目的 探討六味地黃丸聯(lián)合利拉魯肽和二甲雙胍治療2型糖尿病的臨床療效。方法 選取2013年12月-2015年12月在榆林市中醫(yī)醫(yī)院接受治療的2型糖尿病患者84例，隨機(jī)分成對照組和治療組，每組各42例。所有患者均給予飲食和運動健康教育控制血糖。對照組患者口服鹽酸二甲雙胍片，1片/次，3次/d；同時皮下注射利拉魯肽注射液，0.6 mg/次，1次/d，若1～2周后無不良反應(yīng)，劑量調(diào)整為1.2 mg/次，1次/d。治療組在對照組的基礎(chǔ)上口服六味地黃丸，8丸/次，3次/d。兩組患者均治療12周。觀察兩組的臨床療效，同時比較兩組患者治療前后三酰甘油（TG）、總膽固醇（TC）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、空腹血糖（FBG）、餐后2 h血糖和糖化血紅蛋白（HbA1c）水平及胰島素分泌指數(shù)（HOMA-β）和胰島素抵抗指數(shù)（HOMA-IR），以及白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）和超敏C-反應(yīng)蛋白（hs-CRP）水平變化。結(jié)果 治療后，對照組和治療組的總有效率分別為78.57%、95.24%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者的TG、TC、LDL-C水平降低，而HDL-C水平升高，同組治療前后差異具有統(tǒng)計學(xué)意義（P<0.05）；且治療后，治療組患者的上述血脂指標(biāo)改善程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組患者的FPG、餐后2 h血糖和HbAlc水平均較治療前顯著降低（P<0.05）；與對照組比，治療后治療組的FPG、餐后2 h血糖和HbAlc水平降低更明顯（P<0.05）。治療后，兩組組患者的HOMA-IR降低，HOMA-β升高，同組治療前后差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組的改善程度優(yōu)于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組患者的血清IL-6、TNF-α、hs-CRP水平與同組治療前相比有顯著下降（P<0.05），且治療組患者的上述血清細(xì)胞因子水平下降情況明顯優(yōu)于對照組（P<0.05）。結(jié)論 六味地黃丸聯(lián)合利拉魯肽和二甲雙胍治療2型糖尿病具有較好的臨床療效，可明顯改善胰島素抵抗和提高胰島素敏感性，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of Liuwei Dihuang Pills combined with liraglutide and metformin in treatment of type 2 diabetes mellitus. Methods Patients (84 cases) with type 2 diabetes mellitus in Yulin Hospital of TCM from December 2013 to December 2015 were randomly divided into control and treatment groups, and each group had 42 cases. All patients were given diet and exercise health education to control blood sugar. The patients in the control group were po administered with Metformin Hydrochloride Tablets, 1 tablet/time, three times daily. And they were sc administered with Liraglutide Injection, 0.6 mg/time, once daily, and the dose was adjusted to 1.2 mg/time, once daily, if there was no adverse reaction after 1-2 weeks. The patients in the treatment group were po administered with Liuwei Dihuang Pills on the basis of control group, 8 pills/time, three times daily. The patients in two groups were treated for 12 weeks. The clinical efficacy was evaluated, and the changes of TG, TC, LDL-C, HDL-C, FBG, 2 h postprandial glucose, HbA1c, HOMA-β, HOMA-IR, IL-6, TNF-α, and hs-CRP in two groups were compared before and after treatment. Results After treatment, the clinical effect in the control and treatment groups were 78.57% and 95.24%, respectively, and there were differences between two groups (P<0.05). After treatment, TG, TC, and LDL-C levels in two groups were decreased and HDL-C level was increased, and the difference was statistically significant in the same group (P<0.05). And these blood lipid indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, FPG, 2 h postprandial glucose, and HbAlc levels were lower than those before treatment in the same group, and the difference was statistically significant (P<0.05). And the blood glucose indexes in the treatment group were better than those in the control group with significant difference (P<0.05). After treatment HOMA-IR was reduced, HOMA-β was improved, and the difference was statistically significant in the same group (P<0.05). HOMA-IR and HOMA-β in the treatment group were better than those in the control group with significant difference (P<0.05). After treatment, IL-6, TNF-α, hs-CRP levels in two group were significantly decreased (P<0.05). And these serum cytokine levels in the treatment group were better than that in the control group (P<0.05). Conclusion Liuwei Dihuang Pills combined with liraglutide and metformin has the curative effect in treatment of type 2 diabetes mellitus, and can significantly improve IR and insulin sensitivity, which has a certain clinical application value.

陜西省科技廳項目（2012sp2-08）