686例肥胖并发高脂血症患者不同证型客观指标特征研究  

Characteristic of Objective Indexes of 686 Cases of Obesity Complicated with Hyperlipidemia with Different Syndromes

作　　者：原萌谦 刘志诚[1] 徐斌[1] 

机构地区：[1]南京中医药大学国家重点省部共建针药结合实验室

出　　处：《中医杂志》2016年第24期2124-2129,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(30873307;81303019)

摘　　要：目的探索肥胖并发高脂血症中医证型的客观指标特征。方法纳入686例肥胖并发高脂血症患者,辨证为肝郁脾虚证、脾肾阳虚证、脾虚湿阻证、痰湿内阻证、胃肠腑热证、阴虚夹瘀证。记录患者肥胖指标:体重、肥胖度、体质指数(BMI)和脂肪百分率;脂质指标:总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C);脂肪-胰岛轴相关指标:空腹血糖(FPG)、空腹胰岛素(FINS)、空腹瘦素(FLP)、胰岛素抵抗指数(Homa-IR)、胰岛素分泌指数(Homa-β)、胰岛素敏感指数(ISI);自主神经功能指数;病因诱因。比较各证型患者的指标特征。结果肝郁脾虚证女性患者构成比高于其他证型(P<0.05);与肝郁脾虚证比较,脾虚湿阻证、痰湿内阻证、胃肠腑热证患者病程较长,痰湿内阻证患者体重及BMI均较高(P<0.05);与痰湿内阻证比较,肝郁脾虚证与胃肠腑热证患者年龄较低(P<0.05),阴虚夹瘀证BMI较低(P<0.05),肝郁脾虚证、脾肾阳虚证、阴虚夹瘀型患者的LDL-C较低;与其他证型相比,胃肠腑热证患者的肥胖度较轻(P<0.05);与胃肠腑热证比较,脾虚湿阻型及痰湿内阻型患者TC较高(P<0.05);脾虚湿阻证患者的脂肪百分率高于脾肾阳虚证(P<0.05)。与其他证型相比,肝郁脾虚型患者的自主神经功能指数值最高(P<0.05)。胃肠腑热证、肝郁脾虚证的主要病因诱因分别为过食少动、情志因素(P<0.01)。结论肝郁脾虚证患者与脂肪-胰岛轴紊乱相关;痰湿内阻证患者体重、BMI及LDL-C最高;脾虚湿阻证患者脂肪百分率、TC最高;胃肠腑热证患者肥胖度最轻,副交感神经活动最强;阴虚夹瘀证患者HDL-C最低。Objective To explore the objective index characteristic of Chinese medicine syndromes of obesity complicated with hyperlipidemia. Methods Six hundred and eighty-six cases of obesity complicated with hyperlipidemia were included, whose syndromes were differentiated as syndrome of stagnation of liver Qi and spleen deficiency, syndrome of Yang deficiency of spleen and kidney, syndrome of dampness stagnancy due to spleen deficiency, syndrome of internal stagnation and blockade of phlegm-damp, syndrome of heat in stomach and intestines, syndrome of deficiency of Yin with blood stasis. Obesity indexes, lipid indexes, adipose islet axis related indexes, autonomic nervous function index, and the causes and incentives of patients were recorded. The obesity indexes included weight, obesity level, Body Mass Index （BMI） and percentage of fat. Lipid indexes included total cholesterol （TC）, serum triglyceride （TG）, low density lipoprotein cholesterol （LDL-C） and high density lipoprotein cholesterol （HDL-C）. Adipose islet axis related indexes included fasting plasma glucose （ FPG）, fasting insulin （ FINS）, fasting leptin （FLP）, insulin resistance index （Homa-IR）, insulin secretion index （Homa-β） and insulin sensitivity index （ISI）. The index characteristics of patients of different syndromes were compared. Results Composition ratio of female patients in patients with stagnation of liver Qi and spleen deficiency syndrome was higher than that in patients with other syndromes （P 〈 0. 05 ）. Compared with those with stagnation of liver Qi and spleen deficiency syndrome, the disease course was longer in patients with dampness stagnancy due to spleen deficiency syndrome, internal stagnation and blockade of phlegm-damp syndrome and heat in stomach and intestines syndrome, and body weight and BMI was higher in patients with internal stagnation and blockade of phlegm-damp syndrome （P 〈 0. 05 ）. Compared with those with internal stagnation and blockade of phlegm-damp syndrome, patie

关 键 词：肥胖 高脂血症 中医证型 血脂 胰岛素抵抗 自主神经功能 

分 类 号：R259[医药卫生—中西医结合]