Jiangzhuo Circulation Mixture Nafld In T2dm With Efficacy Evaluation And Mechanism

This thesis includes three parts:literature summarization, clinical observation and experimental research.Literature summarization systematiclly reviewed the recent progress of type 2 diabetes (T2DM) with non-alcoholic fatty liver disease (NAFLD) in clinical and basic research. The first review mainly analysed the closely connection between T2DM and NAFLD from the point of modern medicine, reviewed the recent researches on the relationship between them, comprehensively discussed on the clinical features, risk factors and treatment of patients with T2DM and NAFLD, also discussed the pathogenesis of NAFLD and its relationship with T2DM. The second review ma inly summar ized the view of taditional Chinese medicine (TCM) on pathogenesis, diagnosis and treatment of NAFLD, T2DM with combined NAFLD, The literature summarizations also discussed the problems and weaknesses in the current study, looked into the prospects of research and possible entry points on T2DM with NAFLD in terms of Western medicine and TCM.The clinical research part observed the clinical efficiency of Jiangzhuo Huayu Mixture(JZHYM) on T2DM with simple non-alcoholic fatty liver(NAFL) and its influence on part subclinical inflammation factors. 70 patients were selected in this research, which meet clinical diagnosis standard of T2DM and NAFL, also in accordance with TCM syndrome standard of lier constraint qi stagnation, phlegm and blood stasis. They were randomly divided into treatment group 35 examples, western medicine control group 35 examples. The control group patients were only treated with based therapy (diet, exercise, control glucose and other primary diseases, etc.), The treatment group patients were treated with JZHYM in the foundation of based treatment, observation period to 24 weeks. Observed patients respectively of TCM symptoms integral, body mass index (BMI), blood fat, liver function, insulin resistance index (HOMA-IR), high sensitive C-reactive protein (hs-CRP), the fibrinogen (FIB) and liver imaging change, also monitored blood sugar and recorded adverse reactions. The results showed that JZHYM can effectively improve the TCM symptom scores of T2DM with NAFL patients (P< 0.01), the total effective rate of TCM symptom was 96.78%, much better than it in control group which was 71.88%(P< 0.01). The rate of liver image changing better in treatment group was also better than in control group,as 87.10% vs 59.37%. Serum alanine aminotransferase (ALT), aspertate aminotransferase (AST) in herbal treated group improved obviously (P < 0.01), which did not change obviously in the control group (P> 0.05). Triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) of both groups were significantly lower (P< 0.01), high-density lipoprotein cholesterol (hdl-c) was obviously higher after treatment (P< 0.01), but the reduction of TC and LDL-C in treatment group was more obvious than which in control group (P< 0.01 or P< 0.05). The HOMA-IR, hs-CRP and FIB level all decreased significantly after treatment in herbal treatment group (P< 0.01), but did not significantly changed in control group (P> 0.05). Blood glucose level of both groups were controlled within the target range, there was no significant difference between both grous(P>0.05). No drug-related adverse reactions were seen during the experiment. It Shows:JZHYM can relieve the symptoms of T2DM with NAFLD patients, protect liver, reduce serum ALT, AST, improve the lipid metabolism, ease insulin resistance and the body subclinical inflammation, It also has higher security.Experimental research adopted method of modified fatty diet with low doses STZ injection to establish T2 DM with NAFLD mo del of rats, after validation, the suscessful estblished rats were randomly divided into Chinese medicine group(JZHYM treatment), western medicine group(RosiglitazoneMaleate treatment) and the model group, set the normal group to contrast with. the model group and the normal group irrigated stomach by distilled wate,dosing 8 weeks. Observed JZHYM' s liver protect effect on model rats, the influence on glucolipid metabolism and IR, and the influence on the nuclear factor-κB(NF-κB) pathway of liver and abdominal aorta. Respectively detected liver pathology changes, liver index, ALT, AST, liver tissue homogenate superoxide dismutase (SOD) vigor, malondialdehyde (MDA), glutathione (GSH). Serum TC, TG, LDL-C, HDL-C, free fatty acid (FFA), blood sugar and blood fasting insulin levels (FINS). Detected hematic tumor necros is factor alpha (TNF-α), and western-blot test NF-κB and IκB protein expression of liver and abdominal aortic. The results show:JZHYM significantly improved model rats'liver steatosis. Chinese medicine group and western medicine group both reduced liver index, but the Chinese medicine group was more obvious (P<0.05). JZHYM significantly lower serum ALT (P<0.01). Liver homogenate SOD, GSH of Chinese medicine group is higher than model group, MDA content reduced significantly (all have P< 0.01), SOD and GSH had no change in western medicine group (P> 0.05). Hint that JZHYM has obvious liver protection effect, can improve liver tissue steatosis, reduce blood transaminase, improve liver tissue antioxidant capacity. The serum TC, LDL-C TG and FFA of both Chinese medicine group and western medicine group were lower than model group (P< 0.05 or P< 0.01), but Chinese medicine group's FFA and TG were significantly lower than western medicine group's (P< 0.01); JZHYM have no apparent effect on glucouse-lowering, Chinese medicine group's fasting plasma glucose (FPG) vs model group'FPG (P> 0.05), but HOMA-IR of both Chinese medicine group and western medicine group were significantly lower than model group (P< 0.05). It show that JZHYM can improve the model rats'lipid metabolism and insulin resistance. Compared with model group, Chinese medicine group's blood TNF-αdeclined (P< 0.05), liver and abdominal aortic NF-κB (P65) protein expression significantly lower than model group (P< 0.01), and were also less than western medicine group (P< 0.01), liver IκB protein expression of Chinese medicine group enhanced obviously compared with model group (P< 0.05). the result suggest that JZHYM can obvious ly reduce the liver and abdominal aortic NF-κB pathway activation of T2DM with NAFLD rats, improve liver and abdominal aortic inflammation, and may reduce the occurrence of atherosclerosis and the risk of macrovascular disease through this way.