2021 年第 10 期 第 16 卷

加味黄连温胆汤对代谢综合征合并2型糖尿病痰热互结证患者心血管危险因素的影响

Effects of modified Huanglianwendan decoction on cardiovascular risk factors in patients with metabolic syndrome complicated with type 2 diabetes mellitus with phlegm-heat interaction syndrome

作者：刘莉1杨跃光2邹国良1吴霞2李娜2韩宇博1

英文作者：Liu Li1 Yang Yueguang2 Zou Guoliang1 Wu Xia2 Li Na2 Han Yubo1

单位：1黑龙江中医药大学附属第一医院心血管科，哈尔滨150040；2黑龙江中医药大学研究生院，哈尔滨150040

英文单位：1Department of Cardiology First Affiliated Hospital Heilongjiang University of Chinese Medicine Harbin 150040 China； 2Graduate School of Heilongjiang University of Chinese Medicine Harbin 150040 China

关键词：2型糖尿病；代谢综合征；黄连温胆汤；痰热互结证；心血管危险因素

英文关键词：Type2diabetesmellitus;Metabolicsyndrome;Huanglianwendandecoction;Phlegm-heatinteractionsyndrome;Cardiovascularriskfactors

• 摘要：

• 目的  探讨加味黄连温胆汤对代谢综合征（MS）合并2型糖尿病痰热互结证患者心血管危险因素的影响。方法 选取黑龙江中医药大学附属第一医院2019年12月至2020年12月收治的MS合并2型糖尿病痰热互结证患者68例，应用随机数字表法分为观察组和对照组，各34例。对照组给予常规治疗，观察组在对照组治疗基础上联合加味黄连温胆汤治疗，2组疗程均为8周。治疗8周后对2组患者进行疗效评价，比较2组患者总有效率和治疗前后血压、体重指数、中医证候积分、血糖指标、血脂指标、炎症因子、血管内皮功能指标水平以及治疗安全性。结果 治疗8周后观察组总有效率高于对照组［94.1%(32/34)比79.4%(27/34)］（P=0.017）。治疗8周后，2组血压、体重指数、中医证候积分、血糖指标、血脂指标、炎症因子、血管内皮功能指标水平均较治疗前改善，且观察组中医证候积分、空腹血糖、空腹胰岛素、稳态模型胰岛素抵抗指数、低密度脂蛋白胆固醇、肿瘤坏死因子α、瘦素和内皮素1水平均低于对照组［(7.0±1.4)分比（11.0±2.1）分，(5.6±0.9)mmol/L比（6.9±1.4）mmol/L，(6.6±1.1)mU/L比（8.9±1.3）mU/L，(1.4±0.3)比（2.0±0.8），(2.2±0.8)mmol/L比（2.7±1.1）mmol/L，(22±3)ng/L比（28±3）ng/L，(10.1±1.5)mg/L比（13.3±2.0）mg/L，(58±7)μg/L比（69±8）μg/L］，血清脂联素和一氧化氮水平均高于对照组［(37.3±4.3)ng/L比（33.2±3.8）ng/L，(69±8)mmol/L比（59±5）mmol/L］（均P<0.05）。2组患者治疗期间均未发生严重不良事件，未发现与加味黄连温胆汤相关不良反应。结论 黄连温胆汤联合常规方法治疗MS合并2型糖尿病痰热互结证患者，较单纯使用常规方法治疗效果更显著，且能够减轻炎症反应，改善血管内皮功能，从而控制心血管危险因素，且具有较高的安全性。

• Objective To investigate the effect of modified Huanglianwendan decoction on cardiovascular risk factors in patients with metabolic syndrome complicated with type 2 diabetes mellitus with phlegm-heat interaction syndrome. Methods From December 2019 to December 2020, 68 patients with metabolic syndrome complicated with type 2 diabetes mellitus with phlegm-heat interaction syndrome who were admitted to First Affiliated Hospital, Heilongjiang University of Chinese Medicine were enrolled. Patients were randomly divided into the observation group and the control group, with 34 cases in each group. The control group was given conventional treatment, and the observation group was treated with modified Huanglianwendan decoction on the basis of the control group. The course of treatment in both groups was 8 weeks. After 8 weeks of treatment, the curative effect of both groups was evaluated. Total effective rate, blood pressure, body mass index, traditional Chinese medical syndrome score, blood glucose index, blood lipid index, inflammatory factors and vascular endothelial function index before and after treatment as well as treatment safety of the two groups were compared. Results After 8 weeks of treatment, the total effective rate of the observation group was higher than that of the control group ［94.1%(32/34) vs 79.4%(27/34)］(P=0.017). After 8 weeks of treatment, the blood pressure, body mass index, traditional Chinese medical syndrome score, blood glucose index, blood lipid index, inflammatory factors and vascular endothelial function index of the two groups were improved, the traditional Chinese medical syndrome score, fasting blood glucose, fasting insulin, homeostasis model assessment of insulin resistance, low-density lipoprotein cholesterol, tumor necrosis factor-α, leptin and endothelin-1 levels of the observation group were lower than those of the control group ［(7.0±1.4) vs （11.0±2.1），(5.6±0.9)mmol/L vs （6.9±1.4）mmol/L，(6.6±1.1)mU/L vs （8.9±1.3）mU/L，(1.4±0.3) vs （2.0±0.8），(2.2±0.8)mmol/L vs （2.7±1.1）mmol/L，(22±3)ng/L vs （28±3）ng/L，(10.1±1.5)mg/L vs （13.3±2.0）mg/L，(58±7)μg/L vs （69±8）μg/L］， and the serum levels of adiponectin and nitric oxide of the observation group were higher than those of the control group ［(37.3±4.3)ng/L vs （33.2±3.8）ng/L，(69±8)mmol/L vs （59±5）mmol/L］ (all P<0.05). There were no serious adverse events in both groups and no adverse reactions related to modified Huanglianwendan decoction. Conclusions  Huanglianwendan decoction combined with conventional treatment for patients with metabolic syndrome combined with type 2 diabetes mellitus with phlegm-heat interaction syndrome is more effective than conventional treatment alone. It can reduce inflammation and improve vascular endothelial function, thereby controlling cardiovascular risk factors, with higher safety.