超重和肥胖2型糖尿病患者中医证型分布及与胰岛素抵抗相关性分析

发布时间：2018-05-24 16:37

本文选题：超重肥胖 + 2型糖尿病　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:近年来国内外专家提出胰岛素原(proinsulin insulinogen,PI)/胰岛素比值可能对于评价胰岛β细胞功能和判断胰岛素抵抗(insulin resistance,IR)程度有一定的参考价值。本文通过比较正常体重和超重及肥胖2型糖尿病(type2 diabetes mellitus,T2DM)患者的临床资料,分析超重及肥胖与IR的相关性,并初步探讨PI/胰岛素比值对评估IR程度的作用。分析超重及肥胖T2DM患者中医证型的特点与差异,为明确超重和肥胖T2DM患者的中医证型及与IR的相关性,以尽早对超重和肥胖2型糖尿病IR患者采取针对性的干预措施提供参考依据。材料与方法:分析2016年8月1日至11月31日期间于辽宁中医药大学附属医院内分泌科住院治疗的T2DM患者住院资料。参照《中国成人超重和肥胖症预防与控制指南》中提出的超重及肥胖的诊断标准,分为超重组、肥胖组及正常体重组,比较各组间患者的一般资料包括年龄、性别比、病程等,胰岛功能相关指标包括空腹C肽、空腹胰岛素(Fasting insulin,Fins)等,血脂及尿酸代谢情况,糖尿病相关并发症情况,计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI)、PI/Fins比值,分析各组之间理化指标的区别联系及与IR的相关性。再以中医证型为分组依据,比较超重及肥胖组患者临床特征的差异,并分析探讨不同中医证型间各理化指标的区别联系及与IR的相关性。应用SPSS17.0统计软件将上述资料进行分析,计数资料采用卡方检验,计量资料以均数±标准差(x±s)表示,满足正态性及方差齐性采用单因素方差分析,不满足正态性则采用非参数检验,计量资料以中位数±四分位数(M±Q)表示,相关因素分析使用直线相关和等级相关分析。结果:1.纳入病例总数为237例,男性118例,女性119例,年龄在24-80岁之间,病程在1周-30年之间。在年龄、病程、性别构成比、FBG及Hb A1C方面,三组间相互比较无明显差异(P0.05)。2.肥胖组Fins、C肽及PI水平最高,与正常体重组和超重组比较有统计学意义(P0.01),超重组的C肽水平高于正常体重组(P0.01)。3.肥胖组HOMA-IR值最高,与正常体重组及超重组比较有统计学意义(P0.01)。肥胖组ISI值最低,与正常体重组及超重组比较有统计学意义(P0.01)。肥胖组及超重组PI/Fins比值高于正常体重组(P0.01或P0.05)。4.与正常体重组比较,超重组和肥胖组的TG及UA水平相对较高,HDL-C水平相对较低差异有统计学意义(P0.05或P0.01),肥胖组UA水平高于超重组(P0.05)。5.在糖尿病相关并发症的情况方面,正常体重组所占比例最高的是AS(52例,65.82%),其次是DPN(42例,53.16%)和CVD(39例,49.37%),DR(19例,24.05%)和DKD(10例,12.66%)。超重组所占比例最高的是AS(73例,69.52%),其次是CVD(52例,49.52%)和DPN(46例,43.81%),DR(21例,20%)和DKD(13例,12.38%)。肥胖组半数以上并发AS(32例,60.38%)和CVD(30例,56.60%),三组间相互比较无明显差异(P0.05)。6.158例超重及肥胖的T2DM患者中,以证属气阴两虚兼血瘀型(79例,50.00%)及湿热困脾兼血瘀型(42例,26.58%)者所占比例较高,气阴两虚型次之(30例,18.99%),阴阳两虚兼血瘀型者(7例,4.43%)所占比例最低。7.在各证型组中,气阴两虚型患者平均年龄最小(50.60±11.16岁)、病程最短(3.03±4.09年),较少合并糖尿病相关并发症;阴阳两虚兼血瘀型的平均年龄最大(72.86±6.44岁),病程最长(20.71±6.90年),合并各种糖尿病相关并发症的比例较高,除DR外,两组之间比较有统计学意义(P0.05);湿热困脾兼血瘀型患者BMI(29.22±3.40kg/m2)及WC值(97.13±8.81cm)均高于气阴两虚型和气阴两虚兼血瘀型患者(P0.05);在性别比方面各证型间相互比较无明显差异(P0.05)。8.在各证型组中,气阴两虚型Fins水平最低,与湿热困脾兼血瘀型、阴阳两虚兼血瘀型比较有统计学意义(P0.05);气阴两虚兼血瘀型PI水平最低,与阴阳两虚兼血瘀型比较有统计学意义(P0.05)。9.在各证型组中,气阴两虚型HOMA-IR值最低,与湿热困脾兼血瘀型和阴阳两虚兼血瘀型比较有统计学意义(P0.05);与气阴两虚兼血瘀型比较,湿热困脾兼血瘀型和阴阳两虚兼血瘀型有统计学意义(P0.05)。气阴两虚型ISI值最高,与湿热困脾兼血瘀型和阴阳两虚兼血瘀型比较有统计学意义(P0.05)。在PI/Fins方面,与气阴两虚型比较,气阴两虚兼血瘀型有统计学意义(P0.05)。在脂代谢方面,阴阳两虚兼血瘀型TG水平最高,与气阴两虚兼血瘀型比较有统计学意义(P0.05)。10.HOMA-IR与BMI、PI、TG、CHOL呈正相关关系(P0.01),ISI与BMI、PI、TG、CHOL呈负相关关系(P0.01),PI/Fins与BMI呈正相关关系(P0.05)。结论:1.2型糖尿病IR的发生可能与肥胖有关;PI/Fins比值可大致评估体内IR的程度,PI/Fins比值越高IR程度越重。2.超重及肥胖的T2DM患者较易出现血脂及尿酸代谢紊乱。3.超重及肥胖T2DM患者的证型分布特点如下:气阴两虚兼血瘀型湿热困脾兼血瘀型气阴两虚型阴阳两虚兼血瘀型;气阴两虚兼血瘀型是超重及肥胖T2DM患者中最常见的中医证型,且与IR、TG关系密切;湿热困脾兼血瘀型也较为常见;阴阳两虚兼血瘀型合并各种糖尿病相关并发症的比例较高。
[Abstract]:Objective: in recent years, domestic and foreign experts suggested that the proinsulin insulinogen (PI) / insulin ratio may be of reference value for evaluating islet beta cell function and determining the degree of insulin resistance (insulin resistance, IR). This article compares normal weight and overweight and obese type 2 diabetes mellitus (type2 diabetes mellitus, T2DM). The clinical data of the patients, analyzed the correlation between overweight and obesity and IR, and preliminarily explored the role of the ratio of PI/ insulin to evaluate the degree of IR. The characteristics and differences of TCM syndrome types of overweight and obese T2DM patients were analyzed to identify the TCM syndrome type of overweight and obese T2DM patients and the correlation with IR in order to determine the IR in overweight and obese type 2 diabetes as early as possible. Reference basis was provided for targeted