2型糖尿病患者“二三九四”慢病管理模式中医体质干预研究

发布时间：2019-05-08 12:35

【摘要】：背景:2型糖尿病的患病率逐年上升,是卫生服务机构管理的4种慢病之一,“社区防治”意义重大。“二三九四”慢病管理模式是罗仁教授课题组基于“治未病”和亚健康管理与干预的研究上首次提出来的以健康帮扶、健康促进、体质调理为特色的中西医结合慢病管理模式,将此模式运用于2型糖尿病管理,是社区慢病管理的一种方法创新与尝试,在此模式中,“四”是4种干预措施,是以纠正不良生活习惯及偏颇中医体质为目的的干预措施。通过改善偏颇体质状况,显现体质干预对2型糖尿病患者的防治作用,对2型糖尿病的防治有积极意义。目的:1.了解2型糖尿病患者中医体质类型及其与常见心血管危险因素的相关性。2.明确“二三九四”慢病管理模式体质干预对偏颇体质2型糖尿病患者的防治作用。3.探讨气虚和痰湿体质2型糖尿病患者体质干预代谢组学机制。方法:1.通过体检和量表调查,对497例2型糖尿病患者进行中医体质辨识和心血管危险因素判定。2.将100例偏颇体质2型糖尿病患者分干预和对照组,两组维持原有降糖药物治疗。对照组予糖尿病生活方式指导,干预组同时予纠正偏颇体质的4种措施干预6个月,主要疗效指标为血糖水平和中医体质量表评分。3.从干预对象中选取最常见的2种偏颇体质气虚质和痰湿质,采集患者干预前后血清标本,进行代谢组学检测。结果:1.497例2型糖尿病患者平和体质少(24.14%),偏颇体质多(75.86%),偏颇体质以痰湿、阴虚和气虚质为常见;超重和肥胖(58.35%)、血脂异常(54.93%)和高血压(51.91%)是最常见的心血管危险因素;高龄多见阳虚质,痰湿质超重肥胖、血脂异常率高,湿热质吸烟、喝酒、超重肥胖率高,血瘀质高血压、心电图异常、运动缺乏率高。2.干预后,体质评分,干预组平和质评分和偏颇质总分与干预前及对照组比较,有显著差异(P0.05);血糖值,干预组空腹血糖和糖化血红蛋白值显著低于干预前和对照组(P0.05);BMI、腰围、血压值,干预组BMI、收缩和舒张压值显著低于对照组(P0.05);生存质量评分,干预组生理职能和生理机能评分显著高于干预前(P0.05),一般健康状况和生理机能评分显著高于对照组(P0.05)。3.干预后,气虚质患者有22个血清分类贡献较大的差异性代谢产物,痰湿质患者有15个血清分类贡献较大的差异性代谢产物,其共同差异代谢物为酪氨酸、α-亚麻酸、鸟嘌呤核苷、二磷酸腺苷、烟酰胺腺嘌呤二核苷酸、肌苷、烟碱、瓜氨酸、α-葡萄糖、β-葡萄糖。结论:1.2型糖尿病患者偏颇体质多,偏颇体质与心血管危险因素有一定的相关性。2.“二三九四”慢病管理模式能够改善2型糖尿病患者的偏颇体质状态,增进平和体质状态,降低血糖水平,改善临床异常指标,提高患者生存质体。3.体质干预可能通过能量代谢、脂代谢、氨基酸代谢、核苷酸代谢、肠道菌群等途径发挥作用,且不同体质干预其代谢谱变化有一些差异。
[Abstract]:Background: the prevalence of type 2 diabetes is increasing year by year. It is one of the four chronic diseases managed by health service institutions. Community prevention and treatment is of great significance. The "2394" chronic disease management model is the first time put forward by Professor Luo Ren's research group based on the research on "treating no disease" and sub-health management and intervention, which is characterized by health assistance, health promotion, and physical conditioning, which is characterized by integrated Chinese and western medicine and chronic disease management. Applying this model to the management of type 2 diabetes mellitus is a method innovation and attempt of community chronic disease management. In this model, "4" is four kinds of intervention measures, which aim at correcting bad living habits and biased traditional Chinese medicine constitution. The prevention and treatment of type 2 diabetes mellitus has positive significance by improving the biased physical condition and showing the preventive and therapeutic effect of physique intervention on type 2 diabetes mellitus patients. Purpose: 1. To understand the type of traditional Chinese medicine constitution in patients with type 2 diabetes mellitus and its correlation with common cardiovascular risk factors. 2. Clear "2394" chronic disease management model of physical intervention on the prevention and treatment of biased type 2 diabetes mellitus patients. 3. Objective: to explore the mechanism of physique intervention in type 2 diabetes mellitus with qi deficiency and phlegm dampness constitution. Methods: 1. Through physical examination and scale survey, 497 patients with type 2 diabetes mellitus were identified by traditional Chinese medicine physique and cardiovascular risk factors. 100 patients with type 2 diabetes mellitus with biased constitution were divided into two groups: intervention group and control group. The control group was given diabetes lifestyle guidance, and the intervention group was treated with 4 kinds of measures to correct the biased constitution for 6 months. The main therapeutic indexes were blood glucose level and TCM somatosomatic scale score. The two most common types of qi deficiency and phlegm dampness were selected from the intervention subjects, and the serum samples before and after intervention were collected for metabonomics examination. Results: 1.497 patients with type 2 diabetes mellitus had less mild constitution (24.14%) and more biased constitution (75.86%). Phlegm dampness, yin deficiency and qi deficiency were common in the biased constitution. Overweight and obesity (58.35%), dyslipidemia (54.93%) and hypertension (51.91%) were the most common cardiovascular risk factors. Yang deficiency, excessive obesity of phlegm and dampness, high abnormal rate of blood lipid, smoking of dampness and heat, drinking, overweight and obesity, high blood stasis hypertension, abnormal electrocardiogram and high rate of exercise deficiency were found in the elderly. After intervention, there were significant differences in physique score, level and quality score and partial quality score between the intervention group and the pre-intervention and control group (P0.05). The fasting blood glucose and hemin in the intervention group were significantly lower than those before intervention and in the control group (P0.05); BMI, waist circumference, blood pressure, systolic and diastolic blood pressure values of BMI, in the intervention group were significantly lower than those in the control group (P0.05); The scores of quality of life (QOL), physiological function and physiological function in the intervention group were significantly higher than those before intervention (P0.05), and the general health status and physiological function scores were significantly higher in the intervention group than those in the control group (P0.05). After intervention, 22 differential metabolites of serum classification were found in patients with Qi deficiency and 15 in patients with phlegm dampness, and their common differential metabolites were tyrosine, 伪-linolenic acid, and their common metabolites were tyrosine, 伪-linolenic acid, and 伪-linolenic acid (伪-linolenic acid). Guanine nucleoside, adenosine diphosphate, nicotinamide adenine dinucleotide, inosine, nicotine, citrulline, 伪-glucose, 尾-glucose. The patients with type 2 diabetes mellitus have more biased physique, and there is a certain correlation between the biased constitution and cardiovascular risk factors. 2. The "2394" chronic disease management model can improve the biased physique of type 2 diabetic patients, improve the level of calm physique, reduce the blood sugar level, improve the clinical abnormal indexes, and improve the survival body of the patients. 3. Physique intervention may play a role in energy metabolism, lipid metabolism, amino acid metabolism, nucleotide metabolism and intestinal microflora, and there are some differences in metabolic spectrum between different physique.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R587.1

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