本文選題：非酒精性脂肪肝 + 肝郁脾虛證　； 參考：《南京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過(guò)觀察疏肝健脾顆粒劑組方對(duì)2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)肝郁脾虛證型患者的胰島素抵抗(IR)、血脂、血糖及臨床癥狀的影響,結(jié)合目前現(xiàn)代中西醫(yī)研究成果,進(jìn)一步探討其作用機(jī)理,進(jìn)而為治療T2DM合并NAFLD提供新的思路及方法。方法：將2014年12月至2016年1月收集入組的T2DM合并NAFLD肝郁脾虛證患者,按照隨機(jī)對(duì)照的方法分為實(shí)驗(yàn)組和對(duì)照組,每組各30例。對(duì)照組采用生活方式干預(yù)+西醫(yī)基礎(chǔ)治療進(jìn)行治療,而實(shí)驗(yàn)組則是在對(duì)照組的基礎(chǔ)上加用自擬中藥疏肝健脾顆粒劑組方,每日一劑,水沖200m1,早晚各服100ml,兩組均干預(yù)2月。評(píng)估干預(yù)前后中醫(yī)證候積分及體征變化、糖化血紅蛋白(HbAlc).血脂(TG、TC、LDL-C、HDL-C)、肝功能(AST、ALT)水平,并行國(guó)際標(biāo)準(zhǔn)葡萄糖耐量實(shí)驗(yàn),同步測(cè)定0,30,120min血糖及同步胰島素(INS),計(jì)算胰島抵抗指數(shù)(HOMA-IR)、早期胰島素分泌指數(shù)(EISI)、120min胰島素曲線下面積(AUCINS)、120min血糖曲線下面積(AUCIBG)等相關(guān)指標(biāo),并采用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析,評(píng)估干預(yù)前后及兩組之間的差異。結(jié)果：①觀察兩組患者癥狀、體征變化：兩組患者證候積分均較前明顯下降,有顯著差異(P0.01),實(shí)驗(yàn)組明顯優(yōu)于對(duì)照組(P0.01),兩組有效率分別為86.67%、66.67%,實(shí)驗(yàn)組明顯優(yōu)于對(duì)照組(P0.05)；②比較兩組血糖水平：兩組患者FPG、2hPG、 120minAUCIBG、HbAlc較治療前明顯下降(P0.01),實(shí)驗(yàn)組較對(duì)照組下降更為明顯(P0.05)；③在胰島功能方面：兩組患者HOMA-IR均有明顯下降,與治療前相比有顯著差異(P0.01),實(shí)驗(yàn)組明顯優(yōu)于對(duì)照組(P0.01),實(shí)驗(yàn)組患者EISI較前明顯改善,(P0.01),對(duì)照組EISI較前也有所上升,差異有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組之間無(wú)明顯差異(P0.05),兩組患者120minAUCINS與治療前相比雖有所下降,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。④在血脂水平上：實(shí)驗(yàn)組在降低TC、LDL-C,升高HDL-C方面,與對(duì)照組相比有明顯優(yōu)勢(shì),差異有統(tǒng)計(jì)學(xué)意義(P0.05)；實(shí)驗(yàn)組、對(duì)照組與治療前相比TG均有明顯下降(P0.01),但兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義。⑤比較兩組患者肝功能指標(biāo)發(fā)現(xiàn),實(shí)驗(yàn)組與對(duì)照組相比在降低ALT、AST方面有顯著優(yōu)勢(shì)(P0.01)；⑥兩組患者治療期間安全性觀察指標(biāo)均在正常范圍內(nèi),未發(fā)現(xiàn)明顯不良反應(yīng)及副作用。結(jié)論：疏肝健脾顆粒劑能明顯減輕T2DM合并NAFLD肝郁脾虛證患者的胰島素抵抗,改善血糖、血脂水平,保護(hù)其肝功能,并且對(duì)于緩解其臨床癥狀有明顯的優(yōu)勢(shì),而且無(wú)明顯副作用,安全性較好,值得臨床廣泛運(yùn)用。
[Abstract]:Objective: to observe the effects of Shugan Jianpi granule on insulin resistance, blood lipid, blood glucose and clinical symptoms in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver (NAFLDD) syndrome of liver stagnation and spleen deficiency. The mechanism of NAFLD was further discussed and a new method for the treatment of T2DM combined with NAFLD was provided. Methods: T2DM patients with NAFLD liver stagnation and spleen deficiency syndrome were collected from December 2014 to January 2016 and divided into experimental group and control group with 30 cases in each group according to the method of random control. The control group was treated with lifestyle intervention and western medicine basic treatment, while the experimental group was treated with Shugan Jianpi granule, one dose daily, one dose per day, 100 ml in the morning and evening. Both groups intervened for 2 months. To evaluate the changes of syndromes and signs of TCM before and after intervention, and to evaluate HbAlcP in glycosylated hemoglobin. Serum lipids, TGG, LDL-Cn, liver function, ASTL-ALT) levels, and international standard glucose tolerance test were performed. The islet resistance index (HOMA-IRN), the early insulin secretion index (ISI) and the area under the 120min insulin curve were measured simultaneously, and the correlation indexes were analyzed by SPSS 17.0. The differences before and after intervention and between the two groups were evaluated. Results the changes of symptoms and signs of the two groups were observed: the scores of symptoms and signs of the two groups were significantly lower than those of the former, and there was a significant difference between the two groups. The experimental group was obviously superior to the control group (P 0.01), the effective rate of the two groups was 86.67 and 66.67, respectively, and the experimental group was obviously superior to the control group (P 0.05). 2 the levels of blood glucose in the two groups were compared: the levels of FPGG 2hPGand AUCIBGG HbAlc at 120min were significantly decreased compared with those before treatment, and that of the experimental group was significantly lower than that of the control group. In the islet function, HOMA-IR was significantly decreased in both groups. Compared with before treatment, there was a significant difference between the two groups (P 0.01), the experimental group was better than the control group (P 0.01), the EISI of the experimental group was significantly improved than that of the former, and the EISI of the control group was also higher than that of the control group. The difference was statistically significant (P 0.05), but there was no significant difference between the two groups (P 0.05). Although AUCINS at 120 min in the two groups was lower than that before treatment, there was no significant difference in blood lipid level: in the experimental group, LDL-C was decreased and HDL-C was increased in the experimental group. Compared with the control group, the TG in the experimental group decreased significantly compared with the control group, but there was no significant difference between the two groups in terms of liver function, the difference between the two groups was statistically significant, and the difference between the two groups was statistically significant (P 0.05), while that of the control group was significantly lower than that of the control group (P 0.05), but there was no significant difference between the two groups. Compared with the control group, the experimental group had significant advantages in reducing alt. The safety observation indexes of the two groups were within the normal range during the treatment period, and no obvious adverse reactions and side effects were found. Conclusion: Shugan Jianpi granule can obviously reduce insulin resistance, improve blood glucose and blood lipid level, protect liver function in patients with T2DM combined with liver stagnation and spleen deficiency of NAFLD, and has obvious advantages in relieving clinical symptoms and has no obvious side effects. It is safe and worthy of wide clinical application.
【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】：2016
【分類(lèi)號(hào)】：R259

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