glycaemic control, and these reactive adducts form on DNA, lipids and proteins where they represent pathophysiological modifications that precipitate dysfunction at a cellular and molecular level. Many of these adducts form rapidly during diabetes and promote progression of a raft of diabetes-related complications. Recent evidence also suggests an important interaction with other pathogenic mechanisms activated within the diabetic milieu. This review outlines the nature of AGE formation in biological systems and highlights accumulative evidence that implicates these adducts in diabetic complications. As more therapeutic agents are developed to inhibit AGE formation or limit their pathogenic influence during chronic diabetes, it is becoming clear that these anti-AGE strategies have an important role to play in the treatment of diabetic patients.     

中药与化学药比较治疗糖尿病随机对照研究的系统评价

目的:比较中药与化学药治疗糖尿病以及中西药结合与化学药治疗糖尿病的疗效。方法:对中药或中西药结合与化学药比较治疗糖尿病的随机对照试验进行系统评价,应用循证医学的研究方法,采用Revman4.2软件进行Meta分析。结果:14篇随机对照研究满足纳入标准,Meta分析的结果显示,中药与化学药治疗糖尿病的效果无显著性差异;中西药结合治疗糖尿病的疗效显著优于单独采用化学药组。结论:中西药结合治疗糖尿病与化学药比较有其优势,但由于试验方法学质量尚不高,不能充分肯定,需要高质量的试验进一步证实。     

2206例糖尿病患者临床联合使用丹红注射液的用药分析

目的：基于单中心临床数据选取糖尿病患者的用药信息,针对联合使用丹红注射液的用药规律进行数据挖掘,为后续开展丹红注射液与降糖药物相互作用实验研究提供临床依据。方法：选取南京中医药大学附属医院HIS数据库中2013年1月-2015年12月使用丹红注射液的2 206例糖尿病患者的医嘱信息,运用基本统计和关联分析方法分析丹红注射液与治疗糖尿病及其并发症相关药物的联合用药规律,并针对其与联用频数前3组降糖药物组合进行药物相互作用文献研究。结果：与丹红注射液联用的治疗糖尿病及其并发症的药物中,频数最高者依次为阿卡波糖、胰岛素类药物和二甲双胍。通过文献检索发现丹红注射液与这些药物联合用药相互作用研究的文献较少,且不够系统深入。结论：丹红注射液作为有效增益于糖尿病及相关并发症的辅助治疗药物,与降糖药物临床联合用药几率较高,但缺乏相关的药物相互作用研究,值得进一步系统探究。     

中西医结合护理在老年糖尿病患者中的应用及效果

目的 探讨中西医结合护理在老年糖尿病患者中的应用效果,为提高糖尿病患者治疗的依从性及降低并发症的发生.方法 选取该院2010年12月-2012年12月收治的老年糖尿病患者80例,随机分为两组,观察组在基础治疗的基础上采用中西医结合护理模式,对照组在基础治疗的基础上采用一般的护理模式,观察两组患者治疗的依从性（包括遵医嘱和配合护理治疗）,患者及家属满意度及患者的舒适度,以及并发症发生情况.结果 观察组患者的治疗依从性得到了较大的提高,由治疗前的30%上升到治疗后的77.5%,与对照组相比,差异具有统计学意义,P＜0.05.且经中西医结合护理模式后,患者的并发症明显减少,低血糖发生率仅为5%,与对照组的35%相比,差异显著,P＜0.05;且已出现糖尿病足和褥疮患者恢复时间远小于对照组,与对照组相比,差异均具有统计学意义,P＜0.05.结论 对老年糖尿病患者实施中西医结合的护理模式,效果显著,值得临床推广.