低频电针对男、女单纯性肥胖症减肥效应影响的比较研究

发布时间：2018-07-03 06:01

本文选题：低频电针 + 单纯性肥胖症　；参考：《河北医科大学》2016年硕士论文

【摘要】：目的:本课题通过采用低频电针对男、女两组脾虚湿盛型单纯性肥胖症患者的治疗,观察其治疗前后体重、体重指数(BMI)、体脂百分率(F%)、腰围、臀围、腰臀围比值以及血糖(Glu)、胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、胰岛素(Ins)、胰岛素抵抗(Ins-Ab)、瘦素(Leptin)、脂联素(ADPN)、神经肽Y(NPY)等指标变化,并进行比较分析。探讨低频电针对男、女单纯性肥胖症减肥效应的差异性及可能的作用机制,以期为临床应用低频电针针对性治疗男、女单纯性肥胖症提供科学依据。方法:本研究纳入的80例单纯性肥胖症患者,均来自于2014年3月~2015年10月期间河北中医学院门诊部和河北省中医药研究院医院门诊。所有患者均严格按照诊断标准、纳入标准和排除标准进行选择,其中女性组43例,男性组37例。两组治疗方法相同。取穴:阴陵泉(双)、三阴交(双)、足三里(双)、丰隆(双)、曲池(双)、天枢(双)、中脘、水分、气海、关元和脂肪堆积部位阿是穴2~4穴。操作:患者取仰卧位,针具使用φ0.30~0.34×40~75mm毫针。肢体选单侧2~3对穴,两侧穴交替使用。穴位常规消毒,直刺进针,得气后,连接华佗牌SDZ-II型电针仪;腹部穴采用透刺方法,穴位常规消毒后,中脘透水分、气海透关元、脂肪堆积处穴位透刺(直刺得气后,将针尖提至脂肪堆积处,再沿脂肪堆积处向下透刺),然后连接电针仪。肢体及腹部穴均采用连续波,频率为20Hz,留针30min,1次/d,10次为1疗程,疗程间休息2天,连续治疗2个疗程。治疗结束后随访3个月。两组患者治疗前后均由专人测量统计身高、体重、腰围、臀围、腰臀比值和体脂百分率(F%)等指标,同时检测血糖(Glu)、胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、胰岛素(Ins)、胰岛素抵抗(Ins-Ab)、瘦素(Leptin)、脂联素(ADPN)、神经肽Y(NPY)等指标的含量。并将两组治疗前后各项观察指标的数据应用SPSS13.0软件进行统计分析。结果:1一般资料比较:通过对两组治疗前年龄、病程、肥胖程度等资料均衡,差异均无统计学意义(P0.05),具有可比性。2男性组和女性组疗效的比较:男性组显效率为32.43%,总有效率为97.29%;女性组显效率为11.62%,总有效率为86.04%。经χ2检验,两组显效率比较,男性组优于女性组(P0.05);而总有效率比较,虽差异无统计学意义(P0.05),但男性组总有效率明显高于女性组。两组总体疗效比较,经Wilcoxon秩和检验,差异有统计学意义(P0.05),男性组优于女性组。3男性组和女性组治疗前后形体指标的比较:治疗前两组患者体重、BMI、胸围、腰围、臀围、腰臀比以及F%均明显高于正常组,差异有统计学意义(P0.01)。男性组和女性组患者治疗前以BMI为肥胖程度参数均衡性比较,差异无统计学意义(P0.05)。治疗后组内比较:两组患者体重、BMI、胸围、腰围、臀围、腰臀比以及F%较治疗前均明显降低,差异有统计学意义(P0.01)。治疗后组间比较:男性组体重、BMI较女性组降低明显,差异均有统计学意义(P0.01);女性组F%、腰围、臀围较男性组降低明显,差异均有统计学意义(P0.01);两组胸围及腰臀比值的比较,差异无统计学意义(P0.05)。治疗后与正常组比较:男性组体重、BMI、胸围、腰围、臀围、腰臀比、F%较正常组差异均有统计学意义(P0.01);女性组体重、BMI、胸围、腰围、臀围、F%、较正常组差异均有统计学意义(P0.01);腰臀比较正常组差异无统计学意义(P0.05)。4男性组和女性组随访三个月和治疗前形体指标的比较:(1)组内比较:随访3个月两组患者的体重、BMI、胸围、腰围、臀围、腰臀比及F%均明显低于治疗前,差异有统计学意义(P0.01)。(2)组间比较:随访三个月,男性组体重、BMI较女性组相应随访各月的体重、BMI降低明显,差异有统计学意义(P0.01);女性组F%、腰围、臀围较男性组相应随访各月的F%、腰围、臀围降低明显,差异有统计学意义(P0.01)。两组胸围及腰臀比值的比较,差异均无统计学意义(P0.05)5男性组和女性组治疗前后血脂含量的比较:治疗前两组TC、TG、LDL含量均明显高于正常组,差异有统计学意义(P0.01);HDL的含量明显低于正常组,差异有统计学意义(P0.01)。治疗后组内比较:两组患者TC、TG、LDL含量较治疗前均明显降低;HDL的含量较前明显升高,差异有统计学意义(P0.05)。治疗后组间比较:两组患者TC、TG、HDL、LDL含量比较,差异均无统计学意义(P0.05)。治疗后与正常组比较:两组TC、TG、HDL、LDL含量较正常组差异均无统计学意义(P0.05)。6男性组和女性组治疗前后Glu、Ins、Ins-Ab、ADPN含量比较:治疗前两组患者Glu、Ins、Ins-Ab、ADPN含量均明显高于正常组,差异均有统计学意义(P0.01)。治疗后组内比较:两组患者Glu、Ins、Ins-Ab、ADPN的含量较治疗前均明显降低,差异均有统计学意义(P0.01或P0.05)。治疗后组间比较:男性组Ins、ADPN含量较女性组均明显降低,差异均有统计学意义(P0.01或P0.05);而两组Glu及Ins-Ab的含量比较,差异均无统计学意义(P0.05)。治疗后与正常组比较:两组Glu、ADPN、Ins、Ins-Ab含量较正常组差异均无统计学意义(P0.05)。7男性组和女性组治疗前后血清Leptin和NPY含量比较:治疗前两组患者血清Leptin和NPY含量均明显高于正常组,差异均有统计学意义(P0.01)。治疗后组内比较:治疗后两组患者血清Leptin、NPY含量较治疗前均明显降低,差异均有统计学意义(P0.01)。治疗后组间比较:男性组NPY含量较女性组降低明显,差异有统计学意义(P0.01);女性组血清Leptin含量较男性组降低明显,差异有统计学意义(P0.01)。治疗后与正常组比较:两组血清Leptin、NPY含量较正常组差异均无统计学意义(P0.05)。8男性组和女性组患者不良事件率比较:两组的不良事件率均为0%,差异无统计学意义(P0.05)。结论:1低频电针能明显降低男、女单纯性肥胖症患者的体重、BMI、F%,减少胸围、腰围、臀围及腰臀比值。说明该疗法对两组患者均有很好的减肥作用及明显的降重瘦身效果,不但近期疗效好,而且远期疗效亦佳,无明显反弹。2低频电针可明显降低男、女单纯性肥胖症患者TC、TG、LDL含量,同时升高HDL含量。说明低频电针对两组单纯性肥胖症患者的脂代谢具有较好的调节作用,通过调节肥胖患者机体异常的脂代谢,抑制脂肪合成,促进脂肪分解,氧化产热,消耗多余脂肪,从而达到减肥消脂之目的。3低频电针可明显降低男、女单纯性肥胖症患者血清Glu、Ins、Ins-Ab、ADPN的含量。说明低频电针对两组单纯性肥胖症患者血清Glu、Ins、Ins-Ab、ADPN含量具有良好的调节作用,可能是通过增加胰岛β细胞的敏感性和分泌功能,纠正肥胖患者体内紊乱的脂肪-胰岛内分泌轴;同时调节Ins-Ab、ADPN的异常水平,有效改善Ins抵抗状态,提高Ins的利用率,调节血糖和脂代谢,减少食物摄入,增加能量消耗,从而达到减肥目的。4低频电针可明显降低男、女单纯性肥胖症患者血清Leptin、NPY的含量。说明低频电针对两组单纯性肥胖症患者血清Leptin、NPY含量具有良好的调节作用,可能是通过改善肥胖患者体内紊乱的Leptin-下丘脑NPY轴,促使血清Leptin通过血脑屏障,抑制下丘脑弓状核和背状核NPYm RNA表达,减少NPY的分泌,减少食物摄入,增加能量消耗,抑制脂肪形成,从而达到减肥目的。5低频电针对单纯性肥胖症的减肥作用,存在有一定的性别差异。其对男性体重、BMI、血清Ins、ADPN、NPY含量的改善作用更加明显;而女性在F%、腰围、臀围、血清Leptin含量的改善方面优于男性。但对胸围、腰臀比值、血清Glu、TC、TG、HDL、LDL、Ins-Ab的变化差异不明显。这也为临床应用低频电针针对性治疗男、女单纯性肥胖症提供依据。6该疗法临床应用无不良反应,可避免西药所引起的副作用,是一种安全有效的治疗方法。7本实验从性别的角度对低频电针治疗单纯性肥胖症进行了尝试性研究,并取得了一定的成果,但由于经费不足,尚未进行深入研究,如高频电针与低频电针间,不同波形间,对男、女单纯性肥胖症减肥效应的差异性等,有待于今后进一步的研究和探讨。
