Effects of Yunpi Tiaotang prescription on intestinal flora, blood glucose and lipids in type 2 diabetic patients
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摘要: 目的 探讨运脾调糖方对2型糖尿病患者肠道菌群及血糖血脂的影响，旨在分析运脾调糖方的治疗效果。 方法 选取2021年3月—2023年3月我院90例2型糖尿病(脾虚证)患者为研究对象。随机数字表法分为研究组与对照组，各45例。对照组给予常规治疗，研究组在对照组基础上加用运脾调糖方。比较2组治疗前后肠道菌群、血糖指标[空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)]及血脂指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)以及高密度脂蛋白胆固醇(HDL-C)]变化，Pearson法分析肠道菌群与血糖血脂指标的相关性，统计中医症状改善疗效及不良反应发生率。 结果 研究组中医症状改善总有效率高于对照组(97.78% vs 82.22%，P＜0.05)；治疗后，研究组双歧杆菌、拟杆菌及乳杆菌数量高于对照组，肠杆菌及肠球菌数量低于对照组(P＜0.05)；研究组治疗后FBG、2 h PG、HbA1c、TC、TG及LDL-C水平低于对照组，HDL-C水平高于对照组(P＜0.05)；双歧杆菌、拟杆菌及乳杆菌与FBG、2 h PG、HbA1c、TC、TG及LDL-C呈负相关，与HDL-C呈正相关(P＜0.05)，肠杆菌和肠球菌与FBG、2 h PG、HbA1c、TC、TG及LDL-C呈正相关，与HDL-C呈负相关(P＜0.05)。2组不良反应发生率比较，差异无统计学意义(P>0.05)。 结论 运脾调糖方治疗2型糖尿病患者，可改善肠道紊乱菌群，提升血糖、血脂控制效果，增强疗效，且不良反应少，安全性高。Abstract: Objective To investigate the effect of Yunpi Tiaotang prescription on intestinal flora and blood glucose and blood lipids in patients with type 2 diabetes mellitus, so as to analyze the therapeutic effect of Yunpi Tiaotang recipe. Methods Ninety cases of type 2 diabetes mellitus(spleen deficiency) in our hospital from March 2021 to March 2023 were selected for the study. Randomized numerical table method was divided into study group and control group, 45 cases each. The control group was given conventional treatment, and the study group was given Yunpi Tiaotang prescription on the basis of the control group. The changes in intestinal flora, blood sugar index[fasting blood glucose(FBG), 2-hours postprandial glucose(2 h PG), glycated hemoglobin A1c(HbA1c)]and blood lipid index[triglycerides(TG), cholesterol(TC), lowdensity lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C)]before and after treatment were compared between the two groups, Pearson method was used to analyze the correlation between intestinal flora and blood glucose and lipid indexes, and the therapeutic effect of traditional Chinese medical symptom improvement and the incidence of adverse reactions. Results The total effective rate of improvement of TCM symptoms in the study group(97.78%) was higher than that in the control group(82.22%)(P < 0.05). After treatment, the numbers of bifidobacterium, Bacteroides and Lactobacillus in the study group were higher than those in the control group, while the numbers of enterobacterium and enterococcus were lower than those in the control group(P < 0.05). The levels of FBG, 2 h PG, HbA1c, TC, TG and LDL-C in the study group were lower than those in the control group, and the level of HDL-C was higher than those in the control group after treatment(P < 0.05). Bifidobacterium, Bacteroides and Lactobacillus were negatively correlated with FBG, 2 h PG, HbA1c, TC, TG and LDL-C, and positively correlated with HDL-C(P < 0.05), while Enterobacter and Enterococcus were positively correlated with FBG, 2 h PG, HbA1c, TC, TG and LDL-C, and negatively correlated with HDL-C(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Yunpi Tiaotang prescription for the treatment of patients with type 2 diabetes mellitus can improve intestinal disordered flora, enhance the effect of blood glucose and lipid control, and improve therapeutic efficacy, with fewer adverse reactions and higher safety.