interventions. Materials and methods: analysis of inpatient data of T2DM patients hospitalized at the Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from August 1, 2016 to November 31st. The diagnostic criteria for overweight and obesity in the guidelines for the prevention and control of overweight and obesity in Chinese adults were divided. The general data included age, sex ratio and course of disease were compared between the group and the obese group and the normal weight group. The islet function related indexes included fasting C peptide, fasting insulin (Fasting insulin, Fins), blood lipid and uric acid metabolism, diabetic complications, insulin resistance index (HOMA-IR), insulin. The sensitivity index (ISI) and the ratio of PI/Fins were analyzed and the correlation between the physical and chemical indexes and the correlation with IR were analyzed. The differences in the clinical characteristics of overweight and obese patients were compared with the TCM syndrome types, and the correlation between the physical and chemical indexes of different TCM syndromes and the correlation with the IR were analyzed and discussed. The SPSS17.0 statistical software was applied. The above data were analyzed with the chi square test, and the measurement data were expressed with mean number + standard deviation (x + s). The single factor variance analysis was used to satisfy the normality and the homogeneity of variance. The nonparametric test was used to satisfy the normality. The measurement data were expressed in the median of four (M + Q), and the correlation factors were analyzed using the linear correlation and the other factors. Results: 1. the total number of cases included in the 1. cases were 237 cases, 118 men, 119 women, 24-80 years of age, and between 1 weeks and 1 weeks. The three groups had no significant difference (P0.05).2. obesity group Fins, C peptide and PI level, compared with normal weight group and super recombination, in the age, course of disease, sex composition ratio, FBG and Hb A1C. There were statistical significance (P0.01), the level of super recombinant C peptide was higher than normal weight group (P0.01).3. obese group, HOMA-IR value was the highest, and compared with normal weight group and super recombination (P0.01). The lowest ISI value in obese group was statistically significant (P0.01) compared with normal weight group and super recombination (P0.01). The ratio of obese and super recombinant PI/Fins was higher than normal. The weight group (P0.01 or P0.05).4. compared with the normal weight group, the TG and UA levels were relatively high in the super recombinant and the obese group, and the HDL-C level was relatively low (P0.05 or P0.01). The UA level in the obese group was higher than that of the super recombination (P0.05).5. in the diabetes related complications, and the highest proportion of the normal body weight group was AS (52 cases, 6). 5.82%), followed by DPN (42 cases, 53.16%) and CVD (39 cases, 49.37%), DR (19 cases, 24.05%) and DKD (10 cases, 12.66%). The highest proportion of super recombination is AS (73 cases, 69.52%), followed by CVD (52, 49.52%) and DPN, DR (instances, DKD) and AS. There was no significant difference in each other (P0.05).6.158 cases of overweight and obese T2DM patients, with the syndrome of Qi Yin deficiency and blood stasis type (79 cases, 50%) and damp heat trapped in the spleen and blood stasis type (42 cases, 26.58%), the proportion was higher, the