泻热祛瘀、益气养阴法治疗代谢综合征的临床疗效及机理研究
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摘要
第一部分代谢综合征的理论与文献研究
代谢综合征是以胰岛素抵抗为共同病理基础,以中心性肥胖、糖调节受损及/或糖尿病、高血压、血脂异常为主要症候的一组临床症候群。其作为多种危险因素聚集的综合征,其临床预后的不良危险是各组分危险因素的协同加剧,这些危险因素造成糖尿病及心血管疾病。目前代谢综合征的病理生理学机制尚不完全清楚,既往研究主要集中在腹型肥胖、脂毒性和胰岛素抵抗几方面,但其发病机制尚有不同认识,其存在有可能是一个共同机制作用的结果。虽然代谢综合征的诊断标准、临床应用上目前仍然存在争议,但是代谢综合征这一概念的提出,使人们意识到多重危险因素的效应并不是简单叠加,而在一定程度上是糖尿病和心血管疾病的早期“预警”和“风向标”,早期防治具有重要意义。所以在防治方面主要针对改善和减轻胰岛素抵抗及所带来的多代谢失调,不仅要控制血糖,还要全面控制多代谢失调。
当前疾病医学逐渐出现向健康医学转变的趋势,以医学干预为切入点成为更为重要的方面。“治未病”乃中医一大特色,与健康医学的理念在宏观层面有共通之处,以“治未病”思想指导综合防治代谢综合征具有良好的可行性。
历代中医典籍中虽然没有与代谢综合征相对应的病名,但代谢综合征可以归入中医学“消渴”、“脾瘅”、“肥胖”、“眩晕”、“胸痹心痛病”等范畴,对与代谢综合征相关的这些疾病的论述相当丰富。但目前中医辨证分型尚处于探索阶段,缺乏大规模的中医辨证规范研究,此外尚缺少疗效确切的中医药疗法。因而针对代谢综合征的主要病机特点,确立泻热祛瘀、益气养阴的治法,并进行临床疗效评价,为临床治疗代谢综合征提供思路与方法具有广阔前景。
第二部分泻热祛瘀、益气养阴法治疗代谢综合征的临床研究
目的:本课题以研究中医药治疗代谢综合征的相关文献及导师临床经验为基础,探讨代谢综合征的病机特点,初步提出代谢综合征的主要病机为瘀热互结、气阴两虚的理论,并运用泻热祛瘀、益气养阴法治疗。通过观察以该法组方的降糖三黄片临床疗效,进一步论证此理论的正确性,以期为今后降糖三黄片的进一步有效应用提供有价值的理论依据。
方法:本课题为前瞻性研究,临床观察代谢综合征患者72例,均是于2008年8月-2009年3月于广州中医药大学第一附属医院就诊患者,按随机化原则分为中药组(37例)、西药组(35例)。纳入患者在饮食及运动治疗的基础上,分别以泻热祛瘀、益气养阴法(降糖三黄片)和西药常规疗法(拜糖平)干预治疗,治疗周期为2个月,两组间及各组前后进行比较,观察患者治疗前后代谢综合征各诊断指标、OGTT、胰岛素释放试验、IAI、TNF-α、IL-6、ADP、LP、FFA临床症状积分、生存质量量表积分等指标在治疗后改善情况,数据处理使用SPSS 13.0软件包,计数资料采用x~2检验,计量资料采用t检验。
结果:(1)在疗效的总有效率方面,中药组为78.4%,西药组为82.9%,两组间无显著性差异(P＞0.05);两组间中医证候积分改善方面,中药组优于西药组,两组存在显著性差异(P＜0.05),提示在辨证论治思想指导下,中药作用较西药更为全面;两组间生存质量积分方面,中药组优于西药组(P＜0.01),其中在生理维度、治疗影响维度中药组改善明显(P＜0.05),提示中药副作用反应较少。两组间成本-效果比值方面,中药组优于西药组。(2)通过分析治疗前后相关指标,两组在治疗后均能降低FBG、2hPG、HbAl_c、FINS、2hINS、IAI、TC、TG、LDL-C水平(P＜0.05或P＜0.01),HDL-C水平均较治疗前升高(P＜0.05或P＜0.01)。在BMI、WHR、SBP、DBP方面,治疗前后比较均无明显差异(P＞0.05)。(3)治疗后两组间在FBG、2hPG、HbAl_c、FINS、2hINS、IAI、TG、LDL-C水平方面比较无显著性差异(P＞0.05);在降低TC、升高HDL-C水平方面,西药组优于中药组,两组间存在显著性差异(P＜0.05)。(4)治疗前两组患者与正常人对照组在TNF-α、IL-6、LP、ADP、FFA水平方面存在显著性差异(P＜0.05或P＜0.01);治疗后两组TNF-α、IL-6、LP、FFA水平均较治疗前降低(P＜0.05或P＜0.01);ADP水平均较前上升(P＜0.05);治疗后两组间比较,在TNF-α、IL-6、LP、ADP、FFA水平方面无显著性差异(P＞0.05)。(5)治疗前纳入病例患者血尿酸水平与BMI、WHR、FPG、2hPG、TG、LDL-C呈正相关,与HDL-C呈负相关。
