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目的:探讨2型糖尿病超重与非超重者的中医证型与糖代谢、脂代谢、炎症因子、血流变等多指标的关系。方法:糖尿病患者230例。临床资料收集方法:入院时详细询问病史,依据中医四诊资料按照中医辨证治疗消渴病的临床研究指导原则辨证分型,专人测定血压,次晨抽取静脉血检测血脂、血糖、胰岛素、C-反应蛋白等。专人检测身高、体重,并据此计算BMI。据空腹血糖、胰岛素计算胰岛素敏感性指数(ISI)、血流变学检查用普利生LBY-N6A自清洗旋转式黏度计。TG、CHOL、HDL、LDL、LP(a)、APO-A、APO-B用检测全自动生化仪检测,胰岛素测定用放免法,C-反应蛋白检测用免疫比浊法。IMT检测用B超声检测测定,依据BMI是否>23分为超重与非超重两组,比较两组的中医证型构成,超重组中中医各证型之间参数的比较,非超重组中医各证型参数的比较,将BMI纳入观测,考察同一中医证型中超重与非超重者各参数特征。结果:2型糖尿病超重者中医证型构成:阴血火旺占63.95%,气阴两虚占36.04%;非超重中医证型构成:阴虚火旺占36.21%(21/58),气阴两虚占63.79%(37/58);气阴两虚证型2型糖尿病中:超重者CRP、FINS、DBP、全血黏度高切(GAOQIE)高于非超重者,阴虚火旺证型2型糖尿病中:非超重者HDL高于超重者而IMT、DBP、SBP、血浆黏度低于超重者。结论:2型糖尿病超重与非超重者的阴虚火旺证与气阴两虚中医证型有着不同的理化特征,2型糖尿病超重者以阴虚火旺证型为主,非超重者以气阴两虚证型为主,差异显著(χ2=13.6206,P=0.0002);在超重的2型糖尿病者,阴虚火旺证型与气阴两虚证型的差异在于胰岛素抵抗方面,有阴虚火旺证型→气阴两虚证型加重的特征;而同系非超重的2型糖尿病,其证型的差异表现在脂代谢、空腹胰岛素、血流变、IMT、血压等多方面;即便是同一中医证型超重与非超重者的理化特征也有所不同。
Objective: To investigate the relationship between TCM syndromes of type 2 diabetes mellitus and overweight and non-overweight subjects such as glucose metabolism, lipid metabolism, inflammatory factors and hemorrheology. Methods: 230 cases of diabetic patients. Clinical data collection method: hospital history of detailed inquiry, based on four diagnostic data TCM syndrome differentiation according to the principles of clinical research dialectical syndrome differentiation, blood pressure was measured by hand, the next morning blood was drawn venous blood test, blood glucose, insulin, C- Reactive protein and so on. Personnel detect height, weight, and calculate BMI accordingly. According to fasting glucose, insulin calculated insulin sensitivity index (ISI), hemorheology check with Prevenon LBY-N6A self-cleaning rotary viscometer. TG, CHOL, HDL, LDL, LP (a), APO-A, APO-B with automatic biochemical analyzer detection, insulin determination by radioimmunoassay, C-reactive protein detection by immune turbidimetry. IMT test using B ultrasound detection, based on whether the BMI> 23 is divided into two groups of overweight and non-overweight, comparing the constitution of TCM syndromes, overweight groups TCM syndromes between the various parameters, non-overweight groups of TCM each card Type parameters, the BMI included in the observation of the same type of TCM syndrome overweight and non-overweight characteristics of each parameter. Results: Type 2 diabetes mellitus was characterized by TCM syndromes: Yin-Yin Huo-Wan accounted for 63.95%, Qi-Yin Deficiency accounted for 36.04%; non-overweight TCM syndromes accounted for 36.21% (21/58) The deficiency accounted for 63.79% (37/58). In deficiency of qi and yin deficiency type 2 diabetes, CRP, FINS, DBP and GAOQIE in overweight were higher than those in non-overweight, In diabetes, non-overweight HDL is higher than overweight and IMT, DBP, SBP, and plasma viscosity are lower than overweight. Conclusion: Type 2 diabetes is overweight and non-overweight Yin deficiency Huo Zheng and Qi and Yin Deficiency syndromes have different physicochemical characteristics, type 2 diabetes overweight Yin deficiency Huo-Zheng syndrome-based, non-overweight people with Qi and Yin (Χ2 = 13.6206, P = 0.0002). In overweight type 2 diabetic patients, the difference between Yin deficiency and heat deficiency syndrome and deficiency of Qi and Yin deficiency lies in the aspects of insulin resistance and Yin deficiency and fire syndrome Type → deficiency of both qi and yin deficiency type; while the same type of non-overweight type 2 diabetes, the differences in the syndromes of lipid metabolism, fasting insulin, blood rheology, IMT, blood pressure and other aspects; even the same TCM Physical and chemical characteristics of overweight and non-overweight are also different.