从痰湿体质角度研究肥胖亚型

Research on Obesity Subtypes from the Perspective of Phlegm-Wet Constitution

肥胖作为早期发现代谢疾病高危人群的重要标志,成为健康关注的热点。然而肥胖的研究存在诸多困惑,其衡量标准从体重到体重指数,再到体脂率、腰围,虽然在逐步接近代谢紊乱的实质,但是终归停留在形态学的层面上,不能对潜在的危险进行精确的描述,即有一部分人群虽然不肥胖,但是仍然符合代谢综合征的标准且为心脑血管疾病的高危人群,称为正常体重代谢性肥胖,也有一部分人群虽然肥胖,但是并没有代谢紊乱的现象,称为代谢正常肥胖,这两种现象统称为肥胖亚型。中医体质学认为,体质是在先天遗传和后天环境等共同作用下形成的相对稳定的固有特质,是疾病发生的背景及前景因素。研究结果显示,痰湿体质可能是代谢疾病发生的土壤。痰湿体质人形态多表现为肥胖,然而痰湿体质不等于肥胖,痰湿体质并不是简单的形态学概念,而是暗含了生理机制和发病倾向等内在本质,痰湿内蕴除可能表现为肥胖外,腹部松软、舌苔厚腻、面部出油、身体沉重等均可能出现,痰湿体质的诊断标准在进行代谢紊乱高危人群的识别中更为准确。结合肥胖亚型的概念,提出,痰湿体质可能是肥胖亚型现象存在的内在因素,或许可作为肥胖亚型研究的一个切入点,为早期发现和干预代谢疾病高危人群提供方法和手段。

Obesity, as the important mark of high risk population for metabolic disease, has become a concern of the public health field. The development to the depth give impetus to the constant revision of obesity~ diagnosis standard , from weight,body lipid rate,to body mass index（BMI） ,waistline. From the diagnosis standard,we can see the perplexity in research,which is that obesity is only superficial phenomenon ,what is the representation of essence？ The diagnoses above are all stay on the level of morphology, which cant descript the potential connotation. That is the reason of ＂obesity subtypes＂. Obesity subtypes include metabolically healthy but obese and metaboli- cally obese, normal-weight. Phlegm-wet constitution is a biased constitution with the nature of heavy, sticky and stagnant. Based on the fore-working , Phlegm-wet constitution and obesity are closely related ,which may be the background and foreground factors of Metabolic Diseases. Although the morphology description of Phlegm-wet constitution is obesity, it is not equal to obesity. Phlegm-wet constitution is not a simple concept of morphology, but implies the pathophysiological mechanism of body fluid conveyance obstacles and phlegm-damp retention. Therefore we propose that the diagnosis of phlegm-wet constitution is more suitable for the identification of metabolic disorder population. Combined with the concept of obesity subtypes, Phlegm-wet constitution may be the internal factors of subtypes phenomenon of obesity, which can provide methods and means for early detection and intervention of metabolic disease high risk group.