目的 基于真实世界研究探讨全国名中医庞国明教授纯中医缓解2型糖尿病(T2DM)临床特征,为临床实践提供借鉴和参考.方法 采集2020年1月—2022年10月开封市中医院庞国明教授工作室就诊的符合T2DM诊断,并采用纯中医"三辨诊疗模式""序贯三法"治疗方案且达到缓解标准的T2DM患者共计30例.采集患者的人口学资料、中医证型及纯中医治疗前、治疗达标停药时、缓解时患者的体质量指数、血生化检验指标,计算纯中医治疗时长,使用稳态模型评估法评估胰岛素抵抗指数和胰岛β细胞功能指数.分析患者的临床特征、中医证型分布,比较纯中医治疗前与治疗达标停药时、缓解时各项指标的差异.结果 患者平均年龄(50.77±9.77)岁;平均病程中位数22(10.5,39.0)个月;平均体质量指数中位数27.75(25.87,28.80)kg/m2,中医证型分布情况:痰浊中阻证频率最高,其次气阴两虚证.与治疗前比较,患者停药时空腹血糖(FPG)、餐后1 h血糖(1 h PG)、2 h PG、3 h PG、空腹胰高血糖素(FGC)、1 h GC、2 h GC、3 h GC、糖化血红蛋白(HbA1c)、果糖胺(FMN)、胰岛素抵抗指数(HOMA-IR)、体质量指数(BMI)、总胆固醇(TC)水平明显下降,差异有统计学意义(P＜0.05),1 h C肽(CP)、胰岛β细胞功能指数(HOMA-β)水平较前升高,差异有统计学意义(P＜0.05),与治疗前比较,缓解时 FPG、1 h PG、2 h PG、1 h GC、2 h GC、HbA1c、BMI、3 h PG、FGC、3 h GC、TC、HOMA-IR水平明显下降,差异有统计学意义(P＜0.05),HOMA-β、1 h CP、高密度脂蛋白胆固醇(HDL-C)水平较前升高,差异有统计学意义(P＜0.05).结论 纯中医缓解T2DM患者以糖尿病病程＜5年,超重或肥胖为主,纯中医治疗时长多集中在3～12个月,中医证型以痰浊中阻证为主.纯中医可能通过降低体质量,改善胰岛素抵抗,改善胰岛β细胞功能,降低胰高血糖素等途径实现缓解T2DM.
Exploration of National Famous Traditional Chinese Medicine Professor PANG Guomings Pure Traditional Chinese Medicine Alleviation Based on Real World Research
Objective Based on relevant researches,this paper analyzed the TCM treatment methods adopted by Professor PANG Guoming(a famous TCM doctor in China)to alleviate the symptoms of type-2 diabetes mellitus(T2DM),so as to provide the reference for clinical practice.Methods First,it screened out the diagnosis reports of 30 T2DM patients whose symptoms were downgraded after only accepting the following TCM therapeutic regimens from January 2020 to October 2022 in the studio of Pro-fessor PANG of Kaifeng TCM Hospital.These regimens included"three-differentiation diagnosis and treatment mode"(differen-tiation of disease,syndrome and constitution)and"sequential triple therapy".Then,it collected the demographic data,TCM syn-drome types and body mass indexes and blood biochemical indexes in three stages:before the TCM treatment,when the treatment target was achieved and the medicine was stopped and when the patients were in remission.Further,the TCM treatment course is calculated,and insulin resistance index and function index of the pancreatic β cell were evaluated through homeostasis model as-sessment.Finally,it analyzed the clinical characteristics and the distribution of TCM syndromes,and compared various indexes of patients in the above three stages.Results The average age of the patients was(50.77±9.77)years old.The median illness course was 22(10.5,39)months.The median body mass index was 27.75(25.87,28.80)kg/m2.As for the TCM syndromes,most of the patients were the phlegm retention obstruction in the middle-Jiao,followed by the deficiency of Qi and Yin.Com-pared with those before treatment,the levels of fasting plasma glucose(FPG),1 h PG,2 h PG,3 h PG,fasting glucocorticoids(FGC),1 h GC,2 h GC,3 h GC,glycosylated hemoglobin(HbA1c),fructosamine(FMN),homeostatic model assessment insulin resistance index(HOMA-IR),body mass index(BMI)and total cholesterol(TC)decreased significantly while the levels of 1 h CP and HOMA-β increased after the medicine was stopped.The difference was statistically significant.And compared with the pre-treatment period,the levels of FPG,1 h PG,2 h PG,1 h GC,2 h GC,HbA1c,BMI,3 h PG,FGC,3 h GC,TC and HOMA-IR decreased significantly while the levels of HOMA-β,1 h CP and high density lipoprotein cholesterol(HDL-C)increased when the patients were in remission.The difference was also statistically significant.Conclusion TCM therapeutic regimens are a-dopted to alleviate the symptoms of T2DM patients(mainly overweight or obese)whose diabetes course is within 5 years.The treatment is mostly completed within 3-12 months,and the main TCM syndrome is phlegm retention obstruction in the middle-Jiao.Specific TCM solutions to alleviate the symptoms of T2DM include reducing body weight,improving insulin resistance,im-proving the function of the pancreatic β cell and lowering glucagon.
type 2 diabetes mellitusrelievePANG Guomingreal-world researchclinical features
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