| The thesis consists of two parts:the review and the clinical research.The review includes two parts:Review of modern medicine and traditional Chinese Medicine. Modern medical review part mainly introduces the diabetes macrovascular disease epidemiology, pathogenic mechanism, diagnosis method, and related laboratory indexes, the treatment research progress and relevant compilation of possible adverse reactions.It prompts that the pathogenesis of diabetic macrovascular disease is complex. The related research mainly from the aspects of the polyol pathway, advanced glycation end products, insulin resistance, lipid abnormality, inflammation various interpretation.The treatment goal is to lower blood sugar, control pressure and adjust blood fat, evaluating its clinical efficacy remains to be further perfect and comprehensive consideration. The review of TCM is according to the relevant research on diabetic macrovascular disease in TCM diagnosis and treatment in 15 years, which is a brief overview of the diabetic macrovascular disease in etiology, pathogenesis, clinical classification, research progress of diagnosis and treatment based on differentiation of symptoms and signs. It has carried out different types of blood canal lesions and learned the latest research on relevant Chinese medicine.Initially considering that integrated Chinese and Western medicine has certain characteristics and advantages in treating diabetic macrovascular complications.Objective To investigate the effect of Chinese medicine intervention on dynamic carotid intima-media thickness in type 2 diabetes.Methods Using the historical cohort study, all of the patients are from the Department of Endocrinology or TCM Department of hospitalized in Beijing hospital during January 2010 and December 2015.According to the inclusion and exclusion criteria selected 42 medical records which were based on western standard of antidiabetic, antihypertensive and lipid-lowering therapy and with integrated data. The patients were divided into two groups: Traditional Chinese medicine intervention group (22 cases) were exposed to a traditional Chinese medicine. All of the inpatient and outpatient were given oral medicine, and the kinds and dosage of Chinese medicine were according to the patients’ syndrome and symptom.20 cases in the control group were unexposed to Chinese medicine, routine treatment of Western medicine alone.42 medical records were hospitalized 3 times from January 2010 to December 2015, each time intervals 1-1.5 years. Main outcome measures:the carotid intima-media thickness during 3 times hospitalization, the dynamic change of the difference between compared two groups. Secondary index:fasting blood glucose, serum total cholesterol, triglyceride, low density lipoprotein cholesterol, high density fat cholesterol, glycosylated hemoglobin, serum uric acid, serum urea nitrogen, serum creatinine,etc.Results The whole of carotid artery intima-media thickness thinning compared to before, traditional Chinese medicine intervention group intima-media thickness thinning rate lower than the conventional western medicine treatment group, but no statistical difference (P = 0.083). with cardiovascular and cerebrovascular disease patients intima-media thickness (1.7±0.6 mm) and not complicated with cardiovascular disease patients with intima-media thickness (1.4 ± 0.2 mm) significantly statistical difference (P< 0.05); the two groups of patients in the second hospitalized time, a secondary indexes of blood creatinine (SCR), a traditional Chinese medicine intervention group (64 ± 16 mmol/L) was lower than that of the conventional Western Medicine treatment group of (75 ± 15 mmol/L), and the results have statistical difference (P< 0.05). Patients third hospitalized time with the traditional Chinese medicine intervention group glycosylated hemoglobin (7.7 ± 1.03 (%)) compared with the control group (8.54 ± 1.53 (%))lower, but the results were not statistically significant (P= 0.058); patients hospitalized with a second control group fib-c (2.85 ± 0.50 g/L) than the traditional Chinese medicine intervention group (3.47±0.83g/L) low, a significant statistical difference (P= 0.006).Conclusion Chinese medicine intervention in T2DM patients with large vascular combined with conventional western medicine in the treatment of type 2 diabetic carotid intima-media thickness degree of improvement may be superior to conventional treatment of Western medicine alone. Carotid artery intima-media thickness is related with cardiovascular and cerebrovascular complications. Traditional Chinese medicine intervention may protect the renal of the patients. Chinese herb intervention combined with conventional treatment of Western medicine may be able to effectively reduce HbAlc levels. |
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