Clinical Observation Of60Cases Of T2DM And NAFLD By Strengthening Spleen And Removing Dampness

BackgroundAs people life style change, prevalence rate of metabolic disease increase year by year. In one hand,11.1%of prevalence rate of diabetes incidence makes us into the grim situation. On the other hand, investigation shows that the prevalence of NAFLD in some developed areas has reached more than20%, though lack of national scale survey. While patients may fail to cause attention at early stage, the risk of cardiovascular or renal diseases could serious threat to people’s quality of life. Medicine presents that insulin resistance acts as the common link of the two kinds of diseases, and the main cause throughout the whole process of the disease. Therefore, doctors of Western Medicine recommend healthy diet, exercise, medication and surgery, etc, to keep patients in healthy stage. However, most people could not insiste exercise and keep diet, which is considered as the indispensable treatment of the disease. Although guidelines on western medicine recommend metformin or TZDs, hepatic protector, hepatic anti-inflammatory as therapeutic schemes, but the effect of the treatment lack of large-scale clinical research support. Surgical treatment, such as bariatric surgery, which has carried out at the current domestic parts of the hospital, is lack of evidence-based medicine support and long-term clinical observation. Patients of T2DM and NAFLD, who are all under the condition of exercise, diet intervention and oral medications, are diagnosed as spleen deficient with dampness basing on the principle of pathology of TCM. So herbs, such as rhizoma atractylodis, tuckahoe, lotus leaf, hawthorn, etc, are used to strengthen spleen and remove dampness.ObjectivesThis clinical randomized controlled trials study the clinical value of TCM in T2DM and NAFLD. It will provide clinical application in the treatment of TCM of T2DM and NAFLD, and explore the possible targets of the herbs. Methods60patients were randomized to herbs-metformin add-on therapy and pioglitazone-metformin add-on therapy for six months, each containing the cases of30people and on the basic therapy of diabetes diet and instruction of exercise. Patients should test GLU at least once per week, and subsequently visit once every2weeks to1month according to the condition. Compare differences of the indicators before and after the treatment to learn the curative effect of two groups. Establish a database and input data for statistical analysis via SPSS18.0.Results1. Comprehensive score comparison:80.0%effective rate of herbs-metformin group compares to53.3%effective rate of pioglitazone-metformin group. There is significant difference between the two groups (P<0.05). And the total effective rate of this trail is66.7%.2. Analysis shows the difference of WH、FPG、2h CP、ALT、AST isn’t statistically significant in control group(P>0.05), while only AST isn’t showed statistically significant in the treatment group(P>0.05). Reduction of the level of BMI, WHR, waist circumference, hip circumference, GLU, CP, HbAlc, TG, CHO, LDL-c and increase of the level of HDL are statistically significant (P<0.05). The treatment group reduce the level of waist circumference, hip circumference, TCM symptom score, TG and ARFI more significantly than the control group by difference value analysis (P<0.05). In addition, Cr, and Urea numerical reduction of the treatment group was statistically significant after treatment (P<0.05).3. We come out some conclusion through analysis of the correlation. There is positive correlation between CP and BMI. So are among ARFI and waist circumference, hip circumference, C peptide, TNF-α, TG, BMI, TNF-α and TG, CHO, LDL-C, waist circumference. And there is negative correlation among adiponectin and HbAlc, TNF alpha, TG, CHO, HDL, LDL-C, ARFI. All the correlations are statistically significant (P<0.05).ConclusionThe decoction can adjust the glucolipid metabolism, regulate fat distribution, and reduce the visceral fat, circumference of waist and hip, lose weight. Patients with T2DM and NAFLD can be cured in this way, which was safe, but also additional benefit to the metabolism of liver and kidney. The Chinese medicine can increase the level of adiponectin and reduce the level of TNF-α. However, the specific pharmacological effect of the decoction is not yet clear. In addition, ARFI could assesse the severity of NAFLD. But this primary detection technology needs more clinical data and researches support.