耳皮内刺迷走神经影响２型糖尿病患者餐后血糖峰值的随机交叉对照临床研究

背景　研究迷走神经传入信号的整合和代谢作用，是发现新的治疗靶点以恢复糖尿病和肥胖症患者能量和葡萄糖平衡的潜在策略。本团队在前期的预试验中发现了耳穴埋针有降血糖作用。在埋针的基础上，本团队发展了耳皮内刺技术，其是一新型的迷走神经刺激技术。目的　探索耳皮内刺对2型糖尿病患者餐后血糖水平的影响。方法　设计类型为单盲随机交叉对照临床研究。选取2017年12月-2018年3月江苏省中医院及江苏省第二中医院内分泌科病房饮食、运动、生活方式及降糖药物治疗方案固定的2型糖尿病患者31例，随机分为A、B两组，总观察期为6 d。A组于第2天、第5天7：30分别进行真针刺、假针刺操作；B组于第2天、第5天7：30分别进行假针刺、真针刺操作。连续6 d〔第1天（基线日）、第2天（干预日）、第3天（干预后1 d）、第4天（基线日）、第5天（干预日）、第6天（干预后1 d）〕检测空腹、早餐后2 h及早餐后4 h末梢血糖水平。结果　A组真针刺干预日及干预后1 d时早餐后2 h血糖水平均低于基线日，A组真针刺干预日早餐后2 h血糖水平低于假针刺干预日（P<0.05）。B组真针刺干预日及干预后1 d早餐后2 h血糖水平均低于基线日，B组真针刺干预日早餐后2 h血糖水平低于假针刺干预日（P<0.05）。两组患者第2天、第5天早餐后2 h血糖水平比较，差异有统计学意义（P<0.05）。结论　耳皮内刺迷走神经可以明显降低2型糖尿病患者早餐后2 h血糖水平。

Randomized Cross-over Controlled Clinical Study on the Effect of Intradermal Acupuncture of Auricular Branch of Vagus Nerve on the Peak Postprandial Blood Glucose in Patients with Type 2 Diabetes Mellitus

Background　Studying the integration and metabolism of the afferent signals from the vagus nerve is a potential strategy for discovering new therapeutic targets to restore energy and glucose balance in patients with diabetes and obesity.Our team found the hypoglycemic effect of auricular needle implantation in the preliminary study.On the basis of implanting needles，we developed the technique of auricular intradermal acupuncture，which is a new technique of vagus nerve stimulation.Objective　To explore the effect of auricular intradermal acupuncture on peak postprandial blood glucose in patients with type 2 diabetes mellitus.Methods　A single-blind，randomized，cross-over，controlled clinical study was conducted.Thirty-one patients with type 2 diabetes mellitus with fixed diet，exercise，lifestyle and hypoglycemic medication regimen from the Endocrine Ward，Jiangsu Province Hospital of Chinese Medicine and Jiangsu Second Hospital of Chinese Medicine were enrolled during December 2017 to March 2018 and were randomly divided into groups A and B，with a total observation period of six days.At 7：30 a.m.on the second day（the first acupuncture intervention day），group A was given true acupuncture，group B was given sham acupuncture.At 7：30 a.m.on the fifth day（the second acupuncture intervention day），group A was given sham acupuncture，group B was given true acupuncture，and no acupuncture intervention was given on other observation days.Fasting blood glucose，postprandial（2 and 4 hours after eating breakfast） capillary blood glucose levels were measured in both groups on six consecutive days 〔the first day（the day before the first acupuncture intervention），the second day（the day of receiving the first acupuncture intervention），the third day（the day after receiving the first acupuncture intervention），the fourth day（the day before the second acupuncture intervention），the fifth day（the day of receiving the second acupuncture intervention），the sixth day（the day after receiving the second acupuncture intervention）〕.Results　In group A，the mean 2-hour post-breakfast capillary blood glucose level on the day of and the day after receiving true acupuncture was lower than that on the day before receiving true acupuncture（P<0.05）.And it on the day of receiving true acupuncture was lower than that on the day of receiving sham acupuncture（P<0.05）.Similar conditions were found in group B.Two groups showed significant differences in the mean 2-hour post-breakfast capillary blood glucose level on the day of receiving the first acupuncture intervention as well as on the day of receiving the second acupuncture intervention（P<0.05）.Conclusion　Auricular intradermal acupuncture could significantly reduce the blood sugar level in patients with type 2 diabetes mellitus at 2 hours after breakfast.