结论与启示:(1)代谢综合征的始动外因是饮食不节、情志不遂、劳逸失调,而禀赋不足、脏腑亏虚是其发生发展的内因,在整个疾病过程中,燥热、痰浊与血瘀是其主要病理产物,又是新的发病因素,以泻热祛瘀为法切入符合其主要病机特点。运用泻热祛瘀、益气养阴组方的降糖三黄片能有效干预代谢综合征患者各组分危险因素、提高患者生活质量。其作用机理与改善炎症状态、调节脂肪源细胞因子、降低血脂成分相关。(2)代谢综合征作为DM、CVD危险因素的丛集,早期治疗具有重要意义。以“治未病”思想为指导,对代谢综合征的治疗应抓住中早期,宜祛邪务早,而泻热祛瘀法可及早截断病程,扭转病变。降糖三黄片以其精当配伍,切中代谢综合征主要病机,能取得较好的临床疗效,其总体疗效与西药拜糖平相近。(3)目前代谢综合征的宣教普及仍有很多不足,其早期知晓率偏低,应加大对该病防治的宣教力度。此外在代谢综合征的诊断标准方面,以《内经》肥人三型辨证为指导,评估脂肪分布情况比单纯的BMI评价更为全面;同时,血尿酸与代谢综合征各组分具有较高相关性,提示尿酸检测具有重要意义。
The first part:Study of metabolic syndrome(MS) theory and literature
On the common pathologic basis of IR,MS is a group of clinical syndromes(which is mainly composed of) mainly including central obesity,impaired glucose regulation, diabetes,hypertension,dyslipidemia.Both its syndrome and clinical outcome are concurrently caused by lots of dangerous elements,which contribute to diabetes and cardiovascular disease.Previous studies mainly focused on abdominal obesity,lipid toxicity and IR.Currently,the pathophysiologic mechanism of MS is not yet entirely clear, there are different understandings of its pathogenesis and it may be caused by a common mechanism.Although controversial problems still exist in both of the diagnostic criteria and clinical applications of MS,But putting forward the concept of MS not only can make people aware that the effects of multiple risk factors is not a simple overlay,as the early "early warning" and "wind vane" of diabetes and cardiovascular disease,but also can be significant in the early prevention and treatment in some degree.Therefore,in order to improve the multiple metabolic disorders caused by IR,attentions in the prevention and treatment should be paid in controlling the level of blood sugar as well as full controlling of multiple metabolic disorders.
Nowadays,with trends in medical developing from pathema medicine to health medicine,medical intervention plays a more and more important part as a breakthrough point in medicine.To prevent diseases before it occur "which has some viewpoints in common with health medicine at the macro level is one of most important characteristics of Chinese medicine.So,it is feasible way to give some meaningful directions in comprehensive prevention and treatment of MS.