Qi and Yin deficiency type (30 cases, 18.99%), the Yin and yang two deficiency and blood stasis type (7 cases, 4.43%) accounted for the lowest proportion of.7. in the various syndrome groups, The average age of the patients with Qi and yin deficiency (50.60 + 11.16 years) was the shortest (3.03 + 4.09 years), less complicated with diabetes related complications; the average age of the Yin and yang two deficiency and blood stasis type was the largest (72.86 + 6.44 years), the longest course (20.71 + 6.90 years). The proportion of the complications associated with various kinds of diabetic diseases was higher. Except for DR, the two groups were more common. Study significance (P0.05); BMI (29.22 + 3.40kg/m2) and WC value (97.13 + 8.81cm) in patients with damp heat and spleen and blood stasis were higher than those of Qi Yin deficiency type and Qi Yin deficiency and blood stasis type (P0.05). There was no significant difference (P0.05).8. in each syndrome type group, and the lowest level of Qi and yin deficiency type Fins, with damp and hot stranded spleen and blood. The blood stasis type, yin and yang two deficiency and blood stasis type had statistical significance (P0.05); the level of Qi Yin deficiency and blood stasis type PI was the lowest, and there was statistical significance (P0.05) with Yin and yang two deficiency and blood stasis type (P0.05), in each type of syndrome group, the value of Qi and yin deficiency type HOMA-IR was the lowest, and there were statistical significance (P0.05) with the type of damp heat trapped in spleen and blood stasis type and Yin Yang two deficiency and blood stasis type. Compared with the deficiency of Qi and Yin and blood stasis type, the damp heat trapped in spleen and blood stasis type and Yin Yang two deficiency and blood stasis type had statistical significance (P0.05). The ISI value of Qi Yin deficiency type was the highest, compared with the damp heat trapped spleen and blood stasis type and Yin yang two deficiency and blood stasis type (P0.05). In PI/Fins square, compared with Qi Yin deficiency type, Qi Yin deficiency and blood stasis type had unification. Study significance (P0.05). In lipid metabolism, yin and yang two deficiency and blood stasis type TG level was the highest, compared with Qi and yin deficiency and blood stasis type (P0.05),.10.HOMA-IR and BMI, PI, TG, CHOL were positively correlated (P0.01), ISI and BMI, PI, and had a negative correlation. Conclusion: type 1.2 diabetes mellitus The incidence of obesity may be related to obesity; the PI/Fins ratio can roughly evaluate the degree of IR in the body, the higher the PI/Fins ratio, the higher the IR degree, the more overweight and the obese, the T2DM patients are more susceptible to blood lipid and uric acid metabolic disorder,.3. is overweight and obese T2DM patients are distributed as follows: Qi Yin deficiency and blood stasis type damp heat trapped in spleen and blood stasis type Qi Yin deficiency and yin deficiency type Yin and yang two deficiency and blood stasis type, Qi Yin deficiency and blood stasis type is the most common type of TCM syndrome in overweight and obese T2DM patients, and is closely related to IR, TG; damp heat trapped in spleen and blood stasis type is also more common; the proportion of yin and yang deficiency and blood stasis type with various diabetes related complications is higher.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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