2型糖尿病痰热互结证证候分布及生物学基础研究

【作者】 周丽波；

【导师】 仝小林；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2009， 博士

【摘要】 世界卫生组织统计,糖尿病患病率为6.3%。目前中国每年增加糖尿病病例100万,其中95%是2型糖尿病,积极开展2型糖尿病的防治工作已成为主要的社会公共卫生问题。运用中医药有效防治糖尿病是中医学界研究的重要任务。导师多年从事糖尿病的临床与科研工作,导师的临床实践和课题组既往研究表明痰热互结证是2型糖尿病的主要证型之一。本研究主要是对2型糖尿病痰热互结证证候进行理论探讨、临床流行病调查及生物学基础研究,以期阐明2型糖尿病痰热互结证证侯分布及生物学基础。1.理论研究部分梳理了糖尿病中医病因病机与辨证分型研究文献,概述了2型糖尿病中医证型与微观指标关系研究进展,归纳总结了导师对2型糖尿病痰热互结证的认识及诊治心得。得出如下结论:长期的不良生活习惯伴随着现代人的精神压力、体质变化是糖尿病亦是其痰热互结证候形成的最重要的因素。2型糖尿病痰热互结证其形成多因过食肥甘、多坐少动、精神紧张等而致。2型糖尿病发病过程中痰热可互结共存、易与腑实胶结、易耗气伤阴、易痰热瘀互结等,致病具有复杂性,痰热互结可阻碍气机,壅遏血脉,变证丛生,致病具有广泛性,针对其致病广泛性、复杂性的特点,在临床中要引起高度重视,积极防治2型糖尿病痰热互结证。2.临床研究部分采用随机、分层、整群抽样的前瞻性研究方法,对北京市宣武区、昌平区及平谷区的3个社区20岁以上长住社区居民5465人进行糖尿病流行病学和中医证型分布调查。得出如下结论:2型糖尿病与消渴病古今存在差异,无典型“三多一少”症状的肥胖患者为2型糖尿病的主体,痰热互结证是2型糖尿病的主要证型之一。正确认识它的作用和地位,对于2型糖尿病患者病情的控制具有重要意义。3.基础研究部分以代谢状态异常为切入点,从人体测量学、血液代谢学、内分泌因子等三个层次研究2型糖尿病痰热互结证的生物学基础,得出如下结论:2型糖尿病痰热互结证组抵抗素分泌显著降低,与阴虚热盛证组组间差异有显著性意义,提示抵抗素可作为区分痰热互结证、阴虚热盛证不同证型的指标;脂联素的水平两证型组较对照组显著降低、瘦素、IL-6的水平两证型组较对照组显著升高。E-选择素、TNF-α、GLP-1、体重指数、腰臀比、糖代谢指标中空腹血糖、糖化血红蛋白、胰岛素、C-肽水平、脂代谢指标中胆固醇、甘油三酯、低密度脂蛋白、极低密度脂蛋白,尿肾功三项中尿白蛋白排泄率、糖蛋白和β₂-微球蛋白,血压、红细胞压积、纤维蛋白原、C反应蛋白指标中痰热互结证组较阴虚热盛证组虽无统计学差异,但皆有明显变化趋势,提示2型糖尿病痰热互结证与阴虚热盛证可能存在差异,还需进一步研究。本研究的创新点在于1.开展了前瞻性2型糖尿病证型分布的流行病学调查,为2型糖尿病证型客观化研究提供思路与方法,资料证实了痰热互结证是现代2型糖尿病的主要证型之一。2.结合现代医学研究进展选择多个指标,对2型糖尿病痰热互结证的生物学基础进行了多角度、多层次的积极探索。更多还原