Although a term of MS can't be found in the Chinese medicine's books,ample descriptions of some diseases related to MS can be found,such as "Diabetes","obesity", "dizziness","obstruction of chest" and so on.All of which are equivalent to MS,for differentiation of symptoms and signs for classification of syndrome is still in the exploratory stage,we are still lack of large-scale normative study of TCM,furthermore,a definitive Chinese medicine therapy has not been established yet.Hence,establishing treatment combined with the evaluation of clinical efficacy by clearing heat and eliminating stasis and supplement the vital energy according to Metabolic syndrome's main characteristics,when providing new ideas and methods for clinical treatment of MS is concerned,it shows Vast Vistas.
The second part:Purging heat and eliminating blood stasis,replenishing qi and nourish yin treatment of MS in clinical research
Objective:to research the characteristics of the pathogenesis of MS and preliminarily raise a point that the main pathogenesis of MS is the theory of blood and heat Accumulation、deficiency of Qi and Yin and to encourage the application of the therapy of purging heat and eliminating blood stasis,replenishing qi and nourish yin on MS,based on the study of Chinese medicine treatment of metabolic syndrome in the literature and clinical experience of instructors.By observing the clinical efficacy of Jiangtang Sanhuang pills which were made according to the very therapy,the correctness of this theory is evidenced to provide valuable theoretical basis for the future effective application of Jiangtang Sanhuang pills.
Methods:Carried out a prospective study with the clinical observation of 72 patients with metabolic syndrome in our hospital during the period from August 2008 to 2009 March.The 72 cases were randomized into two groups,the herb group(37 cases)and the Western medicine group(35 cases),and on the basis of the same treatment of eating and physical activity,the herb group received the therapy of purging heat and eliminating blood stasis,replenishing qi and nourish yin(Sanhuang Jiangtang pills) while the western medicine group received conventional Western medicine therapy(acarbose).The course of treatment was 2 months and during the period the observation of kinds of clinical diagnosis criterions of MS,OGTT,the insulin release test,IAI,TNF-α,IL-6,ADP,LP,FFA clinical symptom score and quality of life indicators such as scale points was carried out.Then compared the herb group with the Western medicine group and compared before the treatment with after the treatment respectivey,to find out the change of the data.The data process SPSS 13.0 software package,using x2 test count data,measurement data using t test.
Results:(1) The total effective rate of the herb group was 78.4%,while the western medicine group was 82.9%,the difference between the two groups had no significance (P＞0.05);points between the two groups showed that the quality of life the herb group was superior to the western medicine group,and the difference was significant(P＜0.05);the cost between the two groups-the effect of the ratio,the herb group was superior to the western medicine group.(2)Through the analysis of relevant indicators from comparing before treatment and after treatment,the two groups' levels of FBG,2hPG,HbA1c,FINS, 2hINS,IAI,TC,TG,LDL-C(P＜0.05 or P＜0.01) can be reduced after treatment,but the level of HDL-C is higher than before treatment(P＜0.05 or P＜0.01).Comparing before and after treatment,there is having no significant difference at the level of BMI,WHR,SBP, DBP,(P＞0.05).(3)After treatment,there was no significant difference between the two groups in the levels of FBG,2hPG,HbA1C,FINS,2hINS,IAI,Tg and LDL-C(P＞0.05); there was a significant difference between the two groups in reducing TC and increasing HDL-C level(P＜0.05) that the western medicine group was superior to the herb group.(4) before the treatment,there was a significant difference(P＜0.05 or P＜0.01) between the two groups of patients and normal control group in the levels of TNF-α,IL-6,LP,ADP and FFA; after the treatment,the two groups' levels of TNF-α,IL-6,LP and FFA were lower than before the treatment(P＜0.05 or P＜0.01);after the treatment,the two groups' levels of ADP rose higher than before the treatment(P＜0.05);after the treatment there had no significant difference between the two groups in the levels of TNF-α,IL-6,LP,ADP,and FFA (P＞0.05).(5) Before treatment two groups of patients' SUA level was positively related to BMI,WRH,FPG,2hPG,TG,LDL-C and was negative related to with HDL-C.
