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胰岛素敏感性、胰岛素样生长因子结合蛋白-1与老年期痴呆中医证型关系的临床研究
Clinical Study on Relationship among Insulin Sensitivity、Insulin-like Growth Factor Binding Protein-1 and Traditional Chinese Medicine Syndrome of Senile Dementia
【作者】 刘莹露；
【导师】 张洪；
【作者基本信息】 南京中医药大学 ， 中医内科学， 2010， 硕士
【摘要】 目的：探讨胰岛素敏感性(ISI)和血清胰岛素样生长因子结合蛋白－1(IGFBP-1)与老年期痴呆中医辨证分型的关系及临床意义。方法：临床搜集2008年11月－2009年7月南京市鼓楼医院老年科门诊及住院病人,分为观察组和对照组。观察组为老年期痴呆患者,按中医分型标准,又分为2个亚组：脾肾两虚亚组和痰瘀兼气虚亚组。对照组为老年期非痴呆患者。运用ELISA法检测胰岛素样生长因子结合蛋白-1(IGFBP-1),放射免疫法检测空腹血清胰岛素(FINS),计算胰岛素敏感性指数(IAI),比较观察组各亚组与对照组间空腹血糖(FBG)、FINS、IAI、IGFBP-1、血脂、血压及简易智能精神状态检查量表(MMSE)评分等指标。结果：1、观察组中的脾肾两虚亚组、痰瘀兼气虚亚组和对照组相比,FBG无统计学差异(P>0.05)。2、观察组中的脾肾两虚亚组和痰瘀兼气虚亚组与对照组相比,FINS升高,有显著统计学差异(P<0.01)；脾肾两虚亚组的FINS高于痰瘀兼气虚亚组,此两组之间存在显著统计学差异(P<0.01)。3、观察组中的脾肾两虚亚组和痰瘀兼气虚亚组与对照组相比,IAI下降,有统计学差异(P<0.01,P<0.05)；脾肾两虚亚组的IAI低于痰瘀兼气虚亚组,此两组间存在统计学差异(P<0.05)。4、观察组中的脾肾两虚亚组和痰瘀兼气虚亚组与对照组相比,IGFBP-1均升高,有显著统计学差异(P<0.01);脾肾两虚亚组的IGFBP-1高于痰瘀兼气虚亚组,此两组间存在统计学差异(P<0.05)。5、通过Pearson相关性分析可以看出,IGFBP-1与FBG、FINS、IAI有相关性,与FBG、FINS呈正相关,与IAI呈负相关。6、观察组中的脾肾两虚亚组与对照组相比,甘油三酯(TG)升高,有统计学差异(P<0.05)；其余血脂指标观察组各亚组与对照组相比无统计学差异(P>0.05)。7、观察组中的脾肾两虚亚组和痰瘀兼气虚亚组与对照组相比,收缩压(Systolic pressure)均升高,达到统计学差异(P<0.01,P<0.05)；脾肾两虚亚组的收缩压高于痰瘀兼气虚亚组,此两组间有统计学差异(P<0.05)；脾肾两虚亚组的舒张压(Diastolic pressure)与对照组相比升高,达到统计学差异(P<0.05)。8、脾肾两虚亚组和痰瘀兼气虚亚组的MMSE评分比较未达到统计学差异(P>0.05)。9、老年期痴呆患者不同年龄层次FBG、FINS、IAI、IGFBP-1、MMSE评分、TG、高密度脂蛋白－胆固醇(HDL-C)、低密度脂蛋白－胆固醇(LDL-C)和血压比较无统计学差异(P>0.05),不同年龄层次总胆固醇(T-ch)比较有统计学差异(P<0.05)。结论：老年期痴呆与胰岛素敏感性、胰岛素样生长因子结合蛋白－1有关,脾肾两虚导致的老年期痴呆与胰岛素代谢的关系尤为密切。
【Abstract】 Objective:To investigate the relationship and significance among insulin sensitivity (ISI)、insulin-like growth factor binding protein-1(IGFBP-1) and traditional chinese medicine syndrome of senile dementia.Methods:Observation group and Control group,which collect patients in the wards and out-patient clinic of geriatrics division in Nanjing Durm Tower Hospital from November 2008 to July 2009. Observation group includes senile dementia patients,which is grouped by the diagnostic standard of Traditional Chinese Medicine:deficiency of spleen-kidney group、obstruction by phlegm-blood stasis and deficiency of Qi group. Control group includes patients without dementia.The fasting serum insulin (FINS) and IGFBP-1 are detected by radioimmunity and ELISA.The insulin resistance index(IAI) is calculated.We compare fasting blood glucose (FBG)、FINS、IGFBP-1、IAI、blood lipid、blood pressure and MMSE among each group.Results:1、there is no difference of the level of fasting blood glucose among deficiency of spleen-kidney group、obstruction by phlegm-blood stasis and deficiency of Qi group and control group(P> 0.05).2、the level of serum insulin in deficiency of spleen-kidney group obstruction by phlegm-blood stasis and deficiency of Qi group are increased compared with control group,which have significant differences (P< 0.01);INS in deficiency of spleen-kidney group is higher than in obstruction by phlegm-blood stasis and deficiency of Qi group,and there is significant difference between two traditional chinese medicine syndrome types (P< 0.01).3、compared with control group, the level of insulin resisrance index in deficiency of spleen-kidney group、obstruction by phlegm-blood stasis and deficiency of Qi group are decreased,which have differences(P< 0.01, P< 0.05);IAI in deficiency of spleen-kidney group is lower than in obstruction by phlegm-blood stasis and deficiency of Qi group,and there is difference between two types (P< 0.05).4、IGFBP-1 in deficiency of spleen-kidney group、obstruction by phlegm-blood stasis and deficiency of Qi group are higher than in control group,which have significant differences (P< 0.01); IGFBP-1 in deficiency of spleen-kidney group is higher than in obstruction by phlegm-blood stasis and deficiency of Qi group,and there is difference between two traditional chinese medicine syndrome types(P< 0.05).5、Pearson correlation analysis show that IGFBP-1 is correlated with FBG、FINS and IAI.Among them,IGFBP-1 is positively correlated with FBG and FINS,and negatively correlated with IAI.6、Triglyceride in deficiency of spleen-kidney group is higher than in control group,which has difference(P< 0.05);other blood lipid has no difference among each group (P> 0.05).7、Systolic pressure in two TCM type are higher than in control group,there are differences (P< 0.01, P<0.05);Systolic pressure in deficiency of spleen-kidney group is highest in three groups,and there is difference between two types(P< 0.05); Diastolic pressure in deficiency of spleen-kidney group is higher than in control group,which has difference (P< 0.05).8、there is no difference of MMSE in deficiency of spleen-kidney group、obstruction by phlegm-blood stasis and deficiency of Qi group(P> 0.05).9、there is no difference of FBG、FINS、IAI、IGFBP-1、MMSE、TG、HDL-C、LDL-C and blood pressure in different age(P> 0.05), there is difference of T-ch in different age (P< 0.05)Conclusion:Senile dementia is correlated with ISI、IGFBP-1. Senile dementia which caused by deficiency of spleen-kidney has more relationshiop with the metabolism of INS.