秦亮甫教授“从脾论治”针刺治疗中心型肥胖伴高脂血症的临床研究

Clinical Study on Central Obesity with Hyperlipidemic with Acupuncture of Professor Qin Liangfu from Spleen

目的:探讨秦亮甫教授"从脾论治"的学术经验,采用随机对照研究观察从脾论治针刺治疗中心型肥胖症伴高脂血症的临床疗效与改善胰岛素抵抗的可能机制。方法:选取2013年10月至2017年10月同济大学附属东方医院针灸科门诊就诊的符合标准的中心型肥胖伴高脂血症患者70例,随机分为针刺组与对照组,每组35例。对照组予常规饮食控制;针刺组在常规饮食控制基础上,采用秦师"从脾论治"法,取腹四门[脐周四针三穴:天枢(双)、关元、中脘]配足三里、上巨虚、下巨虚等下合穴。通过2组组间和组内比较,观察体质指数(BMI)、腰臀比、血胆固醇(TC)、血三酰甘油(TG)、血低密度脂蛋白(LDL-C)、血高密度脂蛋白(HDL-C)的差异以及空腹血糖(FBG)、空腹胰岛素(INS)、肿瘤坏死因子-α(TNF-α)、Adiponection、Ghrelin、胰岛素抵抗指素(ISI)的变化。结果:2组患者BMI、腰臀比、血TC、血TG、血LDL-C、血HDL-C,FBG、INS、TNF-α、Adiponection、Ghrelin、ISI治疗前无显著性差异。从脾论治针刺组能明显降低中心型肥胖伴高脂血症患者的BMI(P<0.05),腰臀比(P<0.01);减少TC、TG的含量(均P<0.01)和LDL-C的含量(P<0.05);升高HDL-C的含量较治疗前差异有统计学意义(P<0.01)。与对照组比较,针刺组体质指数(BMI)、腰臀比降低、HDL-C升高,差异有统计学意义(均P<0.01)。另外,针刺组FBG、INS、ISI(均P<0.05),Adiponection(P<0.01)、Ghrelin较治疗前差异有统计学意义(P<0.05)。对照组有效率50%,而针刺组为80%,2组比较,差异有统计学意义(P<0.05)。结论:"从脾论治"针刺能改善中心型肥胖伴高血脂症患者的脂质代谢与形体指标,其可能机制与改善胰岛素抵抗状态,增加胰岛素的敏感性有关。

Objective： To explore the academic experience of Professor Qin Liangfu′s treatment from spleen, and to observe the clinical efficacy of acupuncture from spleen on central obesity and hyperlipidemia by randomized controlled study, and to the possible mechanism of improving insulin resistance. Methods： A total of 60 patients were randomly divided into acupuncture group and control group. Qin Liangfu′s treatment from spleen was used in the acupuncture group, and abdominal three acupoints Tianshu （ST 25）, Zhongwan （RN 12）, Guanyuan （RN 4） with lower confluent acupoints of Zusanli （ST 36）, Shangjuxu （ST 37）, Xiajuxu （ST 39） were selected. The control group was treated with routine diet control. Body mass index （BMI）, waist hip ratio, blood cholesterol （TC）, triglyceride （TG）, serum low density lipoprotein （LDL-C）, serum high density lipoprotein （HDL-C） and the difference of fasting blood glucose （FBG）, fasting insulin （INS） and tumor necrosis factor alpha （TNF-alpha）, Adiponection, Ghrelin, insulin resistance （ISI） were choosed to observe the effect and the possible mechanism of acupuncture on central obesity and hyperlipidemia. Results： There was no significant difference in BMI, waist hip ratio, blood TC, blood TG, blood LDL-C, blood HDL-C, FBG, INS, TNF-alpha, Adiponection, Ghrelin and ISI before treatment. For patients in acupuncture group with treatment from the spleen, BMI （ P 〈0.05）, waist hip ratio （ P 〈0.01）, TC, TG （ P all〈0.01） and LDL-C content decreased （ P 〈0.05）, and the content of HDL-C increased （ P 〈0.01）; there was no significant difference in the control group. Compared with the control group, BMI, waist hip ratio decreased and HDL-C increased （ P all〈0.01） with significant difference. There was significant difference in FBG, INS, ISI （ P all〈0.05）, Adiponection （ P 〈0.01）, Ghrelin （ P 〈0.05） in the acupuncture group. The total effective rate in the control group was 50%, while 80% in the acupuncture group. There was significant difference between two groups （ P 〈0.01）. Conclusion： Acupuncture treatment from the spleen could improve the lipid metabolism and body index of the patients with central obesity and hyperlipidemia, and the possible mechanism may be related with improving insulin resistance and increasing insulin sensitivity.