蒋蓝英 叶茂盛 蔡萃 郦旦明

[摘要] 目的 探討三七总皂苷对2型糖尿病（T2DM）合并外周动脉疾病老年患者炎症因子的影响。 方法 选取我院2018年1月至2019年12月门诊及住院T2DM合并外周动脉疾病患者100例，年龄均>70岁，随机分为观察组和对照组，均给予降血糖、调脂、抗血小板聚集等基础治疗，观察组在此基础上加用三七总皂苷片100 mg，每日3次，总疗程3个月。治疗前后监测两组血压、腰围（WC）、体质量指数（BMI），检测空腹血糖（FBG）、血脂、糖化血红蛋白（HbA1c）、纤维蛋白原（FIB）等代谢指标及超敏C-反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α），B超测定颈动脉内膜中层厚度（C-IMT）。 结果 与治疗前比较，两组患者治疗后总胆固醇、低密度脂蛋白、Fib、hs-CRP、IL-6、TNF-α均明显下降（P<0.05）;治疗后，观察组患者血清Fib、hs-CRP、IL-6、TNF-α较对照组明显下降（P<0.05），C-IMT虽有下降，但两组差异无统计学意义（P>0.05）。 结论 三七总皂苷可能是通过降低炎症因子，改善2型糖尿病动脉粥样硬化的进程，而不是通过调节脂质代谢或降低血糖来发挥作用。

[关键词] 三七总皂苷;炎症因子;2型糖尿病;外周动脉疾病;老年

[中图分类号] R543.5          [文献标识码] A          [文章编号] 1673-9701（2021）33-0011-04

[Abstract] Objective To explore the effect of panax notoginseng saponins on inflammatory factors in elderly patients with type 2 diabetes mellitus （T2DM） complicated with peripheral arterial disease. Methods From January 2018 to December 2019，a total of 100 outpatients and inpatients with T2DM complicated with peripheral arterial disease，all over 70 years old，were selected.The patients were randomly divided into the observation group and the control group.All patients of two groups were given primary treatment such as lowering blood glucose，regulating lipid，anti-platelet aggregation.The patients in the observation group were given panax notoginseng saponins tablets 100 mg， three times a day， for a total treatment period of 3 months. Before and after treatment， blood pressure， waist circumference （WC）， and body mass index （BMI） were monitored. Fasting blood glucose （FBG）， blood lipid， glycosylated hemoglobin （HbA1c），fibrinogen （FIB），as well as high-sensitivity C-reactive protein （hs-CRP）， interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α） were detected. The carotid intima-media thickness （C-IMT） was measured by B ultrasound. Results Compared with that before treatment， the total cholesterol， low-density lipoprotein， Fib， hs-CRP，IL-6， and TNF-α in the two groups were significantly decreased after treatment（P<0.05）;After treatment，the serum Fib， hs-CRP， IL-6 and TNF-α in the observation group were significantly decreased compared with the control group（P<0.05）.C-IMT in the observation group was decreased， but the difference of two groups wasn′t significant （P>0.05）. Conclusion panax notoginseng saponins may improve the process of atherosclerosis in type 2 diabetes mellitus by decreasing inflammatory factors rather than regulating lipid metabolism or lowering blood glucose.

[Key words] Panax notoginseng saponins; Inflammatory factors; Type 2 diabetes mellitus; Peripheral arterial disease; Elderly

随着生活方式的改变及人口老龄化的加速，糖尿病的发病率越来越高。据统计，2017年我国成人糖尿病人数已达到1.14亿，是全球患病人数最多的国家[1]。循证医学证明，严格控制血糖可明显降低糖尿病患者微血管病变的发生率，但没有显著降低大血管病变的发生率[2]。大血管病变是糖尿病患者致死的主要原因[3]。许多学者认为，糖尿病患者动脉粥样硬化（Atherosclerosis，AS）的发生与低水平慢性炎症状态密切相关[4]，是动脉壁对各种炎症损伤的炎症增殖反应。外周动脉疾病（Peripheral arterial disease，PAD）除心脑血管以外的动脉疾病，包括颈动脉、四肢动脉、内脏动脉等疾病[5]。国……