摘要
目的:观察加味十宝汤对肾精亏虚型男性迟发性性腺功能减退症合并糖尿病患者血清性激素水平的影响.方法:选取2022年10月至2023年10月就诊于银川市中医医院符合标准的肾精亏虚型男性迟发性性腺功能减退症合并糖尿病患者60例,随机分为观察组与对照组各30例.两组均维持降糖、调脂等原有治疗手段,观察组予加味十宝汤治疗,对照组予十一酸睾酮胶囊治疗,疗程12周.比较两组治疗前后中医证候评分、中老年男性雄激素部分缺乏综合征(PADAM)症状积分、糖代谢相关指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、血清性激素指标[性激素结合球蛋白(SHBG)、游离睾酮(FT)、总睾酮(TT)、催乳素(PRL)、促黄体生成素(LH)、促卵泡生成素(FSH)、雌二醇(E2)]的变化,并进行安全性评价.结果:(1)临床疗效比较.治疗后与对照组比较,两组患者临床疗效相当,差异无统计学意义.(2)中医证候评分、PADAM症状积分比较.与本组治疗前比较,治疗后两组患者中医证候评分、PADAM症状积分均显著降低(P＜0.01);与对照组治疗后比较,观察组患者中医证候评分、PADAM症状积分降低更明显(P＜0.05).(3)糖代谢相关指标比较.与本组治疗前比较,治疗后两组患者FPG、2 h PG、HbA1c水平均显著降低(P＜0.01);治疗后组间比较,两组患者FPG、2 h PG、HbA1c水平差异无统计学意义.(4)血清性激素指标比较.与本组治疗前比较,治疗后两组患者血清FT、TT、PRL、LH、FSH水平均显著上升(P＜0.01),E2水平显著降低(P＜0.01);治疗后组间比较,两组之间FT、TT、PRL、LH、FSH、E2水平差异无统计学意义.治疗前后两组患者SHBG指标组内及组间比较差异均无统计学意义.临床观察过程中两组患者均未见明显不良反应.结论:加味十宝汤能明显改善肾精亏虚型男性迟发性性腺功能减退症合并糖尿病患者的临床症状,降低血糖,提高性激素水平,其机制可能是通过抑制脂肪细胞中芳香化酶的转化作用,促进促性腺激素释放激素的生成,调节下丘脑-垂体-性腺轴功能而实现的.
Abstract
Objective:To observe the effect of modified Shibaotang on serum sex hormone levels in patients with male late-onset hypogonadism of kidney essence deficiency syndrome complicated with diabetes mellitus.Methods:A total of 60 patients with male late-onset hypogonadism of kidney essence deficiency syndrome complicated with diabetes mellitus,who met the inclusion criteria and were admitted to Yinchuan Hospital of Traditional Chinese Medicine from October 2022 to October 2023,were selected and randomly divided into an observation group and a control group,with 30 patients in each group.Both groups continued their original treatments,including blood glucose lowering and blood lipid regulation.The observation group was treated with modified Shibaotang,while the control group was treated with testosterone undecanoate capsules.The treatment lasted for 12 weeks.The changes in traditional Chinese medicine(TCM)syndrome scores,partial androgen deficiency in aging males(PADAM)symptom scores,glucose metabolism indexes[fasting plasma glucose(FPG),2-hour postprandial glucose(2 h PG),glycosylated hemoglobin(HbA1c)],and serum sex hormone indexes[sex hormone-binding globulin(SHBG),free testosterone(FT),total testosterone(TT),prolactin(PRL),luteinizing hormone(LH),follicle stimulating hormone(FSH),estrogen(E2)]were compared between the two groups before and after treatment.Safety was also evaluated.Results:(1)Clinical efficacy comparison:After treatment,the clinical efficacy in both groups was similar,and there was no statistically significant difference between the two groups.(2)TCM syndrome score and PADAM symptom score comparison:After treatment,both groups showed a significant reduction in TCM syndrome scores and PADAM symptom scores(P＜0.01),and the observation group showed a significantly greater reduction compared to the control group(P＜0.05).(3)Glucose metabolism indexes comparison:After treatment,the levels of FPG,2 h PG,and HbA1c were significantly reduced in both groups(P＜0.01),and there was no statistically significant difference between the two groups regarding FPG,2 h PG,and HbA1c levels after treatment.(4)Serum sex hormone indexes comparison:After treatment,the levels of FT,TT,PRL,LH,and FSH were significantly increased in both groups(P＜0.01),while E2 levels were significantly decreased(P＜0.01).There was no statistically significant difference between the two groups in the levels of FT,TT,PRL,LH,FSH,and E2 after treatment.There was also no significant difference in SHBG levels within or between the groups before and after treatment.During the clinical observation,neither group exhibited any obvious adverse reactions.Conclusion:Modified Shibaotang can significantly improve the clinical symptoms of male late-onset hypogonadism of kidney essence deficiency syndrome complicated with diabetes mellitus,reduce blood glucose,and increase sex hormone levels.The mechanism may involve the inhibition of aromatase transformation in adipocytes,promotion of GnRH production,and regulation of the hypothalamic-pituitary-gonadal axis function.
国家科技期刊平台
NSTL
维普
万方数据