| Part one: Meta-analysis of the effect of Jianpiyiqihuazhuo method in the treatment of prediabetes mellitus.Objective: To systematically evaluate the clinical efficacy of Jianpiyiqihuazhuo method in the treatment of prediabetes mellitus by Meta analysis.Methods: The databases of CNKI,Wanfang,VIP and Pub Med were searched by Internet.All randomized controlled trial literatures(RCTS)published from the establishment of the database to January 31,2023 on the treatment of pre-diabetic patients with Jianpiyiqihuazhuo method were collected.Two evaluators conducted a separate analysis of the included articles according to the inclusion and exclusion criteria,and used Review Manager 5.4 software for meta-analysis.Results: A total of 14 RCTS were included in this study,including 1296 patients.Ten indexes,including clinical efficacy,free fatty acids,fasting blood glucose content,2-hour postprandish blood glucose level,insulin resistance index,triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,and body mass index,were separately included in the meta-analysis.1.The clinical efficacy of the treatment group was significantly better than that of the control group: [OR=3.28,95%CI(2.40,4.48)],Z=7.43,P < 0.01;2.Compared with the control group,free fatty acids were significantly decreased in the treatment group: [MD=-104.75,95%CI(-134.09,-75.41)],Z=7.00,P < 0.01;3.Fasting blood glucose in the treatment group was significantly lower than that in the control group: [MD=-0.32,95%CI(-0.53,-0.11)],Z=3.01,P < 0.01;4.Compared with the control group,the blood glucose level at 2 hours after meal was significantly reduced in the treatment group: [MD=-0.92,95%CI(-1.38,-0.46)],Z=3.90,P < 0.01;5.Compared with the control group,the treatment group could effectively reduce the insulin resistance index: [MD=-0.22,95%CI(-0.43,-0.01)],Z=2.04,P < 0.05;6.Compared with the control group,the treatment group could effectively reduce triglyceride: [MD=-0.44,95%CI(-0.87,-0.01)],Z=2.02,P < 0.05;7.Compared with the control group,total cholesterol in the treatment group was significantly reduced: [MD=-0.30,95%CI(-0.54,-0.06)],Z=2.43,P < 0.05;8.The low density lipoprotein cholesterol in the treatment group was significantly lower than that in the control group: [MD=-0.14,95%CI(-0.23,-0.06)],Z=3.25,P < 0.01;9.Compared with the control group,high density lipoprotein cholesterol was significantly increased in the treatment group: [MD=0.07,95%CI(0.02,0.11)],Z=2.82,P < 0.01;10.Compared with the control group,the body mass index in the treatment group was significantly decreased: [MD=-0.65,95%CI(-1.27,-0.03)],Z=2.06,P <0.05;Conclusion:The treatment of prediabetes with Jianpiyiqihuazhuo method has significant clinical effect,which can significantly reduce free fatty acids,fasting blood glucose,2 hours postprandial blood glucose levels and low density lipoprotein cholesterol,effectively reduce insulin resistance index,triglyceride,total cholesterol and body mass index,and significantly increase high density lipoprotein cholesterol.It deserves to be promoted.However,the whole study quality of the contained literatures is low,and multi-center,large-sample RCT studies are also needed to supplement to provide support.Part two: Based on the level of free fatty acids to explore the preventive and therapeutic effects of Sanggehuazhuo decoction on prediabetes mellitus rats and its mechanism.Objective: Guided by clinical experience,animal experiments were conducted to study the regulatory effects of Sanggehuazhuo decoction on serum free fatty acids in pre-diabetic rats,and the possible mechanism of action was preliminically discussed.Methods: Sixty healthy male SD rats were purchased,and after 1 week of adaptive feeding,10 of them were randomly selected as normal group(NC group)rats,which continued to be fed with ordinary diet,and the remaining 50 rats were fed with high-sugar and high-fat diet.After 4 weeks,50 rats except the normal group were intraperitoneally injected streptozotocin(STZ)diluted with sodium citrate solution to build the model,and 10 rats in the normal group were injected with the same dose of sodium citrate buffer.After the model was established,50 rats were randomly divided into 5 groups with 10 rats in each group,which were Sanggehuazhuo decoction low-dose group(group L),Sanggehuazhuo decoction medium-dose group(group M),Sanggehuazhuo decoction high-dose group(group H),metformin group(group MH)and model group(group PM).Groups L,M and H were intragaically given Sanggehuazhuo decoction suspension of 2.7g/(kg·d),5.4g/(kg·d)and 10.8g/(kg·d),MH group was intragaically given metformin suspension of 200mg/(kg·d),NC group and PM group were intragaically given 2ml distilled water.The rats in 6 groups were given continuous gavage for 8 weeks,during which the general state,body weight and blood sugar of the rats were observed and recorded every 2 