大柴胡汤合桂枝茯苓丸对2型糖尿病合并非酒精性脂肪性肝病患者胰岛素抵抗及肝纤维化指标的影响OA
Effect of Dachaihu and Guizhi Fuling decoction on insulin resistance and fibrosis in patients with type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease
目的:探讨大柴胡汤合桂枝茯苓丸用于2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者的临床疗效,及对胰岛素抵抗和肝纤维化指标的影响.方法:纳入2023年1月至2024年5月于石家庄市第二医院治疗的T2DM合并NAFLD患者100例.采用随机数字表法分为对照组、观察组,各50例.对照组患者给予盐酸二甲双胍片联合水飞蓟宾胶囊治疗,观察组患者在对照组基础上加用大柴胡汤合桂枝茯苓丸.两组疗程均为12周.比较两组患者治疗前后中医证候积分,血糖指标[空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)]、肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]、肝脏脂肪受控衰减参数(CAP)、肝脏硬度(LSM)、血脂指标[总胆固醇(TC)、甘油三酯(TG)]、胰岛素相关指标[空腹C肽(FCP)、空腹胰岛素(FINS)、餐后2 h C肽(2 h CP)、餐后2 h胰岛素(2 h INS)、稳态模型β细胞功能指数(HOMA-β)]及肝纤维化指标[Ⅳ型胶原(Ⅳ-C)、透明质酸(HA)、层黏蛋白(LN)]水平变化.结果:与治疗前比较,两组患者治疗12周后中医证候积分明显下降(P＜0.05),血清FBG、2h PG、HbA1c、HOMA-IR 及 ALT、AST、CAP、LSM、TC、TG、Ⅳ-C、HA、LN 的水平明显降低,FCP、FINS、2 h CP、2 h INS、HOMA-β的水平改善(P＜0.05);组间比较,观察组治疗后总有效率明显高于对照组(P＜0.05),在缓解患者中医症状及降低血糖、肝脏脂肪、纤维化水平,改善肝功能方面均优于对照组(P＜0.05).结论:大柴胡汤合桂枝茯苓丸辅助治疗T2DM合并NAFLD患者疗效确切,能有效控制血糖、血脂,改善胰岛素抵抗及肝纤维化程度.
Objective:To observe the clinical effect of Dachaihu and Guizhi Fuling Decoction on type 2 diabetes mellitus(T2DM)patients with nonalcoholic fatty liver disease(NAFLD),and its influence on insulin resistance and fibrosis indicators.Methods:One hundred patients with T2DM complicated with NAFLD were randomly divided into a control group and an observation group,with 50 cases in each group.The control group was given metformin hydrochloride tablets and silibinin capsules orally,while the observation group was given Dachaihu and Guizhi Fuling Decoction in addition to the control group.Evaluate the clinical efficacy of two groups after 12 weeks of treatment.Observe the changes in traditional Chinese medicine(TCM)syndrome scores before and after treatment.Measure the levels of fasting blood glucose(FBG),2-hour postprandial glucose(2 h BG),glycated hemoglobin(HbA1c),live function(alanine aminotransferase[ALT],aspartate aminotransferase[AST]),liver fat and stiffness(controlled attenuation parameter[CAP],liver stiffness measurement[LSM]]),in two groups of patients.Observe the changes in insulin resistance[fasting C-peptide(FCP),fasting insulin(FINS),2-hour postprandial C-peptide(2-hour CP),2-hour postprandial insulin(2-hour INS)],pancreatic beta cell function[pancreatic beta cell function index(HOM A-β),insulin resistance index(HOMA-IR)]and fibrosis indicators[type Ⅳ collagen(Ⅳ-C),hyaluronic acid(HA),lamin(LN)]levels of patients.Results:Compared with before treatment,the scores of TCM symptoms in both groups decreased significantly after treatment(P＜0.05).The levels of FBG,2 hBG,HbA1c,HOMA-IR and ALT,AST,CAP,LSM,TC,TG,Ⅳ-C,HA,LN were significantly reduced,while the levels of FCP,FINS,2-hour CP,2-hour INS,and HOMA-β were significantly increased(P＜0.05).The comparison between groups showed that the total effective rate of the observation group after treatment was significantly higher than that of the control group(P＜0.05).In terms of relieving TCM symptoms,reducing blood sugar,liver fat,fibrosis levels and improving liver function,the treatment group was superior to the control group(P＜0.05).Conclusion:Dachaihu and Guizhi Fuling Decoction has good hypoglycemic and hepatoprotective effects in patients with T2DM complicated with NAFLD.It can effectively control blood glucose and lipid levels,improve insulin resistance,liver fatty and fibrosis.Combined with Western medicine treatment,the curative effect was further improved.
武朝英;高若愚;刘琼
石家庄市第二医院糖尿病中西医结合科(河北 石家庄,050000)石家庄市第二医院糖尿病中西医结合科(河北 石家庄,050000)石家庄市第二医院糖尿病中西医结合科(河北 石家庄,050000)
医药卫生
2型糖尿病非酒精性脂肪性肝病大柴胡汤桂枝茯苓丸胰岛素抵抗肝纤维化
type 2 diabetesnon-alcoholic fatty liver diseaseDachaihu decoctionGuizhi Fuling pillinsulin resistancehepatic fibrosis
《中西医结合肝病杂志》 2026 (4)
418-422,5
河北省中医药管理局科研计划项目(No.2023386)
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