Conclusions and revelations:(1) The external causes of MS are incontinence diets, emotions failures,the maladjustments between work and rest,and the internal causes are inadequate gifts,viscera deficiency during its occurrence and development.In the process of this disease,dryness-heat,corrupt sputum and gore are not only its pathological products,but also its new causes.The treatment in accord with its main pathological character.The treatment of purging heat and eliminating blood stasis,replenishing qi and nourish yin can effectively intervene dangerous factors of the patients and improve their life quality.Its mechanism is related to improving the state of inflammation,adjusting the fat source of cytokines and lowing lipid composition.(2)Early treatment for MS(a cluster of the DM and CVD risky factors)is of great importance.According to the idea of treating "non-disease",the treatment for MS should be given as early as possible,eliminating the pathogenic factor and the therapy of purging heat and eliminating blood stasis could cut off the disease course.Sanhuang Jiangtang pills with its compatibility hit the main pathogenesis of MS,could achieve better clinical efficacy,its total effect was similar to the western medicine acarbose.
So far,there are still many disadvantages of MS' universal education.Its early finding rate is very low,so we should increase the education on disease prevention and control efforts.Besides,in the diagnosis of MS standards,To "Endo-meridians" as the guide, accessing the distribution of fat is more comprehensive than evaluating simple BMI;At the same time,serum uric acid are closely related to MS components,which suggests that the detection of uric acid is important.
Innovation:on the basis of the prospective study,clinical research is adapted to make the evaluation of Sanhuang Jiangtang pills" efficacy of MS.By observing the relevant indicators,it is found that the medical prescription of clearing heat and eliminating stasis and supplement the vital energy has a certain effect on the prevention and treatment of MS which has provided a reliable scientific basis for the expansion of Sanhuang Jiangtang pills'clinical application and expanded methods and thinking in the Chinese medicine treatment of MS.By observing this prescription's impact on the pathogenesis of MS in different lights,such as Inflammatory cytokines,fat-derived factor,lipid composition factor, etc,the Primary mechanism of Sanhuang Jiangtang pills can be expounded.
代谢综合征是以胰岛素抵抗为共同病理基础,以中心性肥胖、糖调节受损及/或糖尿病、高血压、血脂异常为主要症候的一组临床症候群。其作为多种危险因素聚集的综合征,其临床预后的不良危险是各组分危险因素的协同加剧,这些危险因素造成糖尿病及心血管疾病。目前代谢综合征的病理生理学机制尚不完全清楚,既往研究主要集中在腹型肥胖、脂毒性和胰岛素抵抗几方面,但其发病机制尚有不同认识,其存在有可能是一个共同机制作用的结果。虽然代谢综合征的诊断标准、临床应用上目前仍然存在争议,但是代谢综合征这一概念的提出,使人们意识到多重危险因素的效应并不是简单叠加,而在一定程度上是糖尿病和心血管疾病的早期“预警”和“风向标”,早期防治具有重要意义。所以在防治方面主要针对改善和减轻胰岛素抵抗及所带来的多代谢失调,不仅要控制血糖,还要全面控制多代谢失调。
当前疾病医学逐渐出现向健康医学转变的趋势,以医学干预为切入点成为更为重要的方面。“治未病”乃中医一大特色,与健康医学的理念在宏观层面有共通之处,以“治未病”思想指导综合防治代谢综合征具有良好的可行性。
历代中医典籍中虽然没有与代谢综合征相对应的病名,但代谢综合征可以归入中医学“消渴”、“脾瘅”、“肥胖”、“眩晕”、“胸痹心痛病”等范畴,对与代谢综合征相关的这些疾病的论述相当丰富。但目前中医辨证分型尚处于探索阶段,缺乏大规模的中医辨证规范研究,此外尚缺少疗效确切的中医药疗法。因而针对代谢综合征的主要病机特点,确立泻热祛瘀、益气养阴的治法,并进行临床疗效评价,为临床治疗代谢综合征提供思路与方法具有广阔前景。
