本文關(guān)鍵詞：瀉胃補(bǔ)脾法針刺治療糖尿病前期的臨床研究　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 糖尿病前期 瀉胃補(bǔ)脾 胃強(qiáng)脾弱 針刺 胰島素抵抗

【摘要】：目的:1.觀察瀉胃補(bǔ)脾針刺法對(duì)糖尿病前期患者的臨床療效。2.探討瀉胃補(bǔ)脾針刺法對(duì)糖尿病前期患者糖脂代謝指標(biāo)及胰島素抵抗效應(yīng)的影響。3.探索瀉胃補(bǔ)脾法干預(yù)糖尿病前期的病理學(xué)機(jī)制。方法:將60例患者按照隨機(jī)數(shù)字表法分為針灸組(32例)與對(duì)照組(28例)。對(duì)照組采用健康教育、控制飲食、合理運(yùn)動(dòng),單純生活方式干預(yù);針刺治療組在科學(xué)生活方式干預(yù)基礎(chǔ)上予瀉胃補(bǔ)脾為指導(dǎo)原則選穴針灸,主取脾俞、中脘、足三里、三陰交、太白、內(nèi)庭,先刺脾俞,后刺余穴,中脘、足三里、內(nèi)庭用瀉法,先行提插瀉法,輕插重提,行針6次,后行捻轉(zhuǎn)瀉法,拇指向后、食指向前捻轉(zhuǎn),行針6次。脾俞、太白、三陰交用補(bǔ)法,先行提插補(bǔ)法,重插輕提,行針6次,后行捻轉(zhuǎn)補(bǔ)法,拇指向前,食指向后,行針6次,余穴平補(bǔ)平瀉,留針30 min。每周3次,隔日一次,兩組皆干預(yù)12周。記錄患者治療前后證候積分,檢測(cè)治療前后空腹血糖(FPG)、糖化血紅蛋白(HbA1c)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹胰島素(FINS)、空腹血清C肽(FCP)、瘦素(LEP)、抵抗素(RETN)、胰升糖素樣肽-1(GLP-1),計(jì)算胰島素抵抗指數(shù)(HOMA-IR)、胰島素敏感指數(shù)(ISI)胰島β細(xì)胞功能指數(shù)(HOMA-β),評(píng)價(jià)療效。結(jié)果:1.兩組臨床療效分布比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組癥狀積分干預(yù)前后相較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),組間比較,針刺組總癥狀積分顯著低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療前多食易饑、口渴多飲、倦怠乏力、便秘或腹瀉癥狀積分比重較大,針刺治療對(duì)以上癥狀積分下調(diào)效果明顯。2.與干預(yù)前比較,兩組干預(yù)后FPG、HbA1c、FINS、FCP差異有統(tǒng)計(jì)學(xué)意義(P0.05)。針刺組以上指標(biāo)下降程度顯著大于對(duì)照組(P0.05)。3.與干預(yù)前比較,針刺組干預(yù)后ISI、HOMA-IR差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組干預(yù)后無(wú)明顯差異(P0.05)。針刺組干預(yù)后ISI、HOMA-IR差異顯著大于對(duì)照組。4.與干預(yù)前比較,針刺組干預(yù)后TG、LDL-C差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組干預(yù)后脂代謝指標(biāo)無(wú)明顯差異(P0.05),針灸組對(duì)TG、HDL-C、LDL-C改善優(yōu)于對(duì)照組。5.與干預(yù)相比較,針刺組干預(yù)后RETN、GLP-1差異有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組RETN、LEP、GLP-1干預(yù)前后差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。針刺組干預(yù)后RETN、GLP-1差異顯著大于對(duì)照組(P0.05)。結(jié)論:1.生活方式干預(yù)對(duì)糖尿病前期患者糖脂代謝有改善作用,但其療效低于針刺治療。2.糖尿病前期患者證候多以胃強(qiáng)脾弱表現(xiàn)為主,瀉胃補(bǔ)脾法能緩解臨床癥狀,糾正糖脂代謝紊亂狀態(tài),調(diào)節(jié)胰島素分泌,增強(qiáng)胰島素敏感性,改善胰島素抵抗,其作用機(jī)制可能與下調(diào)RETN水平,增加外周組織對(duì)葡萄糖利用率,上調(diào)GLP-1表達(dá),促進(jìn)胰島β細(xì)胞增生,減少β細(xì)胞凋亡有關(guān)。3.瀉胃補(bǔ)脾法是改善糖尿病前期患者癥狀的有效治療手段。
[Abstract]:Objective:. 1. To observe the clinical effect of the acupuncture of purging stomach and reinforcing spleen on the patients with prediabetes. 2. To explore the effect of acupuncture of purging stomach and reinforcing spleen on the indexes of glucose and lipid metabolism and the effect of insulin resistance in patients with prediabetes. 3. To explore the effect of purging stomach and replenishing spleen. Methods: methods:. 60 patients were divided into acupuncture and moxibustion group (. Health education was used in the control group (n = 32) and the control group (n = 28). Control diet, reasonable exercise, simple lifestyle intervention; Acupuncture treatment group on the basis of scientific lifestyle intervention on the basis of diarrhea stomach spleen as the guiding principle of acupuncture and moxibustion, the main spleen Yu, Zhongwan, Zusanli, Sanyinjiao, Taibai, chamber, first prick spleen Yu, then prick Yu, Zhongwan. Zusanli, the chamber with the method of diarrhea, the first lifting and reducing method, gently inserted re-raise, needle 6 times, after twirling diarrhea, thumb backward, index finger forward twist, needle 6 times. Spleen Yu, Taibai, Sanyinjiao with the complement method. The method of lifting and inserting first, heavy inserting light lifting, taking needle 6 times, then twirling complement method, thumb forward, index finger backward, needle 6 times, remaining acupoint flat reinforcing and reducing, keeping needle 30 