消痞通絡方干預糖尿病胃輕癱寒熱錯雜證臨床及機制研究

韓笑 王秀閣 何澤 隋曉丹 包揚 金美英

[摘要] 目的 觀察消痞通絡方干預糖尿病胃輕癱（寒熱錯雜證）的臨床療效，探討其作用機制。方法 選取2018年7月—2019年3月該院收治的70例糖尿病胃輕癱患者，隨機分為實驗組和對照組，前者給予中藥消痞通絡方聯合枸櫞酸莫沙必利片治療，后者給予枸櫞酸莫沙必利片治療，每組各35例。觀察治療前后各組中醫證候積分、胃排空、胃泌素、胃動素的指標變化。結果 實驗組有效率91.4%，對照組有效率85.7%，差異有統計學意義（P<0.05）;治療前后兩組中醫證候積分、胃動素、胃泌素組內和組間對比，差異有統計學意義（P<0.05）。 結論 消痞通絡方能夠改善糖尿病胃輕癱（寒熱錯雜證）臨床癥狀，促進胃排空，作用機制與調節胃動素、胃泌素有關。

[關鍵詞] 中醫藥;胃輕癱;糖尿病;絡病;臨床觀察

[中圖分類號] R259? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1672-4062（2020）01（b）-0012-03

[Abstract] Objective To observe the clinical efficacy of Xiaopitongluo Recipe in intervention of diabetic gastroparesis （cold fever and miscellaneous syndrome） and to explore its mechanism. Methods Seventy patients with diabetic gastroparesis admitted to the hospital from July 2018 to March 2019 were randomly divided into experimental group and control group. The former was given Chinese medicine Xiaopitongluo combined with mosapride citrate tablets， and the latter was treated with mosapride citrate tablets. Each group has 35 cases. The changes of TCM syndrome scores， gastric emptying， gastrin and motilin were observed before and after treatment. Results The effective rate of the experimental group was 91.4%， and the effective rate of the control group was 85.7%. The difference was statistically significant（P<0.05）. The difference between TCM syndrome scores， motilin， gastrin group and group between the two groups before and after treatment， statistically significant（P<0.05）. Conclusion Xiaopitongluo Recipe can improve the clinical symptoms of diabetic gastroparesis （cold fever and miscellaneous syndrome） and promote gastric emptying. The mechanism of action is related to the regulation of motilin and gastrin.

[Key words] Traditional Chinese medicine; Gastroparesis; Diabetes; Collateral disease; Clinical observation

糖尿病胃輕癱是糖尿病的慢性并發癥之一，以腹脹、惡心、嘔吐為主要臨床表現，嚴重者可并發酮癥、低血糖、營養不良等危證，導致患者生活質量下降。現代醫學以促進胃動力藥及手術治療為主，中醫藥治療簡、便、易、廉，近年來顯示良好的治療前景，課題組采用消痞通絡方治療2018年7月—2019年3月收治的35例糖尿病胃輕癱患者，取得較好的臨床療效，并從胃腸激素機制探討如下。

1? 資料與方法

1.1 一般資料

選取糖尿病胃輕癱患者70例，隨機分為實驗組和對照組，每組各35例，所有病例來源于長春中醫藥大學附屬醫院內分泌科門診及療區的患者，實驗組給予消痞通絡方聯合枸櫞酸莫沙必利片治療，對照組應用枸櫞莫沙必利片治療，兩組患者性別、年齡、病程一般情況如下（表1）。

1.2? 西醫診斷標準

參照《胃輕癱臨床管理指南》[1]（ACG，2013，1）和《實用糖尿病學》（第三版）。……