六味地黄丸联合利拉鲁肽和二甲双胍治疗2型糖尿病的临床研究

目的探讨六味地黄丸联合利拉鲁肽和二甲双胍治疗2型糖尿病的临床疗效。方法选取2013年12月—2015年12月在榆林市中医医院接受治疗的2型糖尿病患者84例,随机分成对照组和治疗组,每组各42例。所有患者均给予饮食和运动健康教育控制血糖。对照组患者口服盐酸二甲双胍片,1片/次,3次/d;同时皮下注射利拉鲁肽注射液,0.6 mg/次,1次/d,若1~2周后无不良反应,剂量调整为1.2 mg/次,1次/d。治疗组在对照组的基础上口服六味地黄丸,8丸/次,3次/d。两组患者均治疗12周。观察两组的临床疗效,同时比较两组患者治疗前后三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FBG)、餐后2 h血糖和糖化血红蛋白(Hb A1c)水平及胰岛素分泌指数(HOMA-β)和胰岛素抵抗指数(HOMA-IR),以及白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和超敏C-反应蛋白(hs-CRP)水平变化。结果治疗后,对照组和治疗组的总有效率分别为78.57%、95.24%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者的TG、TC、LDL-C水平降低,而HDL-C水平升高,同组治疗前后差异具有统计学意义(P0.05);且治疗后,治疗组患者的上述血脂指标改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的FPG、餐后2 h血糖和Hb Alc水平均较治疗前显著降低(P0.05);与对照组比,治疗后治疗组的FPG、餐后2 h血糖和Hb Alc水平降低更明显(P0.05)。治疗后,两组组患者的HOMA-IR降低,HOMA-β升高,同组治疗前后差异有统计学意义(P0.05);且治疗组的改善程度优于对照组,两组比较差异有统计学意义(P0.05)。治疗后,治疗组患者的血清IL-6、TNF-α、hs-CRP水平与同组治疗前相比有显著下降(P0.05),且治疗组患者的上述血清细胞因子水平下降情况明显优于对照组(P0.05)。结论六味地黄丸联合利拉鲁肽和二甲双胍治疗2型糖尿病具有较好的临床疗效,可明显改善胰岛素抵抗和提高胰岛素敏感性,具有一定的临床推广应用价值。

Clinical study on Liuwei Dihuang Pills combined with liraglutide and metformin in treatment of type 2 diabetes mellitus

Objective To investigate the clinical effect of Liuwei Dihuang Pills combined with liraglutide and metformin in treatment of type 2 diabetes mellitus.Methods Patients (84 cases) with type 2 diabetes mellitus in Yulin Hospital of TCM from December 2013 to December 2015 were randomly divided into control and treatment groups, and each group had 42 cases. All patients were given diet and exercise health education to control blood sugar. The patients in the control group werepo administered with Metformin Hydrochloride Tablets, 1 tablet/time, three times daily. And they were sc administered with Liraglutide Injection, 0.6 mg/time, once daily, and the dose was adjusted to 1.2 mg/time, once daily, if there was no adverse reaction after 1 — 2 weeks. The patients in the treatment group were po administered with Liuwei Dihuang Pills on the basis of control group, 8 pills/time, three times daily. The patients in two groups were treated for 12 weeks. The clinical efficacy was evaluated, and the changes of TG, TC, LDL-C, HDL-C, FBG, 2 h postprandial glucose, HbA1c, HOMA-β, HOMA-IR, IL-6, TNF-α, and hs-CRP in two groups were compared before and after treatment.Results After treatment, the clinical effect in the control and treatment groups were 78.57% and 95.24%, respectively, and there were differences between two groups (P < 0.05). After treatment, TG, TC, and LDL-C levels in two groups were decreased and HDL-C level was increased, and the difference was statistically significant in the same group (P < 0.05). And these blood lipid indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, FPG, 2 h postprandial glucose, and HbAlc levels were lower than those before treatment in the same group, and the difference was statistically significant (P < 0.05). And the blood glucose indexes in the treatment group were better than those in the control group with significant difference (P < 0.05). After treatment HOMA-IR was reduced, HOMA-β was improved, and the difference was statistically significant in the same group (P < 0.05). HOMA-IR and HOMA-β in the treatment group were better than those in the control group with significant difference (P < 0.05). After treatment, IL-6, TNF-α, hs-CRP levels in two group were significantly decreased (P < 0.05). And these serum cytokine levels in the treatment group were better than that in the control group (P < 0.05).Conclusion Liuwei Dihuang Pills combined with liraglutide and metformin has the curative effect in treatment of type 2 diabetes mellitus, and can significantly improve IR and insulin sensitivity, which has a certain clinical application value.