目的 探讨玉泉丸联合沙格列汀治疗老年2型糖尿病的临床效果。方法 选取2017年1月-2019年2月镇平县人民医院收治的老年2型糖尿病患者98例，随机分成对照组（49例）和治疗组（49例）。对照组口服沙格列汀片，5 mg/次，1次/d。治疗组在对照组的基础上口服玉泉丸，6 g/次，4次/d。两组患者均连续治疗12周。观察两组患者临床疗效，同时比较治疗前后两组患者糖脂代谢参数、血流变学、胰岛功能和炎症标志物水平。结果 治疗后，对照组临床有效率为83.67%，显著低于治疗组的95.92%，两组比较差异有统计学意义（P<0.05）。治疗后，两组血清糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后2 h血糖（2 h PG）、总胆固醇（TC）和三酰甘油（TG）水平均显著降低（P<0.05），且治疗组比对照组降低更明显（P<0.05）。治疗后，两组血浆黏度（PV）、胰岛素抵抗指数（HOMA-IR）值均显著降低（P<0.05），而红细胞变形指数（EDI）、胰岛素敏感性指数（ISI）和胰岛β细胞功能指数（HOMA-β）值显著升高（P<0.05），且治疗组血流变学及胰岛功能指标的改善效果均显著优于对照组（P<0.05）。治疗后，两组患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-18（IL-18）、C反应蛋白（CRP）浓度及外周血中性粒细胞/淋巴细胞比值（NLR）均显著下降（P<0.05），治疗组以上炎症标志物水平较同期对照组更低（P<0.05）。结论 玉泉丸联合沙格列汀治疗老年2型糖尿病疗效显著，能有效调控患者体内糖脂代谢状态，纠正血流变学异常，缓解胰岛素抵抗，改善胰岛β细胞功能，减轻机体慢性微炎症状态。

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

河南省卫计委科研课题（201605A3086）