【摘要】：糖尿病是危害人類健康的重大疾病,隨著生活水平的提高、營養(yǎng)結構的改變、交通工具的發(fā)達、勞動強度的降低、再加上環(huán)境惡化、公民社會心理壓力的漸增,糖尿病已經發(fā)展成為一種常見病、多發(fā)病,可能為終身性的慢性疾病。目前已成為嚴重危害人類健康的公共衛(wèi)生問題。在我國糖尿病發(fā)病率呈增高趨勢,并且出現(xiàn)向低齡化發(fā)展的嚴重性。因此,防治極為重要。目前,糖尿病造成聽力下降與神經性耳聾相近似,病理機制尚未明確,所有治療的效果非常有限。本文依據(jù)“腎主骨”、“腎開竅于耳”理論,結合本組患者均有不同程度腎虛證并伴有聽力下降,觀察補腎中藥方結合辨證療法治療糖尿病聽力臨床研究。目的:糖尿病是危害人類健康的重大疾病,糖尿病所致感音神經性耳聾,因其病因尚未明確,所以治療極其困難,根據(jù)糖尿病聽力下降患者均表現(xiàn)程度不同腎虛證,參照“腎主骨”、“腎開竅于耳”理論。本研究觀察補腎中藥方對糖尿病聽力下降患者療效的影響,為補腎中藥方防治糖尿病聽力下降提供思路與方法。方法:根據(jù)國際標準化組織(ISO)1964年公布的耳聾等級標準,選取2012年10月至2015年11月在河北醫(yī)科大學附屬邢臺市人民醫(yī)院內分泌科及邢臺醫(yī)學高等�？茖W校第二附屬醫(yī)院中西醫(yī)結合科308例(416耳)2型糖尿病(NIDDM)伴耳聾患者。屬輕度聾72耳,中度聾120耳,中重度聾132耳,重度聾60耳,深度聾32耳;單側耳聾236耳,雙側耳聾180耳;出現(xiàn)突發(fā)性耳聾患者46耳,逐漸發(fā)生所引起耳聾患者370耳。上述患者按病情分組分別進行隨機分為治療組和對照組:治療組(補腎中藥組)170例(220耳),男73例,女97例,年齡36-69歲,平均50.6歲,病程1-10年,平均4.6年。對照組(西藥組)138例(196耳),男67例,女71例,年齡34-67歲,平均49.8歲,病程1-9年,平均4.3年。兩組分組經齊同性檢驗無統(tǒng)計學差異(P0.05)。另外兩組均排除的病因包括,藥物中毒性耳聾、腦外傷、噪音性耳聾,以及其它中毒性疾病等病史。診斷標準符合世界衛(wèi)生組織(WHO)確診為NIDDM標準。辯證分型依據(jù)《新藥(中藥)治療糖尿病(消渴病)臨床研究指導原則》。耳聾分級為國際標準化組織(ISO)1964年公布的耳聾等級標準。聽力學療效標準:痊愈:治療后聽力逐漸恢復,耳鳴逐漸減至消失,全頻率聽閾曲線漸回升至正常范圍或與健側相似;顯效:全頻率聽閾曲線較治療前回升超過30d B或進入實用聽區(qū),主觀癥狀明顯好轉;進步:聽閾曲線的多頻率回升15-30d B,主觀癥狀亦好轉;無效:聽閾曲線的多數(shù)頻率較治療前上升不足15d B,無論主觀癥狀是否好轉。治療組170例(220耳)用補腎中藥方結合辯證論治用藥。對照組132例糖尿病耳聾患者,用格列本脲片和治療常規(guī)所采用的耳聾藥物。觀察兩組治療前后聽力影響,空腹血糖(FBG)、餐后2h血糖(PBG)、24h尿糖定量,主要見癥改善情況,血小板功能,超氧化物歧化酶(SOD)、過氧化脂質(LPO)等變化。結果:1兩組治療前后聽力比較治療組治療后聽力提高總有效率為57.7%,對照組為28.5%,兩組比較有明顯差異(P0.05)。2兩組FBG、PBG、24h治療前后變化兩組空腹血糖(FBG)、餐后2h血糖(PBG)、24h尿血糖定量和治療前相比改善明顯(P0.05.P0.01),其中餐后2h血糖(PBG)、24h尿血糖定量治療組療效明顯優(yōu)于對照組(P0.01),兩組空腹血糖(FBG)無明顯差異(P0.05)。3兩組治療前后主要癥狀改善情況治療組和治療前相比較,在腰膝酸軟、小便量多、易肌善食,消瘦無力等癥狀改善比較明顯,(P0.05.P0.01),而對照組在上述癥狀改善不明顯。4兩組血小板粘附率、血小板聚集率、超氧化物歧化酶(SOD)、過氧化脂質(LPO)治療前后情況治療組治療后血小板粘附率,血小板聚集率,超氧化物歧化酶(SOD),過氧化脂質(LPO)有較好改變(P0.05.P0.01),而對照組除LPO有改變外(P0.05),余三項指標均無明顯差異(P0.05)。結論:1補腎中藥方結合辨證治療糖尿病聽力下降患者療效確切,未見患者引起副作用癥狀。2補腎中藥方能夠提高糖尿病聽力下降患者聽力、提高超氧化物歧化酶活性,改善糖尿病聽力下降患者主要癥狀,降低血小板聚集、過氧化脂質含量,且療效優(yōu)于常規(guī)對照組治療方法,該研究為中西醫(yī)結合防治糖尿病耳聾提供較好思路與方法。
[Abstract]:diabetes is a major disease which is harmful to human health, with the improvement of living standard, the change of the nutrition structure, the development of the transportation vehicle, the reduction of the labor intensity, the environment deterioration, the increasing of the psychological pressure of the citizen, the diabetes has developed into a common disease, It may be a life-long, chronic disease. At present, it has become a public health problem which is seriously harmful to human health. The incidence of diabetes in China is increasing, and the severity of the development of diabetes is present. Therefore, the prevention and control is of great importance. At present, the hearing loss caused by diabetes is similar to that of the nerve deafness, the pathological mechanism is not clear, and the effect of all treatments is very limited. According to the "kidney main bone" and "The kidney opens to the ear" theory, in combination with the different degree of kidney deficiency syndrome and the hearing loss of the patients in this group, the clinical study on the treatment of diabetes with the combination of the traditional Chinese medicine prescription and the syndrome differentiation therapy is observed. Objective: Diabetes is a major disease which is harmful to human health. The sensorineural hearing loss due to diabetes is not clear due to its etiology. Therefore, it is extremely difficult to treat, and according to the different degree of kidney deficiency of the patients with impaired hearing, refer to the "kidney main bone" and the "The kidney opens to the ear" theory. The purpose of this study is to observe the effect of the prescription for tonifying the kidney and the effect of the prescription on the patients with impaired hearing, and to provide a train of thought and method for the prevention and treatment of diabetes hearing loss. Method: According to the criteria for the level of deafness published by the International Organization for Standardization (ISO) in 1964, 308 cases (416 ears) of type 2 diabetes mellitus (NIDDM) with deafness were selected from October,2012 to November,2015 at the Second Affiliated Hospital of the People's Hospital of the Affiliated Hospital of Hebei Medical University. Of the patients with mild deafness,72 ears,120 ears with moderate deafness,132 ears with moderate to severe deafness,60 ears with severe deafness,32 ears with deep deafness,236 ears of one-sided deafness and 180 ears of bilateral deafness,46 ears of patients with sudden deafness and 370 ears of patients with sudden deafness. The above-mentioned patients were randomly divided into the treatment group and the control group according to the condition group: the treatment group (the kidney-tonifying traditional Chinese medicine group)170 cases (220 ears), the male 73 cases, the female 97 cases, the age 36-69 years, the average age of 50.6 years, the course of the disease 1-10 years, the average 4.6 years. 