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Key words:
- type 2 diabetes mellitus /
- Yunpi Tiaotang prescription /
- intestinal flora /
- blood sugar /
- blood lipid
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表 1 2组患者基线资料的比较
例，X±S 组别 例数 性别 年龄/岁 病程/年 BMI/(kg/m2) 男 女 对照组 45 29 16 51.63±7.65 4.65±2.71 27.13±3.54 研究组 45 27 18 51.54±7.71 4.81±2.58 27.08±3.17 t/χ2 0.189 0.056 0.287 0.071 P 0.664 0.478 0.387 0.472 
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表 2 2组中医症状改善疗效的比较
例(%) 组别 例数 治愈 显著改善 有效 无效 总有效 对照组 45 20(44.44) 12(26.67) 5(11.11) 8(17.78) 37(82.22) 研究组 45 24(53.33) 14(31.11) 6(13.33) 1(2.22) 44(97.78) Z/χ2 6.049 4.444 P 0.014 0.035
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表 3 2组不同时段肠道菌群数量的比较
CFU/g，X±S 组别 例数 双歧杆菌 拟杆菌 乳杆菌 肠杆菌 肠球菌 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 45 8.79±1.35 15.52±1.751) 9.32±1.45 14.28±1.561) 10.79±1.52 16.73±2.311) 9.41±1.32 4.49±1.021) 8.77±1.37 4.63±1.161) 研究组 45 8.67±1.23 16.43±1.681) 9.48±1.37 15.09±1.411) 10.56±1.48 18.59±2.191) 9.42±1.41 4.01±1.081) 8.81±1.39 4.16±0.971) t 0.441 2.516 0.538 0.812 0.727 3.920 0.035 2.168 0.137 2.085 P 0.660 0.014 0.592 0.006 0.469 ＜0.001 0.486 0.038 0.445 0.040 与本组治疗前比较，1)P＜0.05。
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表 4 2组不同时段血糖指标的比较
X±S 组别 例数 FBG/(mmol/L) 2hPG/(mmol/L) HbA1c/% 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 45 10.14±2.33 6.77±1.051) 12.84±2.04 8.84±1.421) 7.61±0.96 6.44±0.821) 研究组 45 10.21±2.46 5.34±1.141) 12.89±2.12 7.54±1.321) 7.55±0.98 5.61±0.761) t 0.139 6.189 0.114 4.498 0.293 4.980 P 0.445 ＜0.001 0.455 ＜0.001 0.385 ＜0.001 与本组治疗前比较，1)P＜0.05。
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表 5 2组不同时段血脂指标的比较
mmol/L，X±S 组别 例数 TC TG LDL-C HDL-C 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 45 5.85±0.51 4.95±0.321) 1.89±0.52 1.62±0.371) 3.57±0.26 2.08±0.321) 1.12±0.25 1.41±0.261) 研究组 45 5.81±0.49 4.44±0.261) 1.92±0.44 1.31±0.461) 3.61±0.24 1.81±0.361) 1.13±0.22 1.72±0.251) t 0.379 8.298 0.295 3.523 0.758 3.760 0.201 5.765 P 0.353 ＜0.001 0.384 ＜0.001 0.225 ＜0.001 0.420 ＜0.001 与本组治疗前比较，1)P＜0.05。
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表 6 肠道菌群与血糖血脂指标的相关性
指标 双歧杆菌 拟杆菌 乳杆菌 肠杆菌 肠球菌 r P r P r P r P r P FBG -0.723 0.001 -0.659 0.031 -0.654 0.041 0.672 0.021 0.654 0.036 2hPG -0.694 0.012 -0.681 0.026 -0.623 0.047 0.603 0.043 0.627 0.041 HbA1c -0.734 ＜0.001 -0.673 0.029 -0.674 0.036 0.641 0.033 0.631 0.039 TC -0.769 ＜0.001 -0.695 0.018 -0.657 0.040 0.689 0.018 0.731 0.006 TG -0.731 ＜0.001 -0.703 0.012 -0.632 0.043 0.665 0.024 0.721 0.009 LDL-C -0.724 0.006 -0.684 0.027 -0.647 0.038 0.631 0.039 0.695 0.014 HDL-C 0.734 0.003 0.702 0.013 0.684 0.021 -0.657 0.026 -0.682 0.019
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