代谢综合征中医证候糖脂代谢及瘦素表达规律研究

Research of Regularity on Glucose and Lipid Metabolism and Leptin Expression with Traditional Chinese Medicine Syndromes of Metabolic Syndrome

目的:研究代谢综合征常见中医证型糖脂代谢及瘦素表达规律,为本病的辨证施治提供客观依据。方法:对235例代谢综合征患者进行中医辨证分型,即痰瘀互结组、痰浊阻遏组、气阴两虚组和阴虚热盛组,观测空腹血糖(FPG)、血脂—甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C);血压(BP);腰围(WC);体重指数(BMI);空腹胰岛素(FINS)和瘦素(LEP);计算胰岛素敏感指数(ISI)。结果:气阴两虚组的BMI和WC与痰浊阻遏组比较有显著性差异(P<0.05)。痰浊阻遏组收缩压(SBP)较高,与气阴两虚组比较有显著性差异(P<0.05),痰浊阻遏组舒张压(DBP)亦较高,与阴虚热盛组比较有显著差异(P<0.05)。气阴两虚组TG较高,与痰浊阻遏组比较有显著差异(P<0.05)。痰浊阻遏组FINS较高,与气阴两虚组和阴虚热盛组比较均有显著差异(P<0.05);痰浊阻遏组ISI较低,与其他三组比较均有显著差异(P<0.05)。痰瘀互结组和痰浊阻遏组LEP与气阴两虚组比较均显著升高(P<0.05)。结论:痰浊是代谢综合征发生和发展的关键病理环节,高瘦素血症使"脂肪—胰岛内分泌轴"紊乱和胰岛素抵抗在其中发挥重要的作用。

Objective ：We study the regularity on glucose and lipid metabolism and the expression of leptin of traditional Chinese medicine common syndromes in metabolic syndrome in order to provide an objective basis for differential treatments of MS patients. Methods ：235 patients with MS can be classified into four patterns ： intermingled phlegm and blood stasis group, phlegm accumulation group, deficiency of both qi and yin group and yin deficiency and heat - hyperactivity group. And then we observed their fasting plasma glucose （FPG）, blood lipids -triglycerides （TG）, high -density lipoprotein cholesterol （ HDL - C, blood pressure （BP） , waist circumference （ WC ）, body mass index （ BMI）, fasting insulin （FINS） and leptin （LEP） and calculated insulin sensitive index （ISI）. Results：There was a significant difference on BMI and WC in deficiency of both qi and yin group and phlegm accumulation group （P 〈 0.05）. The systolic blood pressure （SBP） of phlegm accumulation group was higher than that of the group of deficiency of both qi and yin. The two groups had a significant difference （P 〈 0.05 ）. The diastolic blood pressure （DBP） of phlegm accumulation group was higher than that of yin deficiency and heat - hyperactivity group and there was a significant difference between the two groups （P 〈 0.05）. The triglycerides （TG） level of deficiency of both qi and yin group was higher than that of the group of phlegm accumulation and it showed a significant difference （P 〈 0.05 ）. There was a significant difference on fasting insulin （FINS） in phlegm accumulation group,deficiency of both qi and yin group and yin deficiency and heat -hyperac-tivity group and the phlegm accumulation groups was higher （P 〈 0.05 ）. The insulin sensitive index （ISI） of phlegm accumulation group was lower than that of the other three groups and the data of four groups had significant difference （ P 〈 0.05 ）. The levels of leptin （LEP） in phlegm and blood stasis group and phlegm accumulation group were significantly increased than those in the group of deficiency of both qi and yin （ P 〈 0.05 ）. Conclution ： Phlegm is a key pathological aspect for causing and developing the metabolic syndrome. The disorder of fat - pancreatic endocrine axis which is caused by the hyperleptinemia and insulin resistance plays an important role in metabolic syndrome patients.