目的：观察活血祛湿方联合针灸对乙型肝炎肝硬化糖尿病患者肝细胞胰岛素抵抗的影响。方法：以68例乙型肝炎肝硬化糖尿病患者为研究对象，按随机数字表法分为中药组与针药组各34例。对两组患者进行控制血糖、保肝、抗病毒等基础性治疗。中药组患者在此基础上每日口服活血祛湿方，日1剂。针药组患者在中药组治疗基础上同时选取脾俞、胃脘下俞、肾俞、肝俞、三阴交、足三里、中脘、丰隆，进行针刺治疗。疗程为2个月。观察治疗前后胰岛素抵抗指数（HOMA-IR）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、餐后2 h血糖（2 hPG）、瘦素（LEP）、脂联素（ADPN）水平、体质量指数（BMI）、证候积分、FPG、HbA1c、2 hPG肠道菌群水平及临床疗效。结果：治疗后，中药组及针药组HOMA-IR、BMI、腹胀积分、肢体沉重积分、肢体浮肿积分、肌肤甲错积分、LEP水平、肠道大肠埃希菌水平均较治疗前减少，ADPN水平、双歧杆菌水平均较治疗前升高，且针药组改变程度更明显（P<0.05）。治疗后，中药组治疗总有效率76.47%，针药组97.06%，两组疗效比较，差异具有统计学意义（P<0.05）。结论：活血祛湿方联合针刺可通过保护肝细胞、提高胰岛素利用率、促进胰岛β细胞释放、降低感染程度等方式，改善肝源性糖尿病患者胰岛素抵抗，提高治疗效果。

Objective : To observe the effect of Huoxue Qushi Formula （ 活 血 祛 湿 方 ） combined with acupuncture on insulin resistance of liver cells in patients with diabetes Caused by Hepatitis B Cirrhosis.Methods:A total of 68 patients with hepatitis B,liver cirrhosis and diabetes were included and divided into Chinese medicinals group and acupuncture and medicinals group with a random number table,34 patients in each group. Both groups were given routine treatments including treatments for blood glucose control,liver protection,and antivirus. Chinese medicinals group was given oral administration of Huoxue Qushi Formula,one dose a day. Acupuncture and medicinals group were further treated with acupuncture on Pishu(BL 20),Weiwanxiashu(EX-B 3),Shenshu(BL 23),Ganshu(BL 18),Sanyinjiao(SP 6),Zusanli(ST 36),Zhongwan(CV 12),and Fenglong(ST 40) besides the treatment in the Chinese medicinals group. The treatment lasted for 2 months. Before and after treatment,homeostasis model assessment for insulin resistance(HOMA-IR),fasting plasma glucose(FPG),glycosylated hemoglobin A1C(HbA1C),2 h postprandial blood glucose(2 h PG),leptin(LEP),adiponectin(ADPN) levels,body mass index(BMI),intestinal flora level were tested,syndromes score and efficacy were compared. Results:After treatment,HOMA-IR,BMI,abdominal distension score,limb weight score,limb edema score,scaly skin score,LEP levels,and intestinal Escherichia coli levels were reduced before treatment in Chinese medicinals group and the acupuncture and Chinese medicinal group,while levels of ADPN and Bifidobacteria increased compared with before treatment,and the changes were more obvious in the acupuncture and medicinals group(P<0.05). After treatment,the total efficacy rate was 76.47% in the Chinese medicinals group and 97.06% in the acupuncture and medicinals group. Acupuncture and medicinals group was significantly higher than Chinese medicinals group on the efficacy rate, with statistical difference( P < 0. 05). Conclusions : Huoxue Qushi Formula combined with acupuncture can improve the insulin resistance of patients with liver-derived diabetes by protecting liver cells,increase the utilization rate of insulin,promote the release of islet β-cells,reduce the degree of infection,and improve the total efficacy.