胰岛素短期强化联合辛开苦降方治疗初发2型糖尿病的临床研究

目的：采用胰岛素强化联合辛开苦降方治疗初发2型糖尿病（T2DM），以评价其临床疗效。方法：选择空腹血糖≥11．1mmol／L的初发2型糖尿病患者53例，行口服葡萄糖耐量试验（OGTF）检测血糖、胰岛素、糖化血红蛋白、血脂等指标后，随机分为两组，即中药组（A组）和强化组（B组），两组均每天4次行“三短一中”胰岛素强化治疗，B组患者未服任何其他药物，A组加用中药辛开苦降方，治疗4周后两组均停用胰岛素，其他治疗不变继续治疗4周后，重新评价上述指标。采用稳态模型（HOMA）胰岛素抵抗指数（HOMA—IR）和胰岛素敏感指数（HOMA—IAI）评价研究对象的胰岛素抵抗情况；以HOMA—B评价胰岛B细胞的功能。结果：经过4周的胰岛素强化治疗，中药组患者空腹血糖、糖化血清蛋白、血清总胆固醇、体重指数、症状积分、HOMA—IR和HOMA—IAI改善程度好于强化组（P〈0．05）。结论：早期在胰岛素强化治疗的基础上联合中药辛开苦降方可减轻胰岛素抵抗，有助于胰岛B细胞功能的保护和临床症状的改善。

Clinical study on short-term insulin intensive therapy combined with Xinkai-kujiangfang in newly diagnosed type 2 diabetic patients

Objective： To evaluate the effect of insulin intensive therapy combined with Xinkaikujiangfang on newly diagnosed type 2 diabetic patients. Methods： 53 newly diagnosed type 2 diabetic patients with fasting blood glucose （FBG） more than 11.1 mmol/L were chosen. Glucose tolerance test （OGTI） was taken and afterwards blood glucose, insulin, glycosylated hemoglobin A1c （HbA1c）, lipid and some other indexes were detected before randomly grouping. Both two groups, Chinese medical group and intensive group, named group A and B respectively, were treated with insulin intensive therapy 4 times per day. In the first 4 weeks patients of group B were administered no other drugs, while Xinkaikujiangfang was simultaneously given in group A, then only herbs were still on in the following 4 weeks. In the eighth week, indexes mentioned above were evaluated again. HOMA-IAI, HOMA-IR and HOMA-B were calculated. Results： FBG, glycosylated serum protein, cholesterol, body mass index, symptom scores, HOMA-IR and HOMA-IAI decreased more dramatically in group A than those in group B after 4 weeks insulin intensive therapy （P〈0.05）. Conclusion： Insulin intensive therapy combined with herbs can reduce insulin resistance on early stage of type 2 diabetes, and contribute to the protection of pancreatic B-cell＇s function and improvement of clinical symptoms.