2型糖尿病湿热困脾证合并血脂紊乱胰岛功能变化及其影响因素分析

Analysis on Changes of Pancreatic Function and Its Influencing Factors in Type 2 Diabetes Mellitus Patients with Dampness-Heat Encumbering Spleen Syndrome of Blood Lipid Disorder

目的探讨2型糖尿病湿热困脾证合并血脂紊乱患者胰岛功能变化及其影响因素。方法选择2020年1月—2020年12月医院收治的2型糖尿病湿热困脾证患者100例,根据美国ATPIII评估标准将其分为血脂紊乱组62例与血脂正常组38例。比较各组SF-36积分、胰岛素分泌功能(Homeostasis model assessment-β,HOMA-β)、胰岛素抵抗水平(Homeostasis model assessment-IR,HOMA-IR)、胰岛素敏感指数(Insulin sensitivity index,ISI)、空腹C肽和空腹胰岛素。应用单因素和多因素分析法研究血脂异常的相关因素。结果高甘油三酯组与混合型高脂组空腹胰岛素水平显著高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组空腹C肽水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。混合型高脂组与高甘油三酯组的ISI水平低于高胆固醇组(P<0.05)。高甘油三酯组HOMA-β水平明显高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组及混合型高脂组HOMA-IR水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。两组患者在躯体疼痛、整体健康、活力、社会功能和精神健康维度方面比较,差异有统计学意义(P<0.01)。多因素Logistic分析显示,喜食油腻、吸烟史、腰围和空腹胰岛素是2型糖尿病湿热困脾证患者血脂异常的危险因素,有氧运动是2型糖尿病湿热困脾证患者血脂异常的保护因素(P<0.05)。结论不同血脂紊乱类型对胰岛功能的影响并不相同,应针对相关因素积极预防,降低胰岛分泌负担,促使胰岛功能恢复。

Objective To investigate the changes and influencing factors of islet function in type 2 diabetes mellitus(T2DM)patients with dampness-heat encumbering spleen syndrome of blood lipid disorder.Methods A total of 100 cases of T2DM patients with dampness-heat encumbering spleen syndrome of blood lipid disorder admitted to the hospital from January 2020 to December 2020 were selected and divided into the blood lipid disorder group(62 cases)and the normal blood lipid group(38 cases)according to the American ATPⅢevaluation criteria.The MOS item short from health survey(SF-36)scores,insulin secretion function(HOMA-β),insulin resistance level(HOMA-IR),insulin sensitivity(ISI),fasting C-peptide and fasting insulin were compared.The factors related to blood lipid disorder were analyzed by univariate and multivariate analysis.Results Fasting insulin in high triglyceride group and mixed high fat group was significantly higher than that in high cholesterol group and normal lipid group(P<0.05).Fasting C-peptide level in high triglyceride group was significantly higher than that in high cholesterol group(P<0.05).The ISI level of mixed high fat group and high triglyceride group was lower than that of high cholesterol group(P<0.05).The level of HOMA-βin high triglyceride group was significantly higher than that in high cholesterol group and normal lipid group(P<0.05).The level of HOMA-IR in high triglyceride group and mixed high fat group was significantly higher than that in high cholesterol group(P<0.05).There were significant differences in physical pain,overall health,vitality,social functioning and mental health between the two groups(P<0.01).Multivariate Logistic analysis showed that preference for greasy food,smoking,waist circumference and fasting insulin were risk factors for dyslipidemia in T2DM patients with dampness-heat encumbering spleen syndrome,and aerobic exercise was protective factors for blood lipid disorder in T2DM patients with dampness-heat encumbering spleen syndrome(P<0.05).Conclusion Different types of lipid disorder have different effects on islet function,and the treatment should actively prevent the related factors to reduce the secretion burden of islet and promote the recovery of islet function.