[Abstract]:Objective: To observe the weight, body mass index (BMI), body fat percentage (F%), waist circumference, hip circumference, waist to hip circumference and blood glucose (Glu), cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein, and low density fat eggs by the treatment of two groups of men and women with spleen deficiency and humid type of simple obesity. White cholesterol (LDL), insulin (Ins), insulin resistance (Ins-Ab), leptin (Leptin), adiponectin (ADPN), neuropeptide Y (NPY) and so on, and compare and analyze the difference and the possible mechanism of the effect of low frequency electroacupuncture on the weight loss of male and female simple obesity, in order to use low frequency electroacupuncture for the treatment of male and female alone. The scientific basis of sexual obesity was provided. Methods: 80 cases of simple obesity included in this study were from the outpatient department of the Hebei Institute of traditional Chinese medicine (Hebei Institute of traditional Chinese Medicine) and the hospital of the Hebei Institute of traditional Chinese medicine in October March 2014. All patients were selected strictly according to the diagnostic criteria and included in the standard and exclusion criteria, of which 43 cases were in the female group. 37 cases in the male group. The two groups were treated in the same way: Yin Ling spring (double), Sanyinjiao (double), Zusanli (double), Qu chi (double), Tianshu (double), middle Wan, water, Qi sea, Guan Yuanhe fat accumulation site Ashi point 2~4. Operation: patients take the supine position, the needle use of 0.30~0.34 x 40~75mm needle. Extremities selected single side 2~3 pair acupoints alternately. Use. Acupoint routine disinfection, direct puncture needle, after gas, connecting the Hua Tuo brand SDZ-II electroacupuncture instrument; the abdominal cavity through the puncture method, after the routine disinfection of the acupoints, the epigastric water permeates the water, the Qi sea through the point, the fat accumulation point penetration point (after piercing the gas, the needle points to the fat heap place, then down the fat accumulation down pricking), then connected to the electroacupuncture instrument. Continuous wave was used in the limb and abdominal cavity, frequency of 20Hz, needle retention 30min, 1 times /d, 10 times for 1 courses, 2 days of rest during the course of treatment, 2 courses of continuous treatment. After the treatment, the follow-up was 3 months. All the two groups of patients were measured and counted by special persons before and after treatment. The indexes of height, weight, waist, hip, waist hip ratio and body fat percentage (F%) were measured, and blood sugar was detected at the same time (Gl U), cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), insulin (Ins), insulin resistance (Ins-Ab), leptin (Leptin), adiponectin (ADPN), neuropeptide Y (NPY) and other indicators, and the data of the two groups of observation indicators before and after the application of SPSS13.0 software for statistical analysis. Fruit: 1 general data comparison: through the balance of the age, course of disease and the degree of obesity in the two groups, the difference was not statistically significant (P0.05), with the comparison of the curative effect between the male and female groups of comparable.2: the male group was 32.43%, the total effective rate was 97.29%, the female group was 11.62%, the total effective rate was 86.04%. by chi 2 test, two groups Compared with the female group (P0.05), the male group was more effective than the female group (P0.05), although the difference was not statistically significant (P0.05), but the total effective rate of the male group was significantly higher than that of the female group. The total curative effect of the two groups was compared with the Wilcoxon rank test, the difference was statistically significant (P0.05). The male group was better than the female group.3 male group and the female group before and after treatment. Comparison of the indexes: the weight of the two groups before treatment, BMI, chest circumference, waist circumference, hip circumference, waist hip ratio and F% were significantly higher than those of the normal group. The difference was statistically significant (P0.01). The difference between the male group and the female group was compared with the weight equilibrium of BMI before treatment (P0.05). After treatment, the group was compared with the weight of the two groups, BMI, Chest circumference, waist circumference, hip circumference, waist to hip ratio and F% were significantly lower than before treatment. The difference was statistically significant (P0.01). The weight of the male group was significantly lower than that of the female group (P0.01), and the F%, waist and hip circumference of the female group were significantly lower than those in the male group (P0.01); the two groups of chest circumference and the two groups of chest circumference were statistically significant. The difference in waist hip ratio was not statistically significant (P0.05). Compared with the normal group, the weight of the male group, BMI, chest circumference, hip circumference, waist hip ratio and F% were statistically significant (P0.01). The weight of the female group, BMI, chest circumference, waist circumference, hip circumference, F% were statistically significant (P0.01), and the difference between normal waist and hip group was poor. No statistical significance (P0.05).4 male and female groups were followed up for three months and before the treatment of the physique index: (1) compared to 3 months of two groups of patients' weight, BMI, chest circumference, waist circumference, hip, waist to hip ratio and F% were significantly lower than before, the difference was statistically significant (P0.01). (2) a follow-up of three months, male group weight, BMI Compared with the female group, the BMI decreased significantly, and the difference was