中国骨质疏松杂志

中药调节肠道菌群干预2型糖尿病合并骨质疏松患者的影响研究

Study on the effect of traditional Chinese medicine regulating intestinal flora on type 2 diabetes patients with osteoporosis

DOI：10.3969/j.issn.1006-7108.2021.11.003

中文关键词: 肠道菌群 2型糖尿病骨质疏松葛根芩连汤

英文关键词:intestinal flora type 2 diabetes mellitus osteoporosis root of kudzu vine and Qinlian decoction

基金项目:国家自然科学基金（81760856）；云南省应用基础研究计划中医联合专项（2018FF001（-053））；云南省应用基础研究计划青年项目（2017FD174）；云南省科技厅中医联合面上项目（〔2017FF117（-039）〕）

作者	单位
刘弘毅陈岳祺颜洁柳尧马迪*	云南中医药大学第一附属医院/云南省中医医院内分泌科，云南昆明 650021

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中文摘要:

目的研究中药调节肠道菌群对2型糖尿病合并骨质疏松患者的影响。方法选择2017年9月至2019年12月诊断为2型糖尿病合并骨质疏松的患者共100例，根据随机数字表随机分为观察组和对照组各50例。对照组患者采用药物控制血糖，并根据病情控制血压、血脂等，在此基础上予口服维生素D和钙剂以补钙，对于骨痛明显者，予静脉滴注唑来膦酸5 mg（100 mL），静滴时间＞2 h，一次滴完（本研究周期内仅注射一次）。根据中医辨证，对脾胃气虚型采用六君子汤加减，肝肾阴虚型采用左归丸加减，对肾虚血瘀型采用补肾活血剂加减。观察组在上述治疗方案上，对所有患者在中药方剂中加入葛根芩连汤。中药口服28 d为1个疗程，治疗2个疗程后观察疗效。结果对照组总有效率为80.0%，观察组总有效率为94.0%，两组比较，观察组总有效率高于对照组（P＜0.05）；观察组大肠杆菌、双歧杆菌和乳酸杆菌改善程度均显著优于对照组（P均＜0.01）；观察组糖代谢指标、骨密度、骨钙素和血磷改善程度优于对照组（P＜0.05或＜0.01）。结论在辨证论治的基础上，采用具有调节肠道菌群的中药治疗2型糖尿病合并骨质疏松患者，可显著改善临床症状和生化指标。

英文摘要:

Objective To study the effect of traditional Chinese medicine regulating intestinal flora on patients with type 2 diabetes with osteoporosis. Methods A total of 100 patients diagnosed with type 2 diabetes with osteoporosis from September 2017 to December 2019 were selected and randomly divided into observation group and control group, with 50 cases in each group according to the random number table. Patients in the control group used drugs to control blood sugar, blood pressure, and blood lipids according to the condition. In addition, oral vitamin D and calcium were given to supplement calcium. For patients with obvious bone pain, zoledronic acid 5 mg (100 mL) was intravenously infused, with drip time > 2 h, and drip once only in this study period. According to TCM syndrome differentiation, Liujunzi decoction was used for the spleen and stomach qi deficiency type, Zuoguiwan was used for the liver and kidney yin deficiency type, and compound kidney-invigorating decoction was used for the kidney deficiency and blood stasis type. In the observation group, root of kudzu vine and Qinlian decoction was additioned to all patients on the basis of above-mentioned treatment plan. 28-day oral administration of traditional Chinese medicine was a course of treatment. The curative effect was observed after 2 courses of the treatment. Results The total efficacy in the control group was 80.0%, and it was 94.0% in the observation group. Comparing the two groups, the total efficacy in the observation group was higher than that in the control group (P<0.05). E. coli, bifido bacteria and lactobacilli in the observation group improved significantly better than that in the control group (all P<0.01). The improvement of glucose metabolism index, bone mineral density, osteocalcin, and blood phosphorus in the observation group was better than that in the control group (P<0.05 or <0.01). Conclusion On the basis of syndrome differentiation and treatment, the treatment of type 2 diabetes mellitus with osteoporosis patients with traditional Chinese medicine that regulates intestinal flora can significantly ameliorate clinical symptoms and biochemical indicators.

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