【Abstract】 According toWorld Health Organization statistics,There is more than 170 million by 2025 which is expected to more than 300 million all over the world with diabetes,diabetes prevalence was 6.3%.China’s current annual increase of one million cases of diabetes,of which 95 percent are type 2 diabetes, active prevention and treatment of type 2 diabetes has become a major public health problem in society.The use of effective prevention and treatment of diabetes in Chinese medicine are important academic research mission.Instructor for many years engaged in diabetes clinical and research work,clinical practice and the instructor group study shows that previously Phlegm-heat syndrome are the main type of type 2 diabetes syndrome.The purpose of this study are of the type 2 diabetes Phlegm-heat syndrome explore theoretical,clinical epidemiological surveys and basic research in biology,with a view to clarify the type 2 diabetes Phlegm-heat syndrome distribution and basic biology.1.Theoretical Study of some sort of diabetes etiology and pathogenesis of TCM Syndrome Types with the research literature,provides an overview of diabetes TCM Syndrome-and micro-target the relationship between research, summarized instructor of type 2 diabetes Phlegm-heat syndrome know and treatment experiences.Reached the following conclusion:long-term adverse living habits associated with modern mental stress,physical changes are diabetic it is also an inter-node heat syndromes formed the most important factor.Type 2 diabetes Phlegm-heat syndrome because of its formation have been many food,many sitting paucimobilis,mental tension due.Pathogenesis of type 2 diabetes during the heat can be inter-node co-exist easily with the internal organs is cemented, easily gas consumption and easy to heat,such as blood stasis Phlegm,pathogenic complexity,heat each node can block the gas machine,blood,variable permit proliferation with extensive disease,in view of its extensive disease,the complexity of the characteristics of clinical attach great importance to and actively control type 2 diabetes Phlegm-heat syndrome.2.Part of clinical research using randomized,stratified,cluster sampling method A prospective study of Beijing Xuanwu District,Changping District, and Pinggu District 3 community over the age of 20 community residents to live a long 5465 for diabetes epidemiology and people TCM Syndrome Study investigate. Draw the following conclusions:Type 2 Diabetes and Diabetes past differences, non-typical "one little more than three" symptoms of obese patients with type 2 diabetes as the main body of Phlegm-heat syndrome is type 2 diabetes,one of the main type.A correct understanding of its role and status,for patients with type 2 diabetes control the disease of great significance.3.Part of basic research to abnormal metabolic status as the breakthrough point,from anthropometry,blood metabolism study,the three levels of endocrine factors such as type 2 diabetes study of Phlegm-heat syndrome each end of the biological basis of evidence,to draw the following conclusions:Phlegm-heat syndrome group resistin secretion was significantly higher,with the hot-Yin deficiency syndrome group permit difference between groups was significant, suggesting that resistin could be used as evidence to distinguish between Phlegm-heat,the hot-Yin deficiency Syndrome target different;adiponectin the level of pigment-type group than in the two permits a significant reduction in the control group,leptin,IL-6 level of the two syndrome group than in the control group significantly increased.E-selectin,TNF-α,GLP-1 level of each node Phlegm-heat syndrome group than in the hot Yin deficiency syndrome group and the control group no significant difference,but the trend has increased; body mass index,waist-hip ratio,sugar metabolism in the target fasting blood glucose,glycosylated hemoglobin insulin,C-peptide levels,lipid metabolism in the target cholesterol,triglyceride,low-density lipoprotein,very low density lipoprotein,three renal urinary albumin excretion rate in urine,sugar protein andβ2-microglobulin,blood pressure,hematocrit,fibrinogen, C-reactive protein in the target Phlegm-heat syndrome group than the hot-Yin deficiency syndrome group no significant difference between groups,but there is increase or decrease the Change trend,suggesting that there are differences between type 2 diabetes Phlegm-heat syndrom and the hot-Yin deficiency syndrome,and evidence of the possible differences need further study.This study has two innovations:1.To carry out a prospective type 2 diabetes mellitus syndrom epidemiological survey distribution,evidence for Type 2 diabetes to provide an objective study of ideas and methods,data confirmed the evidence that type 2 diabetes Phlegm-heat syndrome was one of the main syndrom. 2.Combined withmodern medical research progress in a number of target selection, type 2 diabetes Phlegm-heat syndrome evidence for the basic biology of many ways to explore multi-level active.更多还原