玉消汤对2型糖尿病胰岛素抵抗患者血清crp tnf-α il-6的影响-effect of yuxiao decoction on serum crp tnf - α il - 6 in patients with type 2 diabetes mellitus insulin resistance.docxVIP

摘 要目的：观察玉消汤（颗粒剂）对痰瘀阻滞型 2 型糖尿病胰岛素抵抗患者血清 C 反应蛋白、肿瘤坏死因子-α 和白介素-6 的影响，探讨其治疗 2 型糖尿病胰岛 素抵抗的作用机制，进而为治疗 2 型糖尿病在新药开发方面做出有意义的探索。 方法：选取符合2型糖尿病胰岛素抵抗痰瘀阻滞型的患者66例，按就诊顺序随 机分为治疗组和对照组，其中对照组33例，给予吡格列酮（艾汀）片治疗；治疗 组33例，给予吡格列酮（艾汀）片加玉消汤（免煎颗粒）治疗。同时，两组给予基础治疗，疗程为3个月。分别观察治疗前后空腹血糖(FPG)、空腹胰岛素(FINS)、 胰岛素敏感指数(ISI)、胰岛素抵抗指数(IRI)、血清C反应蛋白(CRP)、肿瘤坏死 因子-α(TNF-α)、白介素6（IL-6）等指标的变化；并将两组的观察结果进行比 较。结果：两组患者均治疗3个月后统计，(1)治疗组中医证候积分及中医证候疗 效有明显改善，与对照组比较均有显著性差异(P＜0.05)。(2)两组患者的FPG、ISI、IRI等指标治疗前后比较均有显著性差异（P＜0.05）；治疗后两组间比较有显著性 差异（P＜0.05）。(3)与治疗前相比，两组CRP、TNF-α、IL-6水平均有明显降低 (P＜0.05)；治疗后两组间比较有显著性差异(P＜0.05)。(4)治疗组治疗后的总体 有效率与对照组比较有显著性差异（P＜0.05）。结论：(1)玉消汤能够明显改善痰瘀阻滞型2型糖尿病胰岛素抵抗患者的症状、 体征，疗效明显优于吡格列酮组。(2)玉消汤能够有效降低患者的FPG、IRI水平， 升高ISI水平，改善患者的糖代谢和胰岛素抵抗。(3)玉消汤能够明显降低痰瘀阻 滞型2型糖尿病胰岛素抵抗患者的CRP、TNF-α、IL-6，具有一定的抗炎作用，可以改善血管的慢性炎症。(4)玉消汤(颗粒剂)治疗后33例患者的肝肾功能、血尿粪 常规均无异常改变，治疗过程中所有病人均无任何不良反应，说明该药安全性良 好。本研究治疗组中西药并用，为中西医结合治疗2型糖尿病胰岛素抵抗提供了新 疗法、新思路。关键词：2 型糖尿病胰岛素抵抗炎症因子玉消汤Clinical Research and The Effect of CRP、TNF-αIL-6 aboutT2DM with Insulin Resistance Treated byYuxiao DecoctionYang weijie [Internal Medicine of TCM]Directed by Shi hefengAbstractObjective：Research the clinical efficacy of Yuxiao Decoction treated the Type 2 diabetes insulin resistance、secutity and the influence of CRP、TNF-αand IL-6,Toexplore the clinical effects and mechanism of Yuxiao Decoction on type 2 diabetes insulin resistance, have a significative exploration for developing new drugs .Methods：66 cases of type 2 diabetes mellitus (NIDDM) insulin resistance(IR)with Stagnation of Phlegm-stasis were divided randomly into two groups.the controlled group who had 33 cases had been treated by Pioglitazone Hydrochloride tablets,15mg/every tablet,one tablet/everyday, after m eal .The treated group were treated with Yuxiao Decoction (infused with water,morning and night)and Pioglitazone Hydrochloride tablets,At the same time,two groups give elementary treatment for 3 months.The clinical recurrence of both groups before and afte r the treatment were observed, including clinical symptoms, i