本文選題：頸動(dòng)脈內(nèi)中膜厚度 + 2型糖尿病��； 參考：《北京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：本研究論文主要分為兩部分：綜述和臨床研究。綜述又分為現(xiàn)代醫(yī)學(xué)綜述和中醫(yī)學(xué)綜述�，F(xiàn)代醫(yī)學(xué)綜述部分主要介紹了糖尿病大血管病變流行病學(xué)情況、發(fā)病的主要機(jī)制、診斷方法、相關(guān)的實(shí)驗(yàn)室指標(biāo)、目前治療研究的進(jìn)展及可能的不良反應(yīng)作用做了相關(guān)整理。提示糖尿病大血管病變發(fā)病機(jī)制復(fù)雜,相關(guān)研究主要從多元醇通路、晚期糖化終產(chǎn)物、胰島素抵抗、血脂異常、炎癥等多方面闡釋,其治療主要以降糖、控壓、調(diào)脂等對(duì)因處理,其療效評(píng)價(jià)有待進(jìn)一步完善和綜合考量。中醫(yī)學(xué)綜述部分,筆者檢索了近15年來(lái)關(guān)于糖尿病大血管病變的中醫(yī)診治的部分相關(guān)研究,簡(jiǎn)要概述了中醫(yī)對(duì)糖尿病大血管病變病因病機(jī)、臨床分型、辨證論治的研究進(jìn)展,并對(duì)不同類(lèi)型的大血管病變分別進(jìn)行了梳理,同時(shí)對(duì)相關(guān)中藥的最新研究也進(jìn)行了學(xué)習(xí),初步認(rèn)為中醫(yī)和中西醫(yī)結(jié)合對(duì)糖尿病大血管并發(fā)癥的治療有一定的特色和優(yōu)勢(shì)。臨床研究目的探討中藥干預(yù)對(duì)2型糖尿病頸動(dòng)脈內(nèi)中膜厚度動(dòng)態(tài)變化的影響。方法采用回顧性研究,以2010年1月至2015年12月在北京醫(yī)院內(nèi)分泌科及中醫(yī)科住院病人為研究對(duì)象,根據(jù)納入、排除標(biāo)準(zhǔn),篩選出以西醫(yī)規(guī)范的降糖、降壓、調(diào)脂治療為基礎(chǔ)且數(shù)據(jù)資料完整的42份病歷,分為兩組：中藥干預(yù)組22例,暴露于中藥干預(yù),于住院及門(mén)診口服中藥,中藥劑量及種類(lèi)由接診醫(yī)生通過(guò)中醫(yī)辨證開(kāi)具；對(duì)照組20例,未暴露于中藥干預(yù),即單純西醫(yī)常規(guī)治療。42份病歷于2010年1月至2015年12月住院3次,2次住院間隔時(shí)間1-1.5年。觀察主要指標(biāo)：3次住院期間頸動(dòng)脈內(nèi)中膜厚度,比較兩組之間動(dòng)態(tài)變化情況的差異；次要指標(biāo)：空腹靜脈血糖,血清總膽固醇、甘油三酯、低密度脂蛋白膽固醇、高密度脂蛋白膽固醇、糖化血紅蛋白、血清尿酸、血清尿素氮,血清肌酐等。結(jié)果兩組頸動(dòng)脈內(nèi)中膜厚度整體較前變薄,中藥干預(yù)組內(nèi)中膜厚度變薄幅度較西醫(yī)常規(guī)治療組的大,但無(wú)統(tǒng)計(jì)學(xué)差異(P=0.083)；合并心腦血管病變患者內(nèi)中膜厚度(1.7±0.6(mm))和不合并心腦管病變患者內(nèi)中膜厚度(1.4±0.2(m))有明顯統(tǒng)計(jì)學(xué)差異(P0.05)；兩組患者在第2次住院時(shí),次要觀察指標(biāo)肌酐(SCr)中藥干預(yù)組64±16(mmol/L)低于西醫(yī)常規(guī)治療組75±15(mmol/L),且結(jié)果有統(tǒng)計(jì)學(xué)差異(P0.05)�；颊叩谌巫≡簳r(shí)中藥干預(yù)組糖化血紅蛋白(7.7±1.03(%))較對(duì)照組(8.54±1.53(%))低,但結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義(P=0.058)；患者第二次入院時(shí)對(duì)照組FIB-C(2.85±0.50g/L)比中藥干預(yù)組(3.47±0.83g/L)低,有顯著統(tǒng)計(jì)學(xué)差異(P=0.006)。結(jié)論中藥干預(yù)聯(lián)合西藥常規(guī)治療對(duì)2型糖尿病頸動(dòng)脈內(nèi)中膜厚度的改善程度可能優(yōu)于單純西藥常規(guī)治療；頸動(dòng)脈內(nèi)中膜厚度和心腦血管并發(fā)癥相關(guān)；中藥干預(yù)可能對(duì)該組病患的腎功能有保護(hù)作用；中藥干預(yù)聯(lián)合西藥常規(guī)治療可能能夠更有效的降低患者HbA1c水平。
[Abstract]:This research paper is divided into two parts: summary and clinical research. The review is divided into modern medicine review and traditional Chinese medicine review. The part of modern medicine review mainly introduces the epidemiology of diabetic macroangiopathy, the main pathogenesis, diagnostic methods, related laboratory indexes, the progress of current treatment research and possible adverse reactions. It is suggested that the pathogenesis of diabetic macroangiopathy is complicated, and the related studies mainly include polyol pathway, advanced glycosylation end products, insulin resistance, dyslipidemia, inflammation and so on. The evaluation of the therapeutic effect of lipid adjustment and other factors needs further improvement and comprehensive consideration. In the part of summary of traditional Chinese medicine, the author searched some related studies on the diagnosis and treatment of diabetic macrovascular disease in the past 15 years, and briefly summarized the research progress of TCM in the etiology, pathogenesis, clinical classification, syndrome differentiation and treatment of diabetic macrovascular disease. Different types of macrovascular diseases were combed, and the latest research on traditional Chinese medicine was also studied. It was preliminarily concluded that the treatment of diabetic macrovascular complications by TCM and Western medicine has certain