2型糖尿病合并肥胖患者的糖脂代谢状况及中医证素临床分析

Clinical analysis of glucose and lipid metabolism and TCM syndrome elements in patients with type 2 diabetes mellitus complicated with obesity

目的 研究2型糖尿病合并肥胖患者的糖脂代谢状况及其中医证素。方法 选取2020年10月至2022年2月陕西省中医医院内分泌科诊治的200例2型糖尿病患者作为研究对象。按照肥胖标准[体质量指数(BMI)≥28 kg/m^(2)]将患者分为对照组105例(BMI<28 kg/m^(2))和研究组95例(BMI≥28 kg/m^(2))。比较两组患者的糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)、空腹C肽(FCP)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]和中医证素,并分析两组患者的中医病位、中医病性证素分布规律。结果 研究组患者的FPG、PPG、Hb A1c、FCP、FINS、HOMA-IR水平分别为(8.39±0.42) mmol/L、(14.41±2.51) mmol/L、(8.96±0.77)%、(4.69±0.97) ng/L、(35.64±5.09) m U/L、3.88±0.52,明显高于对照组的(7.56±0.31) mmol/L、(10.79±2.36) mmol/L、(7.67±0.45)%、(2.78±0.53) ng/L、(22.56±4.10) m U/L、2.95±0.37,差异均有统计学意义(P<0.05);研究组患者的TG、TC、HDL、LDL水平分别为(2.85±0.36) mmol/L、(5.36±0.68) mmol/L、(1.84±0.52) mmol/L、(3.78±0.76) mmol/L,明显高于对照组的(1.79±0.29) mmol/L、(4.35±0.52) mmol/L、(1.11±0.29) mmol/L、(2.65±0.61) mmol/L,差异均有统计学意义(P<0.05);两组患者的中医病位证素中肺、肾证素占比比较差异均无统计学意义(P>0.05);研究组患者的中医病位证素中胃、脾、肝证素占比分别为23.16%、34.74%、25.26%,明显高于对照组的9.52%、15.24%、9.52%,差异均有统计学意义(P<0.05);两组患者的中医病性证素中阴虚、阳虚占比比较差异均无统计学意义(P>0.05);研究组患者的中医病性证素中气虚、气郁、痰、湿、热、瘀占比分别为11.58%、16.84%、21.05%、28.42%、21.05%、25.26%,明显高于对照组的6.67%、8.57%、11.43%、9.52%、10.48%、8.57%,差异均有统计学意义(P<0.05)。结论 2型糖尿病合并肥胖患者的糖脂代谢水平和HOMA-IR均较高,从中医证素角度出发,诊治2型糖尿病合并肥胖可从调整患者胃、脾、肝功能为着力点,从而改善患者气虚、气郁、痰等。

Objective To study the glucose and lipid metabolism and TCM syndrome elements in patients with type 2 diabetes mellitus complicated with obesity.Methods A total of 200 patients with type 2 diabetes mellitus diag-nosed and treated in the Department of Endocrinology,Shaanxi Provincial Hospital of Chinese Medicine from October 2020 to February 2022 were selected as the research objects.According to the obesity standard[body mass index(BMI)≥28 kg/m^(2)],the patients were divided into 105 patients in the control group(BMI<28 kg/m^(2))and 95 patients in the study group(BMI≥28 kg/m^(2)).The indexes of glucose and lipid metabolism[fasting blood glucose(FPG),2-hour postprandial blood glucose(PPG),glycosylated hemoglobin(HbA1c),fasting C-peptide(FCP),fasting insulin(FINS),homeostasis model insulin resistance index(HOMA-IR),triglycerides(TG),total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL)]and TCM syndromes were compared between the two groups.The distribution of TCM disease location and TCM disease nature syndrome elements in the two groups were analyzed.Results The levels of FPG,PPG,HbA1c,FCP,FINS,and HOMA-IR in the study group were(8.39±0.42)mmol/L,(14.41±2.51)mmol/L,(8.96±0.77)%,(4.69±0.97)ng/L,(35.64±5.09)mU/L,3.88±0.52,respectively,which were significantly higher than(7.56±0.31)mmol/L,(10.79±2.36)mmol/L,(7.67±0.45)%,(2.78±0.53)ng/L,(22.56±4.10)mU/L,2.95±0.37 in the control group(P<0.05).The levels of TG,TC,HDL,and LDL in the study group were(2.85±0.36)mmol/L,(5.36±0.68)mmol/L,(1.84±0.52)mmol/L,(3.78±0.76)mmol/L,respectively,which were significantly higher than(1.79±0.29)mmol/L,(4.35±0.52)mmol/L,(1.11±0.29)mmol/L,(2.65±0.61)mmol/L in the control group(P<0.05).There was no significant differ-ence in the proportion of lung and kidney syndrome elements between the two groups(P>0.05).The proportions of stom-ach,spleen,and liver syndrome elements in the study group were 23.16%,34.74%,and 25.26%,respectively,which were significantly higher than 9.52%,15.24%,and 9.52%in the control group(P<0.05).There was no significant differ-ence between the two groups in the proportion of syndrome elements of yin deficiency and yang deficiency(P>0.05).The proportions of qi deficiency,qi depression,phlegm,dampness,heat,and blood stasis in the study group were 11.58%,16.84%,21.05%,28.42%,21.05%,and 25.26%,respectively,which were significantly higher than 6.67%,8.57%,11.43%,9.52%,10.48%,and 8.57%in the control group(P<0.05).Conclusion The level of glucose and lipid metabolism and HOMA-IR in patients with type 2 diabetes mellitus complicated with obesity are higher.From the per-spective of TCM syndrome elements,the diagnosis and treatment of type 2 diabetes mellitus complicated with obesity can focus on adjusting the stomach,spleen and liver function of patients,so as to improve the patients'qi deficiency,qi depression,and phlegm.