糖尿病新型中醫藥之轉譯醫學研究 (2-2)

侯庭鏞
中國醫藥大學
糖尿病（Diabetes mellitus）是體內胰島素不足或細胞產生胰島素抗性而導致血糖濃度無法降低，造成高血糖症的發生。目前臨床治療糖尿病的策略，大多是使用注射胰島素或口服降血糖藥物等方法控制血糖。然而在糖尿病長程的病程發展過程中，除了血糖的??外，還須留意糖尿病併發症的發生，如：低血糖症（hypoglycemia）、酮酸中毒（ketoacidosis）、心血管疾病、慢性腎衰竭、視網膜病變等，這些併發症往往造成死亡率及醫療費用的攀升。許多研究認為這些併發症高度關聯到醣化血色素（HbA1c），因此若能控制HbA1c就可能減緩或降低併發症的發生。本研究希望經由臨床治療經驗分析可能具控制HbA1c之中醫藥方劑，再透過基礎實驗驗證中醫方劑在控制HbA1c的療效，進一步探究其調控HbA1c是否可減緩或降低糖尿病併發症的發生。本研究分析以中央健保局所推動的「全民健保論質計酬計劃」中的糖尿病病患（ICD-9-CM250）為研究對象，分析病患單獨使用西醫或合併中西醫治療糖尿病其HbA1c值改善情形，接著分析中藥的使用情形，找到具明顯下降HbA1c值之糖尿病治療方劑，進一步建立糖尿病動物模式驗證該方劑是否具控制 HbA1c的效果。本研究將透過Physiological investigations （HbA1c、血糖）、
Biochemical investigations （血清生化）及Pharmacogenomic investigations （DNA微陣列分析）等方式進行基礎驗證，探究該方劑控制HbA1c的效果及機轉，最後利用生物資訊分析推測該方劑於治療糖尿病的潛能，並分析是否可改善HbA1c值達到減緩或降低併發症的發生。由已建立糖尿病及併發症不同發展病程的動物模式，藉以探討糖尿病方劑治療的最適用病程、藥物投與時間、及藥物投與劑量等，期望做為治療糖尿病並達到減緩或降低併發症發生之臨床試驗的基礎。
關鍵字：糖尿病、中醫藥、轉譯醫學

Translational Medicine Study of New Chinese Medicinal Herbs for Diabetes (2-2)

Ho, T.Y.
School of pharmacy, College of Pharmacy China medical University
Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Administration of glucose-lowering agents, such as insulin and insulin secretagogues, has been used for the glycemic management of DM. In addition to hyperglycemia, DM leads to several complications, including retinopathy, nephropathy, and neuropathy. Clinical studies show that reductions in glycated hemoglobin A1c (HbA1c) directly reflect improvements in glycemic control and diabetic complications. Therefore, the specific aims of this study are to find the Chinese medicinal formulae with HbA1c-lowering potentials and to further elucidate the molecular mechanisms and therapeutic effects of these formulae on DM and diabetic complications. By surveying the National Health Insurance Database for the DM patients who administered both Chinese medicinal formulae and clinical agents, we found that TCM-DM significantly lowered the HbA1c level in patients. Therefore, we would like to evaluate the therapeutic effect of TCM-DM in DM mice in this project. The physiological investigations (HbA1c and blood glucose level), biochemical investigations (serum biochemical parameters), and pharmacogenomic investigations (microarray analysis) will be further performed to elucidate the molecular mechanisms of TCM-DM on DM. In conclusion, this project is a translational medicine study that connects the basic molecular studies and clinical studies of TCM-DM.
關鍵字：Diabetes, Chinese medicinal herbs, Translational medicine