新诊断2型糖尿病中医证型与相关客观指标的关系研究

Study on Relationship between TCM Syndrome and Relevant Objective Indicators in Newly Diagnosed Type 2 Diabetes

目的探讨新诊断2型糖尿病患者中医证型与年龄、性别、血糖、血脂、胰岛素等客观指标的相关性。方法将100例新诊断2型糖尿病患者分为阴虚热盛、气阴两虚、痰湿(瘀)阻滞、阴阳两虚4个证型。比较4型患者性别、年龄、身体质量指数(body mass index,BMI)、空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(2-hour postprandial blood glucose,2 hPG)及糖化血红蛋白(glycosylated hemoglobin,HbA 1 c)水平。比较4型患者总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)水平。比较4型患者空腹胰岛素(fasting insulin,FINS)、空腹C肽(fasting C-peptide,FCP)水平,计算胰岛素抵抗指数(insulin resistance index of homeostasismodel assessment,HOMA-IR)、胰岛素敏感指数(insulin sensitivity index of homeostasismodel assessment,HOMA-IS)。结果中医证型分布由多到少分别为气阴两虚型(33%)、痰湿(瘀)阻滞型(29%)、阴虚热盛型(23%)、阴阳两虚型(15%)。阴阳两虚型患者年龄显著高于其他3种证型患者(P<0.05),FCP水平显著低于其他3种证型患者(P<0.05)。痰湿(瘀)阻滞型患者的BMI水平显著高于阴阳两虚型患者(P<0.05),TG、LDL、HOMA-IS水平均显著高于其他3种证型患者(P<0.05)。阴虚热盛型患者的FPG及HbA_(1)C水平显著高于其他3种证型患者(P<0.05),TC水平显著低于痰湿(瘀)阻滞、阴阳两虚型患者(P<0.05)。4型患者FINS、HOMA-IR水平两两比较,差异均有统计学意义(P<0.05),由高到低分别为痰湿(瘀)阻滞型、阴虚热盛型、气阴两虚型、阴阳两虚型。结论新诊断2型糖尿病患者因处于疾病的不同病理阶段而显示出不同的理化特点及中医证型,发病早期主要表现为胰岛素抵抗程度较重的痰湿(瘀)阻滞证,发病晚期则主要表现为胰岛细胞功能较差的阴阳两虚证,临床上应根据疾病的病机演变特点采取不同的治疗措施。

Objective To explore the correlation between TCM syndrome and objective indicators such as age,gender,blood glucose,lipid and insulin in newly diagnosed type 2 diabetes.Methods One hundred patients with newly diagnosed type 2 diabetes were divided into four syndrome types,yin deficiency and intense heat,deficiency of both qi and yin,blockade of phlegm dampness(stasis),deficiency of both yin and yang.Gender,age,body mass index(BMI),fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 hPG)and glycosylated hemoglobin(HbA 1 c)level were compared between these four types.Total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL)and low density lipoprotein(LDL)level were compared between these four types.Fasting insulin(FINS),fasting C-peptide(FCP)level were compared between these four types,and then insulin resistance index of homeostasismodel assessment(HOMA-IR)and insulin sensitivity index of homeostasismodel assessment(HOMA-IS)were calculated.Results The distribution of TCM syndrome ranged from more to less was deficiency of both qi and yin type(33%),blockade of phlegm dampness(stasis)type(29%),yin deficiency and intense heat type(23%),deficiency of both yin and yang type(15%).Ages of deficiency of both yin and yang type were significantly higher than those of the other three syndrome types(P<0.05),and the FCP levels were significantly lower than those of the other three syndrome types(P<0.05).BMI level of blockade of phlegm dampness(stasis)type were significantly higher than those of deficiency of both yin and yang type(P<0.05),and the levels of TG,LDL and HOMA-IS were significantly higher than the other three syndrome types(P<0.05).FPG and HbA_(1)C level in yin deficiency and intense heat type were significantly higher than those in the other three syndrome types(P<0.05),and TC level were significantly lower than those in blockade of phlegm dampness(stasis)type,and deficiency of both yin and yang type(P<0.05).The differences of HOMA-IR and FINS levels between four types respectively were statistically significant(P<0.05),from high to low was blockade of phlegm dampness(stasis)type,yin deficiency and intense heat type,deficiency of both qi and yin type,deficiency of both yin and yang type.Conclusion Newly diagnosed type 2 diabetes patients in different pathological stages of the disease would shows different physical and chemical characteristics and TCM syndrome types.In the early stage of the disease,it is mainly manifested as blockade of phlegm dampness(stasis)type with heavier insulin resistance,and in the late stage of the disease,it is mainly manifested as deficiency of both yin and yang type with worse islet cell function.Clinically,different treatment measures should be taken according to the pathogenesis evolution characteristics of the disease.