柴芩温胆汤加减对糖尿病性胃轻瘫患者血糖水平、胃肠功能障碍的影响

目的:探讨柴芩温胆汤加减对脾胃虚弱型糖尿病性胃轻瘫(diabetic gastroparesis,DGP)患者血糖水平、胃肠功能障碍的影响。方法:将2017年2月至2019年3月海南省第四人民医院收治的138例脾胃虚弱型DGP患者纳入研究,应用随机数字表法将患者分为研究组和对照组。两组患者均进行常规治疗,研究组加用柴芩温胆汤加减治疗,对照组加用多潘立酮片治疗。对两组治疗前后进行中医证候积分评估,抽取静脉血比较血糖、胃肠功能、血液流变学指标,进行胃排空试验和胃电图检查比较两组胃排空功能及胃电活动,利用匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)量表评估两组睡眠质量,利用胃轻瘫主要症状严重指数量表判定两组临床疗效。结果:与本组治疗前比较,治疗后两组患者各中医证候积分及总积分降低(P0.05),空腹血糖(fasting blood glucose,FBG),餐后2 h血糖(2 h-postprandial blood glucose,2 h PBG)及糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平降低(P0.05),血清胃动素(motilin,MOT)及胃泌素(gastrin,GAS)水平升高(P0.05),胆囊收缩素(cholecystokinin,CCK)水平降低(P0.05),胃排空时间缩短(P0.05),胃窦部胃电频率和胃电振幅、胃电节律升高(P0.05),PSQI评分降低(P0.05),全血黏度(whole blood viscosity,WBV)及纤维蛋白原(fibrinogen,FIB)水平降低(P0.05),研究组上述指标变化较对照组明显(P0.05);研究组治疗后总有效率高于对照组(P0.05)。治疗期间研究组患者未出现明显不良反应,对照组有2例出现一过性头晕头痛,数秒后缓解;研究组复发率低于对照组(P0.05)。结论:柴芩温胆汤加减可有效改善脾胃虚弱型DGP患者胃潴留症状提高睡眠质量,控制血糖水平改善血液动力学,并可通过降低血清CCK水平刺激MOT和GAS分泌改善胃肠功能增加胃动力缩短胃排空时间促进胃电活动恢复,安全性高复发率低具有临床应用价值。

Effect of Modified Chaiqin Wendantang on Blood Glucose Level and Gastrointestinal Dysfunction in Patients with Diabetic Gastroparesis

Objective To explore the effect of modified Chaiqin Wendantang on blood glucose level and gastrointestinal dysfunction in patients with diabetic gastroparesis (DGP) of weak spleen and stomach.Method A total of 138 patients with DGP of weak spleen and stomach in Hainan Provincial Fourth People''s Hospital from February 2017 to March 2019 were enrolled, and divided into two groups according to the random number table methods. Both groups received the routine treatment. In addition to this, study group received Chaiqin Wendantang, while control group received domperidone tablets. Traditional Chinese medicine (TCM) syndrome scores, blood glucose, gastrointestinal function, hemorheology index, gastric emptying function and gastric electrical activity, Pittsburgh Sleep Quality Index (PSQI) scale and clinical efficacy were compared.Result After treatment, TCM symptom scores and total scores decreased (P<0.05), levels of fasting blood glucose (FBG), 2 hours postprandial blood glucose (2 h PBG), and glycated hemoglobin (HbA1c) decreased (P<0.05), serum motilin (MOT) and gastrin (GAS) levels increased (P<0.05), cholecystokinin (CCK) levels decreased (P<0.05), gastric emptying time shortened, frequency, amplitude and rhythm increased (P<0.05), PSQI score decreased (P<0.05), and whole blood viscosity (WBV) and fibrinogen (FIB) levels decreased (P<0.05), all of those changes were more obvious in study group than control group (P<0.05). The total effective rate in study group was higher than that in control group (P<0.05). During the treatment period, there were no obvious adverse reactions in study group, while there were 2 cases of transient dizziness and headache in control group, which were relieved after several seconds. The recurrence rate in study group was lower than that in control group (P<0.05).Conclusion Modified Chaiqin Wendantang can effectively ameliorate the symptoms of gastric retention, improve sleep quality, control blood glucose levels, and improve hemodynamics for DGP of weak spleen and stomach patients. Besides, it can improve the gastrointestinal function by reducing serum CCK levels, so as to stimulate the secretion of MOT and GAS, increase gastric motility, shorten gastric emptying time, and promote the recovery of gastric electrical activity. With a high safety and low recurrence rate, it has clinical application value.