阳和贴治疗阳虚体质糖耐量减低的代谢组学研究  

Study on plasma metabolomics analysis of Yanghe-patch in the treatment of impaired glucose tolerance with Yang-deficiency constitution

作　　者：鲁雪珂 翁思颖 周建扬[1] LU Xueke;WENG Siying;ZHOU Jianyang(Department of Endocrinology,Ningbo Municipal Hospital of TCM Affliated to Zhejiang Chinese Medical University,Ningbo 315010,Zhejiang,China;The Third Clinical Medical College,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang,China)

机构地区：[1]浙江中医药大学附属宁波市中医院内分泌科,浙江宁波315010 [2]浙江中医药大学第三临床医学院,浙江杭州310053

出　　处：《中国现代医生》2024年第33期6-12,共7页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2021ZA127);国家中医药管理局-浙江省中医药管理局共建科技计划重点项目(GZY-ZJ-KJ-Z24095)。

摘　　要：目的探讨阳和贴穴位贴敷治疗阳虚体质糖耐量减低(impaired glucose tolerance,IGT)患者的效果及其对血清代谢物的影响。方法选取2022年10月至2024年1月于浙江中医药大学附属宁波市中医院就诊的63例IGT患者,以分层随机化法分为对照组(32例)和治疗组(31例),比较两组患者治疗前后的血糖、血脂、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、阳虚体质评分与红外线热成像温度。另选取同期29名健康体检者作为健康组,采用液相色谱-质谱(liquid chromatograph-mass spectrometer,LC-MS)技术对三组纳入者的血清代谢产物进行分析,结合主成分分析、潜在结构判别分析等方法分析特征性差异代谢物,运用MetaboAnalyst软件进行网络分析以筛选关键代谢通路。结果阳和贴干预后治疗组患者的空腹血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白、TNF-α水平均下降(P<0.05);治疗组患者的阳虚体质评分下降(P<0.05),任脉、督脉、中焦、下焦温度均升高(P<0.05),上焦温度下降(P<0.05)。代谢组学分析发现阳虚体质IGT患者血清中的差异表达代谢物主要为4-乙酰氨基丁酸、3-脱氢胆酸、柠檬酸、胱氨酸等16个,治疗组出现差异表达的代谢物包括二氨基庚二酸、乙酰左旋肉碱、单丁酯等16个。经MetaboAnalyst分析,发现IGT阳虚体质的形成与三羧酸循环、氨基酰生物合成代谢通路、甘氨酸-丝氨酸-苏氨酸(glycine,serine and threonine,Gly-Ser-Thr)代谢轴有关,且阳和贴的针对性治疗与Gly-Ser-Thr代谢轴、鞘脂类代谢相关通路相关。结论阳和贴穴位贴敷可缓解阳虚体质IGT人群的血清慢性炎症、改善阳虚症状,代谢组学分析发现多种差异性代谢物与其作用机制有关,其中Gly-Ser-Thr代谢轴相关代谢通路是调护IGT阳虚体质的关键通路。Objective To investigate the impact of Yanghe-patch acupoint in the treatment of impaired glucose tolerance(IGT)with Yang-deficiency constitution and its influence on serum metabolites.Methods The study enrolled a total of 63 patients with IGT were randomly selected and stratified into two groups:The control group(32 cases)and the treatment group(31 cases)at Ningbo Municipal Hospital of TCM Affliated to Zhejiang Chinese Medical University from October 2022 to January 2024,blood glucose,blood lipids,tumor necrosis factor-α(TNF-α),Yang-deficiency body mass score,and infrared thermal imaging temperature before and after treatment were compared between two groups.Furthermore,29 healthy individuals were selected as healthy negative controls,and their serum metabolites were analyzed by using liquid chromatograph-mass spectrometer(LC-MS)among three groups.Principal component analysis and orthogonal projections to latent structures-discriminate analysis were employed to identify characteristic differential metabolites.Additionally,key metabolic pathways were screened through network analysis by using MetaboAnalyst software.Results The treatment group after Yanghe-patch showed significant reductions in fasting blood glucose,glycosylated hemoglobin,triglycerides,low-density lipopro-tein and TNF-αlevels(P<0.05).Additionally,Yang-deficiency constitution conversion points significantly decreased within the treatment group(P<0.05),while there were significant increases in the temperatures of Ren channel,Du channel,middle-Jiao and lower-Jiao(P<0.05).However,there was a notable decrease in upper-Jiao temperature(P<0.05).Metabolomics analysis identified varying levels of serum metabolites in IGT patients with Yang-deficiency constitution,such as 4-acetylaminobutyric acid,3-dehydrocholic acid,citric acid,and cystine etc.16 metabolites.Treatment group exhibited distinct expression patterns for 16 metabolites(including diaminoheptadecic acid,acetyl-L-carnitine and monobutyl phthalate etc.).The analysis by MetaboAnalyst shows that

关 键 词：糖耐量减低 中医体质学 穴位贴敷 代谢组学 阳和贴 阳虚体质 

分 类 号：R259[医药卫生—中西医结合]