第二部分泻热祛瘀、益气养阴法治疗代谢综合征的临床研究
目的:本课题以研究中医药治疗代谢综合征的相关文献及导师临床经验为基础,探讨代谢综合征的病机特点,初步提出代谢综合征的主要病机为瘀热互结、气阴两虚的理论,并运用泻热祛瘀、益气养阴法治疗。通过观察以该法组方的降糖三黄片临床疗效,进一步论证此理论的正确性,以期为今后降糖三黄片的进一步有效应用提供有价值的理论依据。
方法:本课题为前瞻性研究,临床观察代谢综合征患者72例,均是于2008年8月-2009年3月于广州中医药大学第一附属医院就诊患者,按随机化原则分为中药组(37例)、西药组(35例)。纳入患者在饮食及运动治疗的基础上,分别以泻热祛瘀、益气养阴法(降糖三黄片)和西药常规疗法(拜糖平)干预治疗,治疗周期为2个月,两组间及各组前后进行比较,观察患者治疗前后代谢综合征各诊断指标、OGTT、胰岛素释放试验、IAI、TNF-α、IL-6、ADP、LP、FFA临床症状积分、生存质量量表积分等指标在治疗后改善情况,数据处理使用SPSS 13.0软件包,计数资料采用x~2检验,计量资料采用t检验。
结果:(1)在疗效的总有效率方面,中药组为78.4%,西药组为82.9%,两组间无显著性差异(P＞0.05);两组间中医证候积分改善方面,中药组优于西药组,两组存在显著性差异(P＜0.05),提示在辨证论治思想指导下,中药作用较西药更为全面;两组间生存质量积分方面,中药组优于西药组(P＜0.01),其中在生理维度、治疗影响维度中药组改善明显(P＜0.05),提示中药副作用反应较少。两组间成本-效果比值方面,中药组优于西药组。(2)通过分析治疗前后相关指标,两组在治疗后均能降低FBG、2hPG、HbAl_c、FINS、2hINS、IAI、TC、TG、LDL-C水平(P＜0.05或P＜0.01),HDL-C水平均较治疗前升高(P＜0.05或P＜0.01)。在BMI、WHR、SBP、DBP方面,治疗前后比较均无明显差异(P＞0.05)。(3)治疗后两组间在FBG、2hPG、HbAl_c、FINS、2hINS、IAI、TG、LDL-C水平方面比较无显著性差异(P＞0.05);在降低TC、升高HDL-C水平方面,西药组优于中药组,两组间存在显著性差异(P＜0.05)。(4)治疗前两组患者与正常人对照组在TNF-α、IL-6、LP、ADP、FFA水平方面存在显著性差异(P＜0.05或P＜0.01);治疗后两组TNF-α、IL-6、LP、FFA水平均较治疗前降低(P＜0.05或P＜0.01);ADP水平均较前上升(P＜0.05);治疗后两组间比较,在TNF-α、IL-6、LP、ADP、FFA水平方面无显著性差异(P＞0.05)。(5)治疗前纳入病例患者血尿酸水平与BMI、WHR、FPG、2hPG、TG、LDL-C呈正相关,与HDL-C呈负相关。
结论与启示:(1)代谢综合征的始动外因是饮食不节、情志不遂、劳逸失调,而禀赋不足、脏腑亏虚是其发生发展的内因,在整个疾病过程中,燥热、痰浊与血瘀是其主要病理产物,又是新的发病因素,以泻热祛瘀为法切入符合其主要病机特点。运用泻热祛瘀、益气养阴组方的降糖三黄片能有效干预代谢综合征患者各组分危险因素、提高患者生活质量。其作用机理与改善炎症状态、调节脂肪源细胞因子、降低血脂成分相关。(2)代谢综合征作为DM、CVD危险因素的丛集,早期治疗具有重要意义。以“治未病”思想为指导,对代谢综合征的治疗应抓住中早期,宜祛邪务早,而泻热祛瘀法可及早截断病程,扭转病变。降糖三黄片以其精当配伍,切中代谢综合征主要病机,能取得较好的临床疗效,其总体疗效与西药拜糖平相近。(3)目前代谢综合征的宣教普及仍有很多不足,其早期知晓率偏低,应加大对该病防治的宣教力度。此外在代谢综合征的诊断标准方面,以《内经》肥人三型辨证为指导,评估脂肪分布情况比单纯的BMI评价更为全面;同时,血尿酸与代谢综合征各组分具有较高相关性,提示尿酸检测具有重要意义。
The first part:Study of metabolic syndrome(MS) theory and literature
On the common pathologic basis of IR,MS is a group of clinical syndromes(which is mainly composed of) mainly including central obesity,impaired glucose regulation, diabetes,hypertension,dyslipidemia.Both its syndrome and clinical outcome are concurrently caused by lots of dangerous elements,which contribute to diabetes and cardiovascular disease.Previous studies mainly focused on abdominal obesity,lipid toxicity and IR.Currently,the pathophysiologic mechanism of MS is not yet entirely clear, there are different understandings of its pathogenesis and it may be caused by a common mechanism.Although controversial problems still exist in both of the diagnostic criteria and clinical applications of MS,But putting forward the concept of MS not only can make people aware that the effects of multiple risk factors is not a simple overlay,as the early "early warning" and "wind vane" of diabetes and cardiovascular disease,but also can be significant in the early prevention and treatment in some degree.Therefore,in order to improve the multiple metabolic disorders caused by IR,attentions in the prevention and treatment should be paid in controlling the level of blood sugar as well as full controlling of multiple metabolic disorders.
