2型糖尿病治疗前后舌象客观化指标与胰岛素抵抗的关系

Relationship between insulin resistance and tongue image objectification before and after treatment of type 2 diabetes

目的:探讨2型糖尿病患者治疗前后舌诊客观化指标与胰岛素抵抗的关系。方法:纳入2型糖尿病患者50例作为糖尿病患者组(简称"患者组"),同期纳入健康成年人50例作为正常组。患者组给予健脾清化方治疗3个月,采集患者治疗前后的糖脂代谢、胰岛素抵抗指标,包括空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血清蛋白(GSP)、空腹胰岛素(FIns)、餐后2 h胰岛素(2 h Ins)、空腹游离脂肪酸(FFA)、餐后2 h游离脂肪酸(2 h FFA)及胰岛素抵抗指数(HOMA-IR);采用TDA-1型小型舌象仪采集患者的舌象参数,正常组于试验开始时统一采集舌象参数,包括舌质参数(zhiCON、zhiASM、zhiENT、zhiMEAN)及舌苔参数(taiCON、taiASM、taiENT、taiMEAN)。结果:与治疗前比较,治疗后患者的糖脂代谢指标及胰岛素抵抗指数均呈下降趋势,其中FIns、FFA、2 h PG水平与治疗前比较差异具有统计学意义(P<0.05,P<0.01)。与正常组比较,患者组治疗前的舌质zhiCON与舌苔taiCON值具有显著性差异(P<0.01);与治疗前比较,治疗后患者组的舌质zhiCON、zhiENT值均降低,差异具有统计学意义(P<0.01,P<0.05),且患者组治疗后的舌象参数更接近正常舌象参数。治疗前的HOMA-IR与舌质参数zhiCON、zhiENT、zhiMEAN呈正相关(P<0.05),与zhiASM呈负相关(P<0.05);2 h FFA与zhiENT呈正相关(P<0.05),与zhiASM呈负相关(P<0.05)。治疗后的HOMA-IR、FIns、FFA与舌苔参数taiCON、taiENT、taiMEAN呈正相关(P<0.05),与taiASM呈负相关(P<0.05,P<0.01);FIns与舌质参数zhiCON、zhiENT呈正相关(P<0.05),2 h Ins与zhiASM呈负相关(P<0.05)。结论:舌象客观化指标与2型糖尿病患者的胰岛素抵抗可能具有一定的相关性。

Objective： To explore the relationship between objective indicators of tongue diagnosis and insulin resistance before and after treatment in patients with type 2 diabetes. Methods： Fifty patients with type 2 diabetes were included as the diabetic patients group（ abbreviated as＂patients group＂）,and 50 healthy adults during the same period were included as the normal group. The patients were treated with Jianpi Qinghua Decoction for 3 months. The indicators of glucose and lipid metabolism and insulin resistance,including fasting plasma glucose（ FPG）,2 h postprandial blood glucose（ 2 h PG）,glycated serum albumin（ GSP）,fasting insulin（ FIns）,2 h postprandial insulin（ 2 h Ins）,fasting free fatty acids（ FFA）,2 h postprandial free fatty acids（ 2 h FFA） and insulin resistance index（ HOMA-IR） were collected before and after treatment. The tongue image parameters of the patients were collected by the TDA-1 miniature tongue imager,and in the normal group,the tongue image parameters were collected at the beginning of the experiment,including the tongue nature parameters（ zhiCON,zhiASM,zhiENT and zhiMEAN） and the tongue coating parameters（ taiCON,taiASM,taiENT and taiMEAN）.Results： Compared with before treatment,the indicators of glucose and lipid metabolism and insulin resistance index of patients showed a decreasing trend after treatment,and there were statistically significant differences on the levels of FIns,FFA and 2 h PG between treatment before and after（ P〈0.05,P〈0.01）. Before treatment,there were statistically significant differences on the zhiCON and the taiCON values between the patients group and normal group（ P〈0.01）. Compared with treatment before,the zhiCON and zhiENT values in the patient group were decreased after treatment,with statistically significant differences（ P〈0.01,P〈0.05）,and the tongue parameters after treatment in the patients group were closer to the normal tongue parameters. Before treatment,the level of HOMA-IR was positively correlated with zhiCON,zhiENT and zhiMEAN（ P〈0.05）,and was negatively correlated with zhiASM（ P〈0.05）; the level of 2 h FFA was positively correlated with zhiENT（ P〈0.05） and was negatively correlated with zhiASM（ P〈0.05）. After treatment,the levels of HOMA-IR,FIns and FFA were positively correlated with taiCON,taiENT and taiMEAN（ P〈0.05）,and were negatively correlated with taiASM（ P〈0.05,P〈0.01）; the level of FIns was positively correlated with zhiCON and zhiENT（ P〈0.05）,and the level of 2 h Ins was negatively correlated with zhiASM（ P〈0.05）. Conclusion： Objective indicators of tongue image may have some correlation with insulin resistance in patients with type 2 diabetes.