138 (196 ears) of the control group (196 ears),67 males and 71 females, aged 34 to 67, had an average of 49.8 years, and the course of the disease ranged from 1 to 9 years, with an average of 4.3 years. There was no statistical difference between the two groups (P0.05). The other two groups are excluded from the medical history of drug-induced deafness, brain trauma, noise deafness, and other toxic diseases. The diagnostic criteria were met by the World Health Organization (WHO) as the NIDDM standard. The dialectical type is based on the guiding principle of the clinical study of the treatment of diabetes (diabetes) by the new drug (traditional Chinese medicine). Deafness classification is the standard of hearing loss published by the International Organization for Standardization (ISO) in 1964. The results are as follows: after the treatment, the hearing is gradually restored, the tinnitus is gradually reduced, the full-frequency auditory threshold curve is gradually recovered to the normal range or similar to the healthy side, and the whole-frequency auditory threshold curve is more than 30 days before the treatment, or enters the practical auditory zone, and the subjective symptom is improved; Progress: The multi-frequency recovery of the auditory threshold curve is up to 15-30 d B, and the subjective symptoms are also improved; the majority of the frequency of the auditory threshold curve is less than 15 d B before the treatment, whether the subjective symptom is improved or not. In the treatment group,170 cases (220 ears) were treated with the traditional Chinese medicine for tonifying the kidney. In the control group,132 patients with diabetes and deafness were treated with gliclazide tablets and the treatment of the conventional deafness drugs. The effects of two groups of pre-and post-treatment hearing, fasting blood glucose (FBG),2-hour postprandial blood glucose (PBG) and 24-hour urine glucose were observed, and the changes of blood platelet function, superoxide dismutase (SOD) and lipid peroxide (LPO) were observed. Results: The total effective rate of the two groups was 57.7% after treatment and 28.5% in the control group, and there was a significant difference between the two groups (P0.05). The two groups of FBG, PBG, and 24h were treated with two groups of fasting blood glucose (FBG) before and after treatment. After 2 h postprandial blood glucose (PBG) and 24 h urine glucose level and pre-treatment, the blood glucose (PBG) and 24h urine glucose were significantly better than those in the control group (P 0.01). There was no significant difference between the two groups of fasting blood glucose (FBG) (P0.05). in that control group, the platelet adhesion rate, the platelet aggregation rate, the superoxide dismutase (SOD), the platelet aggregation rate, the platelet aggregation rate, the superoxide dismutase (SOD), The lipid peroxide (LPO) of the control group was better than that of the control group (P0.05). Conclusion:1. The traditional Chinese medicine prescription can improve the hearing of the patients with impaired hearing, improve the activity of the superoxide dismutase and improve the main symptoms of the patients with impaired hearing. In ord to reduce that aggregation of the platelet and the content of the lipid peroxide, and the curative effect is superior to that of the conventional control group, the study provides a good idea and a method for preventing and treating the diabetic deafness by combination of the traditional Chinese and western medicine.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R276.1;R259

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