2型糖尿病合并肥胖中医证素特点研究  

Study on TCM Syndrome and Element Characteristics of Type 2 diabetes with Obesity

作　　者：陈弘东 王耀献[2] 刘伟敬[2] 郭敬 李璐璐 李军[1] 贺仲晨[1] CHEN Hongdong;WANG Yaoxian;LIU Weijing;GUO Jing;LI Lulu;LI Jun;HE Zhongchen(Beijing Hepingli Hospital,Beijing 100013,China;Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京市和平里医院,北京100013 [2]北京中医药大学东直门医院,北京100700

出　　处：《辽宁中医药大学学报》2023年第3期58-65,共8页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81804083);北京市东城区优秀人才培养资助项目(2019DCT-M-32);北京市和平里医院自主课题(2021-1-07)。

摘　　要：目的探讨2型糖尿病(T2DM)合并肥胖的中医证素特点及其代谢指标差异。方法首先根据研究内容设计病例报告表,参考《证素辨证学》设计《糖尿病证候辨证素量表》,并将其智能化。然后纳入70例T2DM合并肥胖的患者,收集临床资料,进行证素诊断,分析其中医证素特点,并分析不同病位、病性证素下患者代谢指标的差异。结果T2DM合并肥胖患者的病位证素有脾、肝、肾、胃、大肠5个,其中以脾、肝、肾占比最多,分别占55.1%、30.6%、30.6%。脾组在空腹胰岛素(FINS)、尿酸(UA)、胰岛β细胞功能指数(HOMA-β)指标方面均高于非脾组,且差异具有统计学意义(P<0.05);肝组在空腹血糖(FPG)、糖化血红蛋白(HbA1c)、FINS、胰岛素抵抗指数(HOMA-IR)指标方面均高于非肝组,在胰岛素敏感指数(ISI)指标方面低于非肝组,差异具有统计学意义(P<0.05);肾组在空腹C肽(FCP)方面低于非肾组,并且差异具有统计学意义(P<0.05)。T2DM合并肥胖患者的病性证素有阴虚、阳虚、热、湿、痰、气虚、血虚、血瘀、气滞、食积10个,其中以湿、热、阴虚占比最多,分别为62.9%、50%、37.1%,湿组在FINS、FCP、HOMA-β指标方面均高于非湿组,并且差异具有统计学意义(P<0.05),甘油三酯(TG)方面明显高于非湿组,并有显著的统计学差异(P=0.003);热组在低密度脂蛋白(LDL)、HOMA-IR指标方面均高于非热组,并且差异具有统计学意义(P<0.05),在总胆固醇(TC)方面明显高于非热组,并有显著的统计学差异(P=0.009),在ISI方面低于非热组,差异具有统计学意义(P<0.05)。结论T2DM合并肥胖多合并其他代谢性疾病,并存在糖脂代谢异常,胰岛素抵抗,胰岛素敏感性较差等情况;中医证素以湿、脾、热占比最高,存在“中满内热”,可针对予以开郁清热法治疗。Objective To investigate the characteristics of TCM syndrome and elements,the differences of metabolic indexes in type 2 diabetes mellitus(T2DM)with obesity.Methods First,a case report form was designed according to the study content.The scale of Syndrome Differentiation of Diabetes Syndrome was designed by referring to Syndrome Differentiation of Syndrome Elements,and it was intellectualized.Then 70 T2DM patients with obesity were included,clinical data were collected,syndrome diagnosis was conducted,characteristics of TCM syndrome were analyzed,and differences in metabolic indicators of patients with different disease locations and syndromes were analyzed.Results There were 5 syndrome elements of spleen,liver,kidney,stomach and large intestine in T2DM patients with obesity among which spleen,liver and kidney accounted for the most,accounting for 55.1%,30.6%and 30.6%respectively.The indexes of FINS,uric acid(UA)and HOMA-βin spleen group were significantly higher than those in non-spleen group(P<0.05).The indexes of FPG,HbA1c,FINS and HOMA-IR in liver group were higher than those in non-liver group,while the indexes of ISI were lower than those in non-liver group,the differences were statistically significant(P<0.05).The FCP of renal group was lower than that of non-renal group,and the difference was statistically significant(P<0.05).In T2DM patients with obesity,there were 10 syndromes including Yin deficiency,Yang deficiency,heat,dampness,phlegm,Qi deficiency,blood deficiency,blood stasis,Qi stagnation and food accumulation,among which dampness,heat and Yin deficiency accounted for the largest proportion(62.9%,50%and 37.1%).The indexes of FINS,FCP and HOMA-βin wet group were higher than those in non-wet group.There was statistical difference(P<0.05),TG was significantly higher than non-wet group,and there was significant statistical difference(P=0.003);The LDL and HOMAIR indexes in the hot group were higher than those in the non-hot group,and the differences were statistically significant(P<0.05).The total ch

关 键 词：2型糖尿病 肥胖 中医证素 

分 类 号：R587.1[医药卫生—内分泌]