消渴通冠汤对糖尿病合并冠心病患者高迁移率族蛋白B1和血清网膜素1水平的影响

目的:探讨消渴通冠汤配合西医常规疗法治疗糖尿病合并冠心病的疗效及对高迁移率族蛋白B1(HMGB1)和血清网膜素-1水平的影响。方法:将92例患者采用随机按数字表法分为对照组和中西医结合组各46例。对照组给予西医综合治疗措施:包括控制血糖和血压,口服阿司匹林肠溶片,0.1/次,1次/d;酒石酸美托洛尔片,50 mg/次,1次/d;辛伐他汀片,10 mg/次,1次/d,晚餐后服用;硝酸甘油片,0.5 mg/次,舌下含服,必要时服用。中西医结合组在对照组治疗的基础上加服消渴通冠汤,1剂/d。两组疗程均为3个月。检测治疗前后空腹血糖(FBG),空腹胰岛素(FINS),糖化血红蛋白(Hb Alc),HMGB1和血清网膜素1水平,并计算胰岛素抵抗指数(HOMA-IR);进行治疗前后心电图检查,记录观察期内心绞痛发作次数和硝酸甘油片用量;进行治疗前后血脂检测及气阴两虚兼血瘀证评分。结果:治疗后中西医结合组中医证候疗效有效率为96.65%,对照组为80.43%,中西医结合组优于对照组(P0.05);治疗后中西医结合组FINS,HOMA-IR和Hb Alc低于对照组(P0.01);治疗后中西医结合组甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)恢复正常例数多于对照组(P0.05);治疗后中西医结合组每周心绞痛发作次数和硝酸甘油用量少于对照组(P0.01),硝酸甘油停减率为84.8%,高于对照组的65.2%(P0.05);治疗后两组血清HMGB1水平比治疗前降低,中西医结合组低于对照组(P0.01);治疗后两组血清网膜素1水平较治疗前上升,中西医结合组高于对照组(P0.01)。结论:在西医常规治疗的基础上加用消渴通冠汤能改善胰岛素抵抗,提高胰岛素敏感性,调节脂代谢,改善冠心病症状;其作用机制可能与下调HMGB-1促炎症介子水平,提高血清网膜素-1水平有关。

Influence of Xiaoke Tongguan Decoction on High Mobility Group Protein-1 and Serum Retinal Element 1 Level in Patients with Diabetes United Coronary Heart Disease

Objective: To discuss the curative efficacy of Xiaoke Tongguan decoction (XTD) combined conventional western medicine therapy in treating diabetes united coronary heart disease and to explore its influence on high mobility group protein B1 (HMGB 1) and serum retinal element 1 level. Method: Ninety-two patients were randomly divided into the control group (46 cases) and the combination group (46 cases) by random number table. Patients in the control group received western medicine comprehensive treatment including controlling blood glucose and blood pressure, aspirin enteric-coated tablets, 0.1 g, once daily, metoprolol tartrate tablets, 50 mg, once daily, simvastatin tablets, 10 mg, once daily and nitroglycerin tablets, 0.5 mg, sublingually taken when necessary. Based on the treatment in the control group, patients in the combination group added XTD, 1 does daily. All patients received 3-month treatment. Levels of fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbAlc), HMGB 1 and serum visfatin 1 were tested. The insulin resistance index (HOMA-IR) was calculated and the electrocardiographic examination was performed before and after treatment. The anginal attacks and nitroglycerin dosage were recorded during observation period. The blood fat and score of Qi and Yin deficiency and blood stasis syndrome were tested. Result: After treatment, the efficient rate of the combination group was 96.65%, which was superior to 80.43% in control group (P<0.05). Levels of FINS, HOMA-IR and HbAlc in the combination group were less than those in control group (P<0.01). Cases of restoring normal with TG and HDL-C in the combination group were higher than those in control group (P<0.05). The number of angina pectoris attack each week and the dosage of nitroglycerin in the combination group were lower than those in control group (P<0.01). Nitroglycerin stopped reduction rate was 84.8% in the combination group, which was more than the rate of 65.2% in control group (P<0.05). Serum HMGB1 in both groups declined compared with the data before treatment. Besides, the degree of declining in the combination group was lower than that in control group (P<0.01). Level of serum retinal element 1 in both groups went up as compared with the data before treatment, while the risen degree in the combination group was higher than that in control group (P<0.01). Conclusion: On the basis of conventional western medicine treatment, adding XTD coud improve insulin resistance, enhance insulin sensitivity, regulate lipid metabolism, improve the symptoms of coronary heart disease. Its action mechanism may be related to reducing proinflammatory meson HMGB1 and enhancing the level of serum retinal element 1.