Nowadays,with trends in medical developing from pathema medicine to health medicine,medical intervention plays a more and more important part as a breakthrough point in medicine.To prevent diseases before it occur "which has some viewpoints in common with health medicine at the macro level is one of most important characteristics of Chinese medicine.So,it is feasible way to give some meaningful directions in comprehensive prevention and treatment of MS.
Although a term of MS can't be found in the Chinese medicine's books,ample descriptions of some diseases related to MS can be found,such as "Diabetes","obesity", "dizziness","obstruction of chest" and so on.All of which are equivalent to MS,for differentiation of symptoms and signs for classification of syndrome is still in the exploratory stage,we are still lack of large-scale normative study of TCM,furthermore,a definitive Chinese medicine therapy has not been established yet.Hence,establishing treatment combined with the evaluation of clinical efficacy by clearing heat and eliminating stasis and supplement the vital energy according to Metabolic syndrome's main characteristics,when providing new ideas and methods for clinical treatment of MS is concerned,it shows Vast Vistas.
The second part:Purging heat and eliminating blood stasis,replenishing qi and nourish yin treatment of MS in clinical research
Objective:to research the characteristics of the pathogenesis of MS and preliminarily raise a point that the main pathogenesis of MS is the theory of blood and heat Accumulation、deficiency of Qi and Yin and to encourage the application of the therapy of purging heat and eliminating blood stasis,replenishing qi and nourish yin on MS,based on the study of Chinese medicine treatment of metabolic syndrome in the literature and clinical experience of instructors.By observing the clinical efficacy of Jiangtang Sanhuang pills which were made according to the very therapy,the correctness of this theory is evidenced to provide valuable theoretical basis for the future effective application of Jiangtang Sanhuang pills.
Methods:Carried out a prospective study with the clinical observation of 72 patients with metabolic syndrome in our hospital during the period from August 2008 to 2009 March.The 72 cases were randomized into two groups,the herb group(37 cases)and the Western medicine group(35 cases),and on the basis of the same treatment of eating and physical activity,the herb group received the therapy of purging heat and eliminating blood stasis,replenishing qi and nourish yin(Sanhuang Jiangtang pills) while the western medicine group received conventional Western medicine therapy(acarbose).The course of treatment was 2 months and during the period the observation of kinds of clinical diagnosis criterions of MS,OGTT,the insulin release test,IAI,TNF-α,IL-6,ADP,LP,FFA clinical symptom score and quality of life indicators such as scale points was carried out.Then compared the herb group with the Western medicine group and compared before the treatment with after the treatment respectivey,to find out the change of the data.The data process SPSS 13.0 software package,using x2 test count data,measurement data using t test.
