摘要
目的探讨2型糖尿病合并肥胖患者的相关危险因素及中医证素。方法采用回顾性病例对照的研究方法,选取120例就诊于杭州市中医院内分泌科(2017年1月-2019年12月)的糖尿病患者,将其按照体重指数分为两组,即肥胖组62例(BMI≥28 kg/m^(2)),正常体重组58例(18.5 kg/m^(2)≤BMI<25 kg/m^(2)),对比两组患者的体重(BW)、体重指数(BMI)、腰臀比(WHR)、糖代谢指标(空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)、空腹C肽(FCP)、空腹胰岛素(FINS)、Homa2-IR)、脂代谢指标(甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL))。中医方面:以朱文峰教授的证素理论为基础,运用证素辨证的方法探讨消渴病与肥胖之间的关系。结果肥胖组与正常体重组FPG、HDL无组间差异。肥胖组患者的BW、BMI、WHR高于正常体重组(P<0.05);糖代谢方面,肥胖组PPG、HbA1c、FCP、FINS、Homa2-IR水平高于正常体重组(P<0.05);脂代谢方面,肥胖组TC、TG、LDL水平均高于正常体重组(P<0.05)。中医证素:脏腑病位证素方面,肥胖组脾、胃、肝证素高与正常体重组(P<0.05);病性证素方面,气虚、气郁、痰、湿、热、瘀证素高与正常体重组(P<0.05)。根据性别及腰臀比对肥胖2型糖尿病患者进行分层比较,在脏腑病位证素方面,肥胖男性中腰臀比≥0.90者脾、肝证素出现频次更高(P<0.05);肥胖女性中腰臀比≥0.85者脾、胃、肝证素出现频次更高(P<0.05);在病性证素方面,腰臀比≥0.90的肥胖男性及腰臀比≥0.85的肥胖女性中气郁、湿、热、瘀证素出现频次较高(P<0.05)。结论肥胖2型糖尿病患者多存在较高的胰岛素抵抗水平及更显著的糖脂代谢紊乱。治疗肥胖2型糖尿病患者,除了传统的"阴虚燥热"和"脾虚痰湿"等常见病机外,可以从调整肝、脾、胃脏腑功能,改善气郁、气虚、痰、湿、热、瘀的方向着手进行辨证论治。
Objective To explore the related risk factors and TCM syndrome elements in patients with type 2 diabetes mellitus complicated with obesity.Methods A retrospective case-control study was conducted to select 120 diabetic patients in the Department of Endocrinology,Hangzhou hospital of traditional Chinese medicine(January 2017 to December 2019),and they were divided into two groups according to body mass index,namely,62 cases of obesity group(BMI≥28 kg/m^(2)),58 cases of normal weight group(18.5 kg/m^(2)≤BMI<25 kg/m^(2)).The body weight(BW),body mass index(BMI),waist hip ratio,glucose metabolism index(WHR,FPG,PPG,HbA1 c,FCP,FINS,HOMA2-IR),lipid metabolism index(TG,TC,HDL and LDL)of the two groups were compared.T For TCM,based on Professor Zhu Wenfeng’s syndrome element theory,the relationship between consumptive thirst and obesity was explored using the syndrome element method of differentiation.Results There was no difference in FPG and HDL between obesity group and normal weight group.BW,BMI and WHR of obese group were higher than those of normal weight group(P<0.05).In terms of glucose metabolism index,the levels of PPG,HbA1 c,FCP,FINS and HOMA2-IR in obese group were higher than those in normal weight group(P<0.05).In terms of lipid metabolism,the levels of TC,TG and LDL in obese group were higher than those in normal weight group(P<0.05).TCM syndrome elements:In terms of syndrome elements of viscera disease location,the syndrome elements of stomach,spleen and liver in obesity group were higher than those in normal weight group(P<0.05);in terms of syndrome elements of disease nature,the syndrome elements of qi deficiency,qi depression,phlegm,dampness,heat and blood stasis were higher than those in normal weight group(P<0.05).According to gender and waist hip ratio,obese patients with type 2 diabetes mellitus were stratified,In terms of viscera disease location,the frequency of spleen and liver syndrome elements was higher in obese men with WHR≥0.90(P<0.05);The frequency of syndrome elements of spleen,stomach and liver was higher in obese women with WHR≥0.85(P<0.05);in terms of disease syndrome elements,the frequency of syndrome elements of qi depression,dampness,heat and blood stasis was higher in obese men with WHR≥0.90 and obese women with WHR≥0.85(P<0.05).Conclusion Obese patients with type 2 diabetes tend to have higher levels of insulin resistance and more significant disturbances in glucolipid metabolism.In addition to the traditional pathogenesis of"yin deficiency and dry heat"and"spleen deficiency and phlegm dampness"in the treatment of obese type 2 diabetes mellitus,we can eliminate the function of liver,spleen and stomach,improve qi stagnation,qi deficiency,phlegm,dampness,heat and blood stasis.
作者
刘晓倩
金剑虹
王保法
傅莉萍
Liu Xiaoqian;Jin Jianhong;Wang Baofa;Fu Liping(Hangzhou Dingqiao Hospital,Hangzhou 310021,China;Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2021年第9期3095-3101,共7页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
浙江省卫生健康委员会浙江省中医药科技计划科研基金项目(2020ZB177):基于JAK/STAT信号转导途径糖Ⅰ号颗粒剂干预脾虚湿热型消渴病患者RANTES表达机制的研究,负责人:王保法
关键词
肥胖
2型糖尿病
中医证素
中医辨证
Obesity
Type 2 diabetes
Syndrome element
TCM syndrome differentiation
