目的 探討玉泉丸聯(lián)合沙格列汀治療老年2型糖尿病的臨床效果。方法 選取2017年1月-2019年2月鎮(zhèn)平縣人民醫(yī)院收治的老年2型糖尿病患者98例，隨機(jī)分成對照組（49例）和治療組（49例）。對照組口服沙格列汀片，5 mg/次，1次/d。治療組在對照組的基礎(chǔ)上口服玉泉丸，6 g/次，4次/d。兩組患者均連續(xù)治療12周。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者糖脂代謝參數(shù)、血流變學(xué)、胰島功能和炎癥標(biāo)志物水平。結(jié)果 治療后，對照組臨床有效率為83.67%，顯著低于治療組的95.92%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組血清糖化血紅蛋白（HbA1c）、空腹血糖（FPG）、餐后2 h血糖（2 h PG）、總膽固醇（TC）和三酰甘油（TG）水平均顯著降低（P<0.05），且治療組比對照組降低更明顯（P<0.05）。治療后，兩組血漿黏度（PV）、胰島素抵抗指數(shù)（HOMA-IR）值均顯著降低（P<0.05），而紅細(xì)胞變形指數(shù)（EDI）、胰島素敏感性指數(shù)（ISI）和胰島β細(xì)胞功能指數(shù)（HOMA-β）值顯著升高（P<0.05），且治療組血流變學(xué)及胰島功能指標(biāo)的改善效果均顯著優(yōu)于對照組（P<0.05）。治療后，兩組患者血清腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-18（IL-18）、C反應(yīng)蛋白（CRP）濃度及外周血中性粒細(xì)胞/淋巴細(xì)胞比值（NLR）均顯著下降（P<0.05），治療組以上炎癥標(biāo)志物水平較同期對照組更低（P<0.05）。結(jié)論 玉泉丸聯(lián)合沙格列汀治療老年2型糖尿病療效顯著，能有效調(diào)控患者體內(nèi)糖脂代謝狀態(tài)，糾正血流變學(xué)異常，緩解胰島素抵抗，改善胰島β細(xì)胞功能，減輕機(jī)體慢性微炎癥狀態(tài)。

Objective To investigate the clinical effect of Yuquan Pills combined with saxagliptin in treatment of type 2 diabetes mellitus in elderly patients. Methods Patients (98 cases) with type 2 diabetes mellitus in Zhenping People's Hospital from January 2017 to February 2019 were randomly divided into control (49 cases) and treatment (49 cases) groups. Patients in the control group were po administered with Saxagliptin Tablets, 5 mg/time, once daily. Patients in the treatment group were po administered with Yuquan Pills on the basis of the control group, 6 g/time, four times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and the glucose and lipid metabolic parameters, the hemorheology, islet function indexes, the levels of inflammatory markers in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 83.67%, which was significantly lower than 95.92% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the serum levels of HbA1c, FPG, 2 h PG, TC, and TG in two groups were significantly decreased (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, PV and HOMA-IR in two groups were significantly decreased (P<0.05), but the EDI, ln(ISI) and HOMA-β were significantly increased (P<0.05), and the hemorheology and islet function indexes in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum levels of TNF-α, IL-18, and CRP, and NLR of peripheral blood in two groups were significantly decreased (P<0.05), and these indexes in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Yuquan Pills combined with saxagliptin has a significant overall effect in treatment of type 2 diabetes mellitus in elderly patients, can effectively regulate glucose and lipid metabolism, correct hemorheological abnormalities, relieve insulin resistance, improve islet β cell function, and relieve chronic microinflammatory state.

R977

河南省衛(wèi)計(jì)委科研課題（201605A3086）