characteristics and advantages. Objective to investigate the effect of traditional Chinese medicine (TCM) intervention on the dynamic changes of carotid artery thickness in type 2 diabetes mellitus. Methods from January 2010 to December 2015, the inpatients in the Department of Endocrinology and the Department of traditional Chinese Medicine of Beijing Hospital were studied by retrospective study. According to the inclusion and exclusion criteria, the standard of lowering blood sugar and blood pressure in western medicine was selected. 42 cases with complete data were divided into two groups: Chinese medicine intervention group (22 cases) exposed to Chinese medicine intervention, oral Chinese medicine in inpatient and outpatient department, and the dosage and type of traditional Chinese medicine were prescribed by TCM syndrome differentiation. In the control group, 20 cases were not exposed to the intervention of traditional Chinese medicine, that is, 42 cases of routine western medicine were hospitalized 3 times from January 2010 to December 2015. The interval between hospitalization and hospitalization was 1-1.5 years. Main outcome measures: carotid intima-media thickness was observed during three hospitalizations, and the difference of dynamic changes between the two groups was compared. Secondary measures: fasting venous blood glucose, serum total cholesterol, triglyceride, low density lipoprotein cholesterol, High density lipoprotein cholesterol, glycosylated hemoglobin, serum uric acid, serum urea nitrogen, serum creatinine, etc. Results the intima media thickness of carotid artery in both groups was thinner than that in the former group, and the thickness of internal media in the Chinese medicine intervention group was larger than that in the routine western medicine treatment group. However, there was no statistical difference between the two groups (P < 0.083; medial thickness was 1.7 鹵0.6mm in patients with cardiovascular and cerebrovascular diseases) and that in patients without cardio-cerebral canal disease was 1.4 鹵0.2mm); there was a significant difference between the two groups in the second hospitalization, and there was no significant difference between the two groups (P < 0.05). The index of creatinine in the intervention group (64 鹵16 mmol/ L) was lower than that in the conventional western medicine group (75 鹵15 mmol / L), and the difference was statistically significant (P 0.05). The glycosylated hemoglobin in the intervention group (7.7 鹵1.03g / L) was lower than that in the control group (8.54 鹵1.53g / L), but the results were not statistically significant, and the FIB-C(2.85 鹵0.50g / L in the control group on the second admission was lower than that in the Chinese medicine intervention group (3.47 鹵0.83g / L), there was significant difference between the two groups (P 0.006). Conclusion the degree of improvement of carotid intima-media thickness in type 2 diabetes mellitus may be better than that of traditional Chinese medicine intervention combined with routine treatment of western medicine, which is related to cardiovascular and cerebrovascular complications. The intervention of traditional Chinese medicine may protect the renal function of the patients, and the intervention of traditional Chinese medicine combined with routine therapy of western medicine may reduce the level of HbA1c more effectively.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R259

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