【作者】 蒋华；

【导师】 张钟爱；

【作者基本信息】 南京中医药大学 ， 中医学， 2009， 硕士

【摘要】 研究背景:糖尿病的发病率正快速增加,中医辨证治疗中,湿热型体质的患者在糖尿病患者中占有重要地位。西医理论中,胰岛素抵抗和脂代谢紊乱贯穿糖尿病的整个过程。近年来糖尿病的炎症学说备受关注,认为糖尿病是一种自然免疫和低度炎症性疾病。炎症因子CRP、IL—6等在糖尿病的研究中正趋深入。研究目的:通过观察2型糖尿病中医辨证分型属湿热型的患者用清热燥湿的四妙颗粒(黄连3克,黄柏6克,苍术10克,苡仁15克)治疗后,患者临床症状、血糖、血脂、胰岛素敏感性指数、炎症因子CRP的变化,对照用西药吡格列酮治疗的患者。探讨清热燥湿法治疗2型糖尿病在改善IR与CRP之间的关系,并进一步证明中医辨证治疗2型糖尿病在临床上的重要性。研究方法:收集南京市中医院2008年10月到2009年1月的门诊及病房西医诊断符合2型糖尿病及IGT诊断标准、中医辨证属湿热型的患者36人,分为治疗组及阳性药物对照组,各18人,其中治疗组男7例女11例,对照组男10例女8例。观察周期为30天。CRP采用免疫增强的透射比浊法;血脂测定采用酶法;糖化血红蛋白采用免疫增强胶乳浊度法;血糖测定采用葡萄糖氧化酶法。研究结果:在两组2型糖尿病患者年龄、性别无统计学差异(P＞0.05),具有可比性的情况下:1.清热燥湿法治疗湿热型糖尿病在患者临床症状改善上优于吡格列酮组。2.清热燥湿治疗与吡格列酮治疗的2型糖尿病中医证型属湿热型的患者,空腹及餐后血糖、糖化血红蛋白均有改善。3.脂代谢方面,两组在疗程30天的观察中,治疗组在治疗前后可改善患者的HDL(P＞0.05)。4.清热燥湿与吡格列酮均能改善胰岛素抵抗。5.总体血液实验室指标变化(包括血糖及糖化血红蛋白改善、血脂、CRP)治疗组与吡格列酮对照组没有差异(P＞0.05)。对照组胰岛素敏感性指数改善优于治疗组。6.治疗组治疗后体重指数减小。结论:结果提示中医辨证治疗在改善糖尿病患者临床症状及生化指标上,有一定的优势,副作用小,安全性好,提高了患者的生活质量。更多还原

【Abstract】 BACKGROUND: The incidence of type 2 diabetes is increasing fast. The sufferers belong to dampa and heat constitution in Traditional Chinese Medicine take an important station. Insulin resisting and lipid metabolic disturbance accompany the hole course of type 2 diabetes in Western medicine. Recent years, the theory of inflammation has been attentioned by more and more people. The type 2 diabetes was thout as a kind of natural immunity and low inflammation. The study about gene of inflammation like CRP, IL-6 etc is deeper and deeper.PURPOSE: To prove the essentiality of treatment based on syndrome differentiation in Traditional Chinese Medicine in treating type 2 diabetes by observing clearing away heat and drying dampness using Si Miao granule (Huanglian 3 g, Huangbo 6g, Cangzu 10g, Yiyiren 15g) in treating the sufferers belong to dampa and heat constitution , the suffers’ clinical symptoms、blood sugar、lipid、exponent of insulin sensitivity> gene of inflammation CRP , and compare with the suffers also belong to damp and heat but were treated by piolitazone, to discuss the connection between the melioration of IR、CRP and the treatment of lclearing away heat and drying damp.STUDY METHODS: The patients are from Nanjing Chinese medicine hospital in October 2008 to January 2009 ,both the outpatients and patients admitted to hospital ,and confirmed the diagnosis of both type 2 diabetes or impaired glucose tolerance and damp and heat type in Traditional Chinese Medicine. There are 36 patients, they were devided to 2 groups randomly, one is test group and the orther is masculine medicament compare group, each contain 18 patients. The test group contains 7 male patients and 11 female patients ; the conpair group contains 10 male patients and 8 female patients. The hole period is 30 days. Then detected CRP by Elisa; lipid by zymology; glycosylated hemoglobin (HbA1C) by microclumu chromatography; fasting plasma glucose (FPG) by glucose oxidase.RESULTS: Under the premise that keeping the age , sexes of 2 groups without difference: 1. It is better using clearing away heat and drying dampness to treat type 2 diabetes in improving clinical symptoms. 2. FBS, 2hPBS, HBA1c all decreased in both groups. 3.The HDL increased in test group. 4.Both clearing away heat and drying dampness and piolitazone can decrease Insulin resisting. 5. However the hemal numerical value increase or decrease of laboratory between the test group and the compare group is without Comparation. 6. The BMI decreased in test group.CONCLUSION: Treatment based on syndrome differentiation in Traditional Chinese Medicine has advantage in improving clinical symptom, we get it through the damp and heat type patients which were treated by clearing away heat and drying dampness ,and treatment of TCM improve the life quality of the patients, also is no worse in hemal numerical value of laboratory meliorate than piolitazone.更多还原