| Objective:To explore the understanding of traditional Chinese medicine on obstructive sleep apnea hypopnea syndrome(OSAHS)complicated with type 2 diabetes mellitus(T2DM),and to use Wendan Decoction to treat OSAHS complicated with type 2 diabetes mellitus with phlegm-dampness.A randomized controlled clinical trial was used to observe the body mass index(BMI),apnea-hypopnea index(AHI),minimum nocturnal oxygen saturation(LSaO2),and Epworth sleepiness scale scores(ESS),fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),fasting insulin(FINS),insulin resistance index(HOMA-IR),glycated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein ApoB/ApoA I and other test indicators changes,evaluate their efficacy and safety,and discuss its mechanism of prevention and treatment of this disease from the perspective of metabolomics and provides an objective basis for clinical promotion and application.Methods:The patients who met the diagnostic criteria of OSAHS with phlegm-dampness and type 2 diabetes mellitus were randomly divided into treatment group and control group.The control group was treated with Metformin combined with Dapagliflozin to control blood sugar,and all of them were given lifestyle coaching at the same time;the treatment group was additionally treated with Wendan Decoction on the basis of the control group,one dose a day,and both groups continued treatment for 8 weeks.Before and after treatment,the changes in clinical symptoms and signs of the two groups of patients were evaluated,and the detection indicators such as BMI,AHI,LSaO2,ESS score,FPG,2hPG,FINS,HOMA-IR,HbAlc,blood lipid levels,as well as the adverse reactions and compliance of the patients were observed and detection of serum metabolites in patients to screen out specific biomarkers.SPSS 21.0 statistical software was used for statistical analysis of all clinical data involved,and metabolomics detection was completed by Jinweibiao Testing Co.,Ltd Suzhou.Result:Clinical Research:A total of 60 eligible patients with phlegm-dampness type OSAHS complicated with type 2 diabetes mellitus were confirmed and included(30 in the treatment group and 30 in the control group).No statistical significance was found in the comparison of baseline data such as age and gender among all patients,which can be further compared(P>0.05).Comparison results of curative effect indicators:① Improvement of symptoms and signs:The symptoms of the treatment group were significantly improved after treatment,the total effective rates in the improvement of TCM syndrome scores in the two groups were 86.67%and 63.33%,respectively.The advancement in the treatment group was better than that in the control group(P<0.05).②OSAHS-related indicators:Compared before and after treatment in the two groups,the AHI and ESS scores of the two groups were decreased after treatment(P<0.01),and the LSaO2 was increased compared with that before treatment(P<0.01).The ESS score was lower than that of the control group with significant differences(P<0.05),and the LSaO2 was significantly higher than that of the control group(P<0.01).③BMI:The BMI of the two groups after treatment was significantly lower than that before treatment(P<0.01),but there was no significant difference in BMI between the two groups after treatment(P>0.05).④Blood glucose-related indexes:FPG,2hPG,FINS,HOMA-IR,and HbAlc in the two groups after treatment were significantly lower than those before treatment(P<0.01).The indexes of the two groups of patients after treatment were compared,and the results showed that the effect of the treatment group was better than that of the control group,and there was a significant difference(P<0.05).⑤Blood lipid-related indicators:TG,TC,LDL-C,ApoB/ApoA I in both groups after treatment were significantly lower than those before treatment(P<0.05),and at the same time,a significant increase in HDL-C was observed(P<0.05),and the statistical analysis of the improvement in the two groups showed that the improvement in the treatment group was greater(P<0.05).2.Experimental Study:Differential metabolites in serum samples of patients before and after Wendan decoction treatment were analyzed by non-target metabolomics,and 21 and 16 differential metabolites were screened out in positive and negative ion mode,and through KEGG enrichment analysis,9 pathways with statistical differences were obtained,which were associated with Alcoholism,Prolactin signaling pathway,Dopaminergic synapse,Cortisol synthesis and secretion,Sphingolipid metabolism,Pantothenate and CoA biosynthesis,beta-Alanine metabolism,Thiamine metabolism,Phenylalanine,tyrosine and tryptophan biosynthesis.Conclusion:Wendan Decoction is a famous traditional Chinese medicine prescription,which is from the "Three Causes,Extremes and One Disease Syndrome" written by Chen Yan in the Southern Song Dynasty.The following conclusions are drawn through this study:1.Wendan Decoction can improve sleep breathing in patients,reduce AHI,increase LSaO2,and improve daytime sleepiness.2.Wendan Decoction can improve the glucose and lipid metabolism in patients,reduce insulin resistance,and reduce the risk of cardiovascular events.3.Non-target metabolomic analysis showed that the mechanism of Wendan Decoction may be related to Prolactin signaling pathway,Dopaminergic synapse,Cortisol synthesis and secretion,cortisol metabolism,tyrosine metabolism and so on. |
PDF Full Text Request