新发2型糖尿病气阴两虚证和脾虚痰湿证血糖稳态及氨基酸代谢差异分析  

Analysis on the differences in blood glucose homeostasis and amino acid metabolism between new-onset type 2 diabetes mellitus with qi and yin deficiency syndrome and spleen deficiency and phlegm-dampness syndrome

作　　者：李雅莉 郭晓霞[2] 李燕[3] Li Yali;Guo Xiaoxia;Li Yan(First Clinical College of Shanxi University of Chinese Medicine,Taiyuan 030024,China;Department of Metabolic Disease,Shanxi Traditional Chinese Medicine Hospital,Taiyuan 030012,China;Department of Gynecology,Shanxi Traditional Chinese Medicine Hospital,Taiyuan 030012,China)

机构地区：[1]山西中医药大学第一临床学院,太原030024 [2]山西省中医院代谢病科,太原030012 [3]山西省中医院妇科,太原030012

出　　处：《国际中医中药杂志》2024年第10期1286-1294,共9页International Journal of Traditional Chinese Medicine

基　　金：山西省中医药管理局项目(2022ZYYZ005、2023ZYYA006)。

摘　　要：目的探讨新发T2DM气阴两虚证和脾虚痰湿证患者血糖稳态与氨基酸代谢的差异。方法本研究为横断面研究和队列研究。选取2021年1月-2022年12月山西省中医院代谢病科136例T2DM住院患者,经筛选符合新发T2DM气阴两虚证与脾虚痰湿证中医辨证标准者18例,并纳入相应的气阴两虚组与脾虚痰湿组,每组9例。所有患者均佩戴动态血糖监测系统,计算24 h平均血糖标准差(SDBG)、血糖变异系数(GLUcv)、血糖最高值(GLUmax)、血糖最低值(GLUmin)、最大血糖波动幅度(LAGE)、平均血糖波动幅度(MAGE)及血糖目标范围内的时间占比(TIR),留取血液标本用于氨基酸代谢检测,筛选2组证型的差异代谢物及代谢通路。结果脾虚痰湿组患者尿微量白蛋白[27.61(13.60,40.45)mg/L比5.10(1.95,9.70)mg/L,Z=-2.34]、血糖(GLU)-0 h[(14.83±4.79)mmol/L比(9.72±2.35)mmol/L,t=2.87]、GLU-1 h[(24.40±5.23)mmol/L比(17.71±2.68)mmol/L,t=3.42]、GLU-2 h[(25.17±4.43)mmol/L比(19.69±3.11)mmol/L,t=3.03]、胰岛素抵抗指数[1.83(1.46,3.19)比1.14(0.90,1.35),Z=-2.14]高于气阴两虚证(P<0.05),GLUcv[16.86(13.58,26.20)%比28.30(23.17,40.87)%,Z=-2.08]低于气阴两虚证(P<0.05),且血糖波动严重。筛选2组差异代谢物发现,苏氨酸、丙氨酸、谷氨酰胺为T2DM气阴两虚证与脾虚痰湿证潜在代谢标志物。分析2组不同中医证型差异代谢物途径发现,氨基酸-tRNA的生物合成富集通路最显著。结论T2DM脾虚痰湿证患者较气阴两虚证患者的胰岛素功能及血糖稳态情况更差;氨基酸代谢的差异是脾虚痰湿证与气阴两虚证发生发展的重要影响因素;氨基酸-tRNA的生物合成参与了早期糖尿病的发展,在T2DM的发病机制中起关键作用。Objective To investigate the differences in glucose homeostasis and amino acid metabolism between patients with new-onset T2DM with qi-yin deficiency syndrome and those with spleen deficiency and phlegm-dampness syndrome.Methods This study was a cross-sectional and cohort study.From January 2021 to December 2022,136 T2DM inpatients were selected from the Department of Metabolic Diseases of Shanxi Traditional Chinese Medicine Hospital,and 18 patients were screened to meet the inclusion criteria of new-onset T2DM,and were identified as qi-yin deficiency syndrome and sspleen deficiency and phlegm-dampness syndrome,and were included in corresponding qi-yin and deficiency group and spleen deficiency and phlegm-dampness group,with 9 cases in each group.All patients wore a dynamic blood glucose monitoring system to calculate the 24-h mean standard deviation of blood glucose(SDBG),the coefficient of variation of blood glucose(GLUcv),the maximum value of blood glucose(GLUmax),the minimum value of blood glucose(GLUmin),the maximum amplitude of glucose fluctuation(LAGE),the average amplitude of glucose fluctuation(MAGE),and the proportion of time within the target range of blood glucose(TIR).Blood specimens were retained for amino acid metabolism testing to screen for differential metabolites and metabolic pathways in the 2 groups of syndromes.Results Patients in the spleen deficiency and phlegm-dampness group had mAlb[27.61(13.60,40.45)mg/L vs.5.10(1.95,9.70)mg/L,Z=-2.34],GLU-0 h[(14.83±4.79)mmol/L vs.(9.72±2.35)mmol/L,t=2.87],GLU-1 h[(24.40±5.23)mmol/L vs.(17.71±2.68)mmol/L,t=3.42],GLU-2 h[(25.17±4.43)mmol/L vs.(19.69±3.11)mmol/L,t=3.03],HOMA2-IR[1.83(1.46,3.19)vs.1.14(0.90,1.35),Z=-2.14]were higher than those in the qi-yin deficiency syndrome(P<0.05),GLUcv[16.86(13.58,26.20)%vs.28.30(23.17,40.87)%,Z=-2.08]was lower than that of the qi-yin deficiency syndrome(P<0.05)and had severe blood glucose fluctuations.Screening of 2 groups of differential metabolites identified threonine,alanine,and glutamine as potential meta

关 键 词：糖尿病 2型 气阴两虚 脾虚痰湿 氨基酸代谢 差异代谢物 

分 类 号：R259[医药卫生—中西医结合]