mins. 3 times a week, every other day. The symptom scores of patients before and after treatment were recorded. Fasting blood glucose (FPGN), HbA1cn, total cholesterol TCU and triglyceride (TGG) were measured before and after treatment. High density lipoprotein (HDL-C), low density lipoprotein (LDL-C), fasting insulin (FINSN), fasting serum C-peptide (FCPP), leptin, resistin (RETNN). Insulin resistance index (HOMA-IRI), insulin sensitivity index (ISI) and islet 尾 cell function index (HOMA- 尾) were calculated. Results: there were significant differences in the distribution of clinical efficacy between the two groups (P 0.05). There was significant difference between the two groups before and after the intervention of symptom score (P 0.05). The total symptom score of the acupuncture group was significantly lower than that of the control group (P 0.05). Before treatment, it was easy to eat, thirsty, tired, constipation or diarrhea. The effect of acupuncture treatment on the score of above symptoms was significantly down-regulated .2.Compared with that before intervention, the two groups were treated with FPGG HbA1cFINS after intervention. The difference of FCP was statistically significant (P 0.05). The degree of decrease of above indexes in acupuncture group was significantly higher than that in control group (P 0. 05. 3). Compared with before intervention, ISI in acupuncture group was higher than that in control group (P < 0. 05). The difference of HOMA-IR was statistically significant (P 0.05), but there was no significant difference after intervention in control group (P 0.05). There was no significant difference in ISI after acupuncture intervention in the control group. The difference of HOMA-IR was significantly higher than that of control group. 4. Compared with before intervention, the difference of LDL-C between acupuncture group and control group was statistically significant (P0.05). There was no significant difference in lipid metabolism indexes after intervention in the control group (P 0.05). The improvement of LDL-C in the acupuncture group was better than that in the control group (.5.Compared with the intervention, the RETN after the intervention in the acupuncture group was better than that in the control group. The difference of GLP-1 was statistically significant (P 0.05), but there was no significant difference before and after intervention of GLP-1 in control group (P 0.05). RETN in acupuncture group after intervention was not significant. The difference of GLP-1 was significantly higher than that of control group (P 0.05). Conclusion the intervention of life style can improve the metabolism of glucose and lipid in prediabetic patients. But its curative effect is lower than acupuncture treatment .2.The symptoms of prediabetes patients are mainly stomach strong spleen weakness. The method of purging stomach and invigorating spleen can relieve clinical symptoms, correct disorder of glucose and lipid metabolism, and regulate insulin secretion. The mechanism of enhancing insulin sensitivity and improving insulin resistance may be related to down-regulation of RETN level, increase of glucose utilization rate in peripheral tissues, up-regulation of GLP-1 expression, and promotion of islet 尾 cell proliferation. Reduction of 尾-cell apoptosis is related to. 3. The method of purging stomach and reinforcing spleen is an effective method to improve the symptoms of prediabetic patients.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.1

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