【作者】 刘臣；

【导师】 孙志；

【作者基本信息】 南京中医药大学 ， 针灸推拿学（专业学位）， 2017， 硕士

【摘要】 目的:观察泻胃补脾针法治疗对2型糖尿病患者相关指标的影响,探讨泻胃补脾针法治疗2型糖尿病的机制。方法:采用随机数表法,随机分配针刺组与对照组各30名患者。两组患者均进行饮食控制及坚持运动,并保持原有的药物治疗方案不变,本研究期间不更换药物或调整药物用量。针刺组在原有治疗基础上加入针刺:主穴中脘、内庭、足三里、脾俞、太白、三阴交。其中足三里、内庭、中脘使用泻法针刺,操作为针刺得气后运用捻转泻法和提插泻法各6次。太白、三阴交、脾俞使用补法针刺,操作为针刺得气后,行捻转补法和提插补法各6次。治疗过程中,脾俞穴针刺后不留针,余穴留针30min,隔日1次,每周3次。本研究时间为1月。观察治疗1月前后两组患者症状、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹C肽(FC-P)、胰岛素抵抗指数[Homa-IR(C-P)]、胰岛β细胞功能指数[Homa-islet(C-P)]及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、瘦素(LEP)、抵抗素(Resistin)、类胰升糖素肽-1(GLP-1)等指标。结果:1、症状积分及疗效:干预前两组患者症状积分无统计学差异(P>0.05),针刺组干预后症状积分较干预前降低(P<0.05),较对照组降低显著(P<0.05);针刺干预后患者总有效率较对照组高,差异显著(P<0.05)。2、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、空腹C肽(FC-P):干预前两组患者FBG、HbA1c、FC-P无统计学差异(P>0.05);针刺组干预后FBG、HbA1c、FC-P较干预前降低(P<0.05),较对照组降低显著(P<0.05)。3、胰岛素抵抗指数[Homa-IR(C-P)]、胰岛β细胞功能指数[Homa-islet(C-P)]:干预前两组患者Homa-IR(C-P)、Homa-islet(C-P)均无统计学差异(P>0.05);针刺组干预后Homa-IR(C-P)较干预前降低(P<0.05),较对照组降低显著(P<0.05);针刺组干预后Homa-islet(C-P)较干预前升高(P<0.05),较对照组降低无显著差异(P>0.05)。4、血脂:干预前两组患者甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)均无统计学差异(P>0.05);针刺组干预后TG、TC、LDL-C较干预前降低(P<0.05),较对照组降低显著(P<0.05);HDL-C较干预前升高(P<0.05)较对照组升高显著(P<0.05)。5、瘦素(LEP)、抵抗素(Resistin):干预前两组患者LEP、Resistin无统计学差异(P>0.05);针刺组干预后LEP、Resistin较干预前降低(P<0.05),较对照组降低显著(P<0.05)。6、类胰升糖素肽-1(GLP-1):干预前两组患者GLP-1无统计学差异(P>0.05);针刺组干预后GLP-1较干预前升高(P<0.05),较对照组升高显著(P<0.05)。结论:泻胃补脾法针刺治疗2型糖尿病可显著改善患者症状、降低患者FBG、HbA1c、FC-P、TG、TC、LDL-C、LEP、Resistin、Homa-IR(C-P),显著升高 HDL-C、GLP-1;具有升高Homa-islet(C-P)的趋势。泻胃补脾法针刺可有效降低患者血糖,调节血脂,改善胰岛素抵抗,增强胰岛β细胞功能,治疗2型糖尿病具有良好的疗效。更多还原

【Abstract】 Objective:To observe the effect on related indexes of patients with type 2 diabetes mellitus made by acupuncture treatment of "purging stomach and tonifying spleen" and to explore the mechanism of it in the treatment of type 2 diabetes.Methods:According to random number table,type 2 diabetes patients are randomly assigned to the acupuncture group and control group,each of them with 30 patients.Both two groups of patients are treated with diet control and exercise,and maintaining the original drug treatment program unchanged during trail.The acupuncture group patients are added acupuncture on the basis of conventional treatment:the main points Zusanli,Neiting,Zhongwan,Taibai,Sanyinjiao,Pishu.Zusanli,Zhongwan Neiting,operated as reducing acupunctureat by light lifting and powerful inserting 6 times,then twisting with large amplitude power 6 times as thumb backward and forefinger forward.Taibai,Sanyinjiao,Pishu use reinforcing method of acupuncture after acupuncture point feeling qi coming,lifting and thrusting 6 times with gentle power.In the course of treatment,remove needle after stimulate Pishu,keep needle in the point 30min,once two days,3 times a week.After 1 month,compare data from two groups’ patients before and after manipulation,such as symptoms,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),fasting insulin(fins),fasting C peptide(fc-p),insulin resistance index[Homa-IR(C-P)],islet beta cell function index[Homa-islet(C-P)]and total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),leptin(LEP),resistin(resistin),glucagon peptide-1(GLP-1)and other indicators.Results:1.Symptoms integral and curative effect:before the intervention,two groups of patients’symptoms integral had no statistical difference(p>0.05),after the intervention,acupuncture group symptoms points lower,compared with before(p<0.05),a significant reduction than the control group(p<0.05);After intervention,acupuncture patients total effective rate is significant higher than before(p<0.05).2.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),fasting C peptide(FC-P):before the intervention,two groups of patients’ FBG,HbA1c,FC-P have no significant difference(p>0.05);after intervention FBG,HbA1c,FC-P in acupuncture group lower than before(p<0.05),compared with the control group decreased significantly(p<0.05).3.Iinsulin resistance index[Homa-IR(C-P)],islet beta cell function index[Homa-islet(C-P)]:before intervention,two groups of patients with Homa-IR(C-P),Homa-islet(C-P)have no statistical difference(P>0.05);after intervention Homa-IR(C-P)in acupuncture group lower than before(P<0.05),compared with the control group decreased significantly(P<0.05);acupuncture group intervention Homa-islet(C-P)lower than before(P<0.05),no significant lower than the control group(P>0.05).4.Fat:before intervention of triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)of two groups have no statistically significant(P>0.05);after intervention TG,TC,LDL-C in acupuncture group decreased significantly compared with before or the control group(P<0.05);after intervention HDL-C increased compared with before or the control group significantly(P<0.05).5.Leptin(LEP),resistin(resistin):before the intervention,LEP and resistin in two groups have no significant difference(p>0.05);after intervention LEP,resistin in acupuncture group lower than before(p<0.05),compared with the control group decreased significantly(p<0.05).6.Glucagon peptide-1(GLP-1):GLP-1 in the two groups were no significant difference before intervention(p>0.05);after intervention acupuncture group GLP-1 increased compared with before(p<0.05),significantly higher than the control group(p<0.05).Conclusion:"Purging stomach and tonifying spleen" in treating type 2 diabetes can be significantly improve symptoms,reduce FBG,HbA1c,FC-P,TQ TC,LDL-C,LEP,resistin,HOMA-IR(C-P),increase HDL-C,GLP-1 significantly,homa-islet(C-P)has increased trend.Spleen stomach purging acupuncture methods can effectively reduce blood glucose,regulating blood lipid,improve insulin resistance,enhance the function of islet beta cells,having a good curative effect on treatment of type 2 diabetes.更多还原