statistically significant (P0.01). The F%, waist circumference and hip circumference of the female group were significantly lower than those of the male group, the waist circumference and the hip circumference decreased significantly (P0.01). There was no significant difference between the two groups of chest circumference and waist hip ratio (P0.05) 5 male and female. Comparison of blood lipid content before and after treatment: the content of TC, TG, LDL in the two groups before treatment was significantly higher than that in the normal group, and the difference was statistically significant (P0.01). The content of HDL was significantly lower than that of the normal group (P0.01). The content of TC, TG, LDL in the two groups was significantly lower than that before treatment, and the content of HDL was significantly higher than that before the treatment. The difference was statistically significant (P0.05). There was no significant difference in the content of TC, TG, HDL and LDL in the two groups after treatment (P0.05). Compared with the normal group, there was no significant difference between the two groups of TC, TG, HDL, LDL content compared with the normal group (P0.05). The contents of Glu, Ins, Ins-Ab and ADPN in the first two groups were significantly higher than those in the normal group, and the difference was statistically significant (P0.01). The contents of Glu, Ins, Ins-Ab and ADPN were significantly lower in the two groups than before the treatment. The difference was statistically significant (P0.01 or P0.05). The difference was statistically significant (P0.01 or P0.05), but there was no significant difference in the content of Glu and Ins-Ab in the two groups (P0.05). After treatment, there was no significant difference between the two groups of Glu, ADPN, Ins, Ins-Ab content compared with the normal group (P0.05).7 male and female groups. The levels of serum Leptin and NPY in the first two groups were significantly higher than those in the normal group (P0.01). After treatment, the serum levels of Leptin and NPY in the two groups were significantly lower than those before treatment, and the difference was statistically significant (P0.01). After treatment, the content of NPY in the male group was significantly lower than that in the female group. There was statistical significance (P0.01); the content of serum Leptin in the female group was significantly lower than that in the male group (P0.01). After the treatment, the serum Leptin was compared with the normal group. There was no significant difference between the two groups of serum Leptin and NPY content compared with the normal group (P0.05) the rate of adverse events in the male and female groups of.8 was compared: the rate of adverse events was 0% in the two groups. There is no statistical significance (P0.05). Conclusion: 1 low frequency electroacupuncture can significantly reduce the weight of men and women with simple obesity, BMI, F%, reduce chest circumference, waist circumference, hip circumference and waist hip ratio. It shows that the therapy has a good weight loss effect and obvious weight reduction effect on two groups of patients, not only in the near future, but also in good long-term effect, and