| Type2diabetes with depression is a kind of depression combined with diabetes. The main clinical manifestation of Type2diabetes with depression is low in spirits, loss of interest and pleasure, sad, dejected, empty, hopeless, depressed, exhausted both in body and mind, sleep disorders,cognitive symptoms and suicide thoughts and behaviours. There is no standards of pattern identification of Traditional Chinese Medicine now. The treatment for Type2diabetes with depression is antidepressant, which has serious side effects and slow onset, thus the patients have poor compliance. Treatment based on pattern identification of traditional Chinese medicine has small side-effects and have certain advantages. It is important to study Type2diabetes with depression from the point of traditional Chinese medicine, and on this basis to improve the clinical curative effect of the disease.ObjectiveTo understand the characteristics of traditional Chinese medicine patterns of Type2diabetes with depression, and to study different patterns with the HAMD scale; observation on the Yishen Jieyu Decoction in treating Type2diabetes with depression of syndrome of kidney deficiency and liver qi stagnation and study on its mechanism.Method1. We developed survey questionnaires, collected information of209cases with survey method, identified the pattern of traditional Chinese medicine diagnosis according to the case information. Then we made a census of the data of the disease.2According to the randomized, placebo-controlled and blinded principles,132patients of Type2diabetes with depression with TCM syndrome diagnostic of kidney deficiency and liver qi stagnation were selected and divided into the treatment and control group. The therapy group was given the Yishen Jieyu Decoction. The control group was given oral fluoxetine capsules,20mg a day. Each group were treated by oral medication for3months. After treatment both group were given the observation of curative effect.Results1. In209cases of Type2diabetes with depression,the highest rate of traditional Chinese medicine is the pattern of kidney deficiency and liver qi stagnation,28.23%, followed by liver qi stagnation and spleen deficiency syndrome,20.11%, pattern of liver qi stagnation syndrome18.66%, pattern of dampness-heat of liver and gallbladder14.35%, blood stasis pattern16.75%, pattern of melancholy and depression impairing the spirit is at least,1,91%.2The anxiety/somatization score of patients with liver qi stagnation and spleen deficiency syndrome is higher than the score of patients with kidney deficiency and liver qi stagnation syndrome.The difference is significant (p<0.05).The weight reduce score, retardation score and despair score of patients with kidney deficiency and liver qi stagnation syndrome is higher than the score of patients with liver qi stagnation and spleen deficiency syndrome. The difference is significant (p<0.01or p<0.05). 3The HAMD scores after treatment are significantly reduced than that before treatment. The difference is significant (p<0.05); The total effective rate of treatment group is85.24%, the total effective rate of the control group is77.42%. The difference is significant (p<0.05). The treatment group is better in improvement of HAMD score than controlled group.4After treatment,anxiety/somatization score in the treatment group is significantly lower than that before the treatment (p<0.05); The retardation score in the treatment group is significantly lower than that before treatment (p<0.05), sleep disturbance score in the treatment group is significantly lower than before treatment (p<0.01). Comparison between the two groups showed that the sleep disturbance score in the treatment group is less than that of the control groups. The difference is significant (p<0.05).5After treatment,SDS scale scores of the two groups declined, compared with that before treatment. The difference is significant (p<0.05). The onset time of the treatment group is2weeks after the treatment. The onset time of the control group is4weeks after the treatment. The total effective rate in the treatment group is90,16%, the total effective rate of the control group is79.03%. The difference is significant (p<0.05). The result proved that the subjective evaluation of the therapeutic effect in the treatment group is better than the control group and the onset time is earlier than the control group.6Curative effect of traditional Chinese medicine index showed that the total effective rate of treatment group is93.44%, the total effective rate of control group is82.26%.Group comparison difference is significant(p<0.05).7Diabetes-specific quality of life scale statistics showed that the physical dimension score, psycho-spiritual dimension score and total score in the treatment group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Psycho-spiritual dimension score and total score in the control group after the treatment is lower than that before treatment. The difference is significant (p<0.05). Comparison between the two groups showed that, after treatment, physical dimension score, psycho-spiritual dimension score and total score in treatment group are lower than the control group. The difference is significant (p<0.05).This proved that the quality of life of treatment group is better than that of the control group.8HPA-axis function index statistics showed that the cortisol level in8:00AM and16:00PM declined after the treatment. The difference is significant (p<0.05); The rate of cortisol rhythm disappears in treatment group decreased after treatment. The difference is significant (p<0.05).9Serum glucose, HbAIC, serum lipids, blood pressure index statistics showed that fasting blood glucose,2H after a meal blood glucose, HbAIC declined after the treatment. The difference is significant (p<0.01, p<0.05); comparison of the two groups showed that fasting blood glucose and2H after a meal blood glucose are lower than the control group, The difference is significant (p<0.05). There is no obvious change in lipids and blood pressure. Conclusion1The syndrome differentiation typing in Type2diabetes with depression is different from a simple depression, high incidence of kidney deficiency and liver qi stagnation are its characteristics.2The dimension on the performance of different patterns of Traditional Chinese Medicine in Type2diabetes with depression is different.3The Yishen Jieyu Decoction can reduce the depression level of patients with Type2diabetes with depression, and improve the quality of life in patients with diabetes.4TheYishen Jieyu decoction can improve dysfunction of the hypothalamus-pituitary-adrenal axis in patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression.5The Yishen Jieyu decoction can help to reduce the serum glucose level of patients of kidney deficiency and liver qi stagnation of Type2diabetes with depression. |
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