| Object: To explore the correlation between the incidence of gastrointestinal adverse reaction of exenatide and TCM syndrome type in patients with type 2 diabetes, predict the incidence rate of gastrointestinal adverse reaction of exenatide through TCM syndrome type, guide rational clinical medication, save medical cost and increase compliance of patients. To provide a basis for later studies in treating the gastrointestinal reaction of exenatide by TCM syndrome differentiation and treatment, also to ease discomforts of patients, expand the clinical application of exenatide. To enlarge the application range of TCM theory system, broaden the way of study in using western medicine under application of TCM theory system.Method:Patients, who suffered from type 2 diabetes and were taking exenatide treatment, were recruited from endocrinology department and geriatric department of Sichuan Provincial People's Hospital, and endocrinology department of Tibet Branch of West China Hospital, and endocrinology inpatient and outpatient departments of Chengdu University of TCM. Finally,137 patients were enrolled in the study. The data of patients, including basic information, BMI, fasting blood-glucose(FBG) and 2h postprandial blood-glucose(2hPG) in oral glucose tolerance test(OGTT), triglyceride(TG), total cholesterol(TC), HDL-C and LDL-C, were collected before study. Patients should fill in the form of TCM syndrome type, being divided into 4 groups, such as qi-deficiency and phlegm-dampness type group, internal accumulation of damp-heat type group, yang-deficiency and cold-dampness type group, and qi-deficiency and blood-stasis type group, according to their clinical symptoms and syndrome differentiation. Patients in each group were treated with low-dose exenatide. The number of the patients who had gastrointestinal adverse reaction were be observed and recorded after 4 weeks. And the index were be tested after 4 weeks too, such as BMI, blood-glucose, blood-lipid, etc. Statistical analyses were performed using SPSS 17.0.Result: The highest incidence rate of gastrointestinal adverse reaction of exenatide was in accumulation of damp-heat type group, followed by yang-deficiency and cold-dampness type group, while qi-deficiency and phlegm-dampness type group and qi-deficiency and blood-stasis type group had lowest incidence rate, and the differences were statistically significant(all p<0.05). The basic data among 4 groups, such as BMI, FPG,2hPG, TC, TG, HDL-L, LDL-C, had no statistically significant difference(all p>0.05). The scores of BMI, FPG,2hPG, TC and LDL-C decreased significantly compared with those before treatment(all p<0.05), while there was no significant difference in TG or HDL-C(both p>0.05). With the treatment of exenatide, the decline of BMI was significant in accumulation of damp-heat type group(p<0.05), followed by other 3 groups; and the decline of LDL-C was significant in accumulation of damp-heat type group too(p<0.05); and other index didn't show significant difference among 4 groups(p>0.05).Conclusion:(1)Treating Patients with type 2 diabetes with exenatide, the highest incidence rate of gastrointestinal adverse reaction of it occurred in internal accumulation of damp-heat syndrome type, and yang-deficiency and cold-dampness syndrome type came second, while it was the lowest in qi-deficiency and phlegm-dampness type and qi-deficiency and blood-stasis syndrome type. In the respect of reducing LDL-C and BMI in patients with type 2 diabetes, exenatide was the most effective in accumulation of damp-heat syndrome type, while lower in other 3 syndrome types. Results also showed that the effect of exenatide in decreasing blood-glucose had no relationship with TCM syndrome type, which could be used to guide clinical medication more rationally.(2)rom the aspect of TCM syndrome type, there was no correlation between clinical effect and gastrointestinal adverse reaction of exenatide in treating patients with type 2 diabetes. (3) From this study, the medical property of exenatide in TCM was:bitter, cold, distributed to spleen, stomach and intestine channel, non-toxic. |
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