no obvious long-term effect. .2 low frequency electroacupuncture can obviously reduce the content of TC, TG, LDL, and increase the content of HDL in men and women with simple obesity. It shows that low frequency electroacupuncture has a good regulating effect on lipid metabolism in two groups of simple obesity patients. It can regulate fat metabolism, inhibit fat synthesis, promote adipose decomposition, oxidize heat production and eliminate heat. .3 low frequency electroacupuncture can significantly reduce the content of serum Glu, Ins, Ins-Ab and ADPN in the serum of men and women with simple obesity, indicating that low frequency electroacupuncture has a good regulatory effect on serum Glu, Ins, Ins-Ab, and ADPN content in two groups of simple obesity patients, which may be by increasing the sensitivity of islet beta cells. Sexual and secretory functions to correct the disorder of fat - islet endocrine axis in obese patients, regulate the abnormal level of Ins-Ab and ADPN, improve the Ins resistance effectively, improve the utilization of Ins, regulate blood glucose and lipid metabolism, reduce food intake, increase energy consumption, and thus achieve the goal of reducing the weight loss of.4. The low frequency electroacupuncture can significantly reduce the purity of men and women. The serum levels of Leptin and NPY in the serum of obese patients showed that low frequency electroacupuncture had a good regulating effect on the serum Leptin and NPY levels in two groups of simple obesity patients. It may be by improving the NPY axis of the hypothalamus in the Leptin- of the obese patients, promoting the serum Leptin through the blood brain barrier and inhibiting the RNA table of the hypothalamus arcuate nucleus and the dorsal nucleus NPYm. To reduce the secretion of NPY, reduce food intake, increase energy consumption, inhibit fat formation, and thus achieve weight loss objective.5 low frequency electroacupuncture on the weight loss of simple obesity, there is a certain gender difference. It is more significant for the male weight, BMI, serum Ins, ADPN, NPY content, while women in F%, waistline, hip circumference, serum Lep The improvement of tin content is better than that of men. However, there is no obvious difference in the changes of chest circumference, waist to hip ratio, serum Glu, TC, TG, HDL, LDL, Ins-Ab. This also provides a basis for the clinical application of low frequency electroacupuncture for male and female simple obesity according to the clinical application of.6, which can avoid side effects caused by western medicine and is a safe and safe method. The effective treatment method.7 is a tentative study on the treatment of simple obesity by low frequency electroacupuncture from the gender perspective, and has achieved certain results. However, due to the lack of funds, there has not been a thorough study, such as the difference between the high frequency electroacupuncture and low frequency electroacupuncture, different waveforms, and the difference in the weight loss effect of male and female obesity. Further research and discussion in the future.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.1

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