目的探讨清热利湿健脾降糖方联合穴位埋线治疗肥胖型2型糖尿病(Type 2 diabetes,T2DM)湿热困脾证的临床价值。方法选取2020年1月—2021年10月期间空军军医大学第一附属医院收治的肥胖型T2DM湿热困脾证患者88例,采用随机数字表法分为对照组与试验组,每组各44例。两组患者均开展T2DM基础治疗,在此基础上,对照组给予盐酸二甲双胍治疗,试验组给予盐酸二甲双胍+中医特色疗法(清热利湿健脾降糖方、穴位埋线)。治疗12周后,观察比较两组患者治疗前后中医证候积分、血糖指标[空腹血糖(Fasting plasma glucose,FPG)、餐后2 h血糖(Blood glucose 2 h after meal,2 h PG)、糖化血红蛋白(Glycosylated hemoglobin,HbAlc)]、血脂指标[高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、甘油三酯(Triglyceride,TG)、总胆固醇(Total cholesterol,TC)]、肥胖指数[体质量指数(Body mass index,BMI)、腰臀比(Waist hip ratio,WHR)]、生活质量评分(Adjusted diabetes-specific quality of life scale,A-DQOL)变化及中医证候疗效、治疗安全性。结果(1)中医证候积分:治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候积分均低于对照组,差异有统计学意义(P<0.05);(2)中医证候疗效:治疗后试验组中医证候总有效率92.86%(39/42)高于对照组64.29%(27/42),差异有统计学意义(P<0.05);(3)血糖水平:治疗后两组患者血糖FPG、2 h PG、HbAlc水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组血糖FPG、2 h PG、HbAlc水平均低于对照组,差异有统计学意义(P<0.05);(4)血脂水平:治疗后两组患者血脂HDL-C、LDL-C、TG、TC水平均较治疗前改善,差异有统计学意义(P<0.05);且试验组血脂HDL-C、LDL-C、TG、TC水平改善均优于对照组,差异有统计学意义(P<0.05);(5)肥胖指数:治疗后两组患者肥胖指数BMI、WHR均较治疗前降低,差异有统�
目的:探讨2型糖尿病(T2DM)湿热困脾证、气阴两虚证患者肠道菌群的结构特征和功能差异。方法:选择2018年6月至2020年1月就诊于南京中医药大学附属南京中医院的T2DM湿热困脾证患者62例,气阴两虚证患者60例,收集其血清及粪便样本,比较两证型患者体质量指数(BMI),糖脂代谢,空腹胰岛素(FINS),空腹C肽(FCP),胰岛素抵抗指数(HOMA-IR),粪便样本提取DNA建库,采用高通量16S rDNA测序技术,对2组肠道菌群及菌群代谢通路分析比较。结果:①与气阴两虚证患者比较,湿热困脾证患者的BMI,空腹血糖(FPG),餐后2 h血糖(2 h PBG),总胆固醇(TC),甘油三酯(TG),低密底脂蛋白(LDL),FINS,FCP,HOMA-IR均明显升高,HDL明显降低(P<0.05,P<0.01)。②两组菌群物种组成及差异,在纲水平上,以拟杆菌纲,梭状芽胞杆菌纲,γ蛋白杆菌纲等为主,气阴两虚证的梭状芽胞杆菌、柔膜菌纲、疣微菌纲的相对丰度明显高于湿热困脾证(P<0.05);目水平下以拟杆菌目、梭菌目、肠杆菌目等为主,气阴两虚证的梭菌目、丹毒丝菌目、疣微菌目的相对丰度明显高于湿热困脾证,而气单胞菌目则在湿热困脾证高于气阴两虚证(P<0.05);科水平下以拟杆菌科、普氏菌科、瘤胃球菌科等为主,其中气阴两虚证的瘤胃球菌科、紫单胞菌科、丹毒丝菌科等的相对丰度明显高于湿热困脾证(P<0.05);属水平下以拟杆菌属、普氏菌属、副拟杆菌属等为主,其中气阴两虚证的副拟杆菌属、丁酸弧菌属、瘤胃梭菌属等的相对丰度显著高于湿热困脾证,而在湿热困脾组的克雷伯菌属、巨球型菌属则高于气阴两虚证(P<0.05)。③基于运算分类单位(OTU)的Venn分析发现湿热困脾证和气阴两虚证患者独有的OUT分别49,47个。④基于OTU的β多样性和α分析,结果Shannon,Simpson指数差异均具有统计学意义,Ace,Chao指数差异无统计学意义,气阴两虚证患者的肠道微生物多样性高于湿热困脾
Objective:To observe the effects of acupoint thread-embedding therapy on serum apelin and glucagon-like peptide-1(GLP-1)in type 2 diabetes mellitus patients with obesity due to dampness-heat encumbering spleen.Methods:Sixty-six patients were randomly divided into a control group and an observation group according to the random number table method,with 33 cases in each group.Patients in the control group were treated with exenatide and metformin,while patients in the observation group were treated with additional acupoint thread-embedding.After 12-week treatment,the obesity-related indicators,including body mass index(BMI),waist circumference and body fat rate,the glycometabolism indicators,including fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin,and the lipid metabolism indicators,including total cholesterol(TC),triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C),as well as serum apelin and GLP-1 levels were observed in patients of the two groups.Results:After treatment,the BMI,waist circumference and body fat rate of patients in the two groups were all reduced(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin levels of patients in both groups were all decreased(all P<0.05),and were significantly lower in the observation group than in the control group(all P<0.05);the TC level was decreased(P<0.05),while the TG and LDL-C levels did not change significantly in the control group(both P>0.05);the TC,TG and LDL-C levels were all significantly reduced in the observation group(all P<0.05),lower than those in the control group(all P<0.05);the serum apelin level was decreased(P<0.05)and the serum GLP-1 level was increased(P<0.05)in the observation group,statistically different from those in the control group(both P<0.05).Conclusion:Combined with the conventional medication,acupoint thread-embedding therapy can significantly improve the obesity-related in