weeks.After the experiment,the plasma of rats was collected to detect the contents of triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)and free fatty acids,and the serum free fatty acid profile was prepared.Results:1.General state: The rats in the NC group had no significant changes in food intake,water intake and urine and feces during the experiment.They were in good mental condition,moved freely and had shiny fur.Compared with the NC group,the food intake,water intake and defecation of rats in groups L,M,H,MH and PM were higher than those in NC group,and the hair color gradually lost luster,mental state was poor,and reaction was delayed.With the extension of gavage time,the symptoms of rats in groups L,M,H and MH were improved to varying degrees compared with that in group PM,and the general state of MH group and H group was similar and the effect was obvious.2.Body weight of rats: During the experiment,the body weight of rats in the6 groups increased with the increase of weekly age.Compared with the NC group,the body weight of the L,M,H,MH and PM groups increased significantly(P< 0.01),and there was no significant difference in body weight among the 5groups after modeling(P > 0.05).After 8 weeks of drug intervention,compared with PM group,the body weight of rats in M group,H group and MH group was decreased to different degrees(P < 0.05 or P < 0.01),but the body weight of rats in L group was not statistically significant(P > 0.05).Compared with MH group,body weight of H group was not significantly different(P > 0.05).3.Rat blood glucose: During the experiment,the fasting blood glucose of rats in NC group was always maintained at a normal level,and the fasting blood glucose in L,M,H,MH and PM groups was significantly higher than that in NC group(P < 0.01).Fasting blood glucose in PM group was always at a high level,and after 8 weeks of drug intervention,fasting blood glucose in L,M,H and MH groups was significantly lower than that in PM group(P < 0.01).Compared with MH group,fasting blood glucose in L group and M group was significantly different(P < 0.01),and that in H group was different(P <0.05).4.Four items of blood lipid: compared with NC group,the contents of TG,TC and LDL-C in serum of groups L,M,H,MH and PM were significantly increased,while the content of HDL-C was significantly decreased(P < 0.01).Compared with the PM group,the contents of TG,TC and LDL-C in serum in groups L,M,H and MH were significantly decreased(P < 0.01),the contents of HDL-C in groups L and M had no statistical significance(P > 0.05),and the contents of HDL-C in groups H and MH were significantly increased(P < 0.01).Compared with MH group,there were significant differences in TG content between L group and M group(P < 0.01),but there was no statistical significance in TG content between H group(P > 0.05).There was no significant difference in TC content among L group,M group and H group(P > 0.05).The contents of LDL-C and HDL-C in group L,group M and group H were significantly different(P < 0.01).5.Free fatty acid spectrum: Among 37 fatty acid methyl esters in samples of different groups,methyl myristate(C14:0),methyl palmitate(C16:0),methyl stearate(C18:0),methyl linoleate(C18:2n6c),cis-8,11,14-eicosatrienoic acid methyl ester(C20: 3n6),methyl arachidonate(C20:4n6),methyl nervonate(C24:1),methyl docosahexaenoate(C22: 6n3),a total of 8 fatty acid methyl esters had statistical significance(P < 0.05),and all the other 29 fatty acid methyl esters showed consistency,but no statistical significance(P >0.05).Compared with NC group,C14:0 and C16:0 were increased in L,M,H,MH and PM groups.C18:0 was increased in groups L,M,H and PM.C20:3n6 and C24:1were increased in L,M and PM groups.C18:2n6c and C22:6n3 were increased in M group and PM group.C20:4n6 was increased in PM group.Compared with PM group,C14:0,C16:0 and C18:0 in L,M,H and MH groups were decreased.C20:4n6decreased in groups M,H and MH.C22:6n3 decreased in group L and group H;C24:1 decreased in H and MH groups.C18:2n6c and C20:3n6 were decreased in MH group.Conclusion:1.Sanggehuazhuo decoction can improve the general state of pre-diabetic rats,effectively reduce the abnormal rise of weight,fasting blood glucose,TG,TC and LDL-C,and increase the content of HDL-C in pre-diabetic rats.The curative effect of high dose Sangge Huazuyin was higher than that of medium and low dose Sangge Huazuyin,but lower than that of metformin group.2.Sanggehuazhuo decoction can reduce serum free fatty acid,which is mainly related to methyl myristate(C14:0),methyl palmitate(C16:0),methyl stearate(C18:0),methyl linoleate(C18:2n6c),cis-8,11,14-eicosatrienoic acid methyl ester(C20: 3n6),methyl arachidonate(C20:4n6),methyl nervonate(C24:1)and methyl docosahexaenoate(C22:6n3)were associated with the decline of 8 fatty acid methyl esters. |
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