Results:(1) The total effective rate of the herb group was 78.4%,while the western medicine group was 82.9%,the difference between the two groups had no significance (P＞0.05);points between the two groups showed that the quality of life the herb group was superior to the western medicine group,and the difference was significant(P＜0.05);the cost between the two groups-the effect of the ratio,the herb group was superior to the western medicine group.(2)Through the analysis of relevant indicators from comparing before treatment and after treatment,the two groups' levels of FBG,2hPG,HbA1c,FINS, 2hINS,IAI,TC,TG,LDL-C(P＜0.05 or P＜0.01) can be reduced after treatment,but the level of HDL-C is higher than before treatment(P＜0.05 or P＜0.01).Comparing before and after treatment,there is having no significant difference at the level of BMI,WHR,SBP, DBP,(P＞0.05).(3)After treatment,there was no significant difference between the two groups in the levels of FBG,2hPG,HbA1C,FINS,2hINS,IAI,Tg and LDL-C(P＞0.05); there was a significant difference between the two groups in reducing TC and increasing HDL-C level(P＜0.05) that the western medicine group was superior to the herb group.(4) before the treatment,there was a significant difference(P＜0.05 or P＜0.01) between the two groups of patients and normal control group in the levels of TNF-α,IL-6,LP,ADP and FFA; after the treatment,the two groups' levels of TNF-α,IL-6,LP and FFA were lower than before the treatment(P＜0.05 or P＜0.01);after the treatment,the two groups' levels of ADP rose higher than before the treatment(P＜0.05);after the treatment there had no significant difference between the two groups in the levels of TNF-α,IL-6,LP,ADP,and FFA (P＞0.05).(5) Before treatment two groups of patients' SUA level was positively related to BMI,WRH,FPG,2hPG,TG,LDL-C and was negative related to with HDL-C.
Conclusions and revelations:(1) The external causes of MS are incontinence diets, emotions failures,the maladjustments between work and rest,and the internal causes are inadequate gifts,viscera deficiency during its occurrence and development.In the process of this disease,dryness-heat,corrupt sputum and gore are not only its pathological products,but also its new causes.The treatment in accord with its main pathological character.The treatment of purging heat and eliminating blood stasis,replenishing qi and nourish yin can effectively intervene dangerous factors of the patients and improve their life quality.Its mechanism is related to improving the state of inflammation,adjusting the fat source of cytokines and lowing lipid composition.(2)Early treatment for MS(a cluster of the DM and CVD risky factors)is of great importance.According to the idea of treating "non-disease",the treatment for MS should be given as early as possible,eliminating the pathogenic factor and the therapy of purging heat and eliminating blood stasis could cut off the disease course.Sanhuang Jiangtang pills with its compatibility hit the main pathogenesis of MS,could achieve better clinical efficacy,its total effect was similar to the western medicine acarbose.
So far,there are still many disadvantages of MS' universal education.Its early finding rate is very low,so we should increase the education on disease prevention and control efforts.Besides,in the diagnosis of MS standards,To "Endo-meridians" as the guide, accessing the distribution of fat is more comprehensive than evaluating simple BMI;At the same time,serum uric acid are closely related to MS components,which suggests that the detection of uric acid is important.
Innovation:on the basis of the prospective study,clinical research is adapted to make the evaluation of Sanhuang Jiangtang pills" efficacy of MS.By observing the relevant indicators,it is found that the medical prescription of clearing heat and eliminating stasis and supplement the vital energy has a certain effect on the prevention and treatment of MS which has provided a reliable scientific basis for the expansion of Sanhuang Jiangtang pills'clinical application and expanded methods and thinking in the Chinese medicine treatment of MS.By observing this prescription's impact on the pathogenesis of MS in different lights,such as Inflammatory cytokines,fat-derived factor,lipid composition factor, etc,the Primary mechanism of Sanhuang Jiangtang pills can be expounded.
引文
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