穴位埋线对糖调节受损伴腹型肥胖患者糖脂代谢及转归影响的临床研究
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摘要
目的观察在生活方式干预基础上或是在生活方式干预加二甲双胍的基础上,加用穴位埋线对糖调节受损(IGR)伴腹型肥胖患者糖脂代谢及转归的影响。方法将160例IGR伴腹型肥胖患者随机分为A组、B组、C组、D组,每组40例。A组予生活方式干预,B组予生活方式干预+口服二甲双胍,C组予生活方式干预+穴位埋线,D组予生活方式干预+穴位埋线+口服二甲双胍。各组疗程均为6个月,观察IGR患者向糖尿病(DM)或正常糖耐量(NGT)转化的转归情况,比较受试者糖化血红蛋白(Hb A1c)、血脂(TC、TG、LDL-C、HDL-C)、空腹血糖、血浆胰岛素、肝功能相关指标及腹围(WC)、身高、体质量水平的变化情况,计算并比较胰岛素抵抗指数(HOMA-IR)、脂肪肝指数(FLI)、内脏脂肪指数(VAI)的变化情况。结果 (1)最终完成试验者156例,A组40例、B组37例、C组40例、D组39例。(2)治疗前后组内比较,B、C、D组的Hb Alc、HOMA-IR、TG、LDLC、WC、BMI、FLI水平均明显降低(P<0.05,P<0.01); A组的BMI、FLI水平明显降低(P<0.05);仅有C、D两组VAI水平下降(P<0.05)。与A组治疗后比较,B、C、D组Hb A1c、TG水平均明显更低(P<0.05,P<0.01); C、D组WC、FLI、VAI水平明显更低(P<0.01);仅有D组HOMA-IR水平明显更低(P<0.01)。与B组治疗后比较,C、D组FLI、VAI下降更加明显(P<0.05,P<0.01)。(3)组间治疗后两两比较,与A组相比,B组、C组、D组IGR向NGT逆转的发生率明显更高(P<0.01),B组、C组、D组IGR向DM转化的发生率明显更低(P<0.01)。与B组相比,C组、D组IGR向NGT逆转的发生率明显更高(P<0.01),C组、D组IGR向DM转化的发生率明显更低(P<0.01)。(4)各组间不良反应发生率比较,差异无统计学意义(P>0.05)。结论无论是在生活方式干预基础上,还是在生活方式干预加二甲双胍的基础上,加用穴位埋线治疗IGR合并腹型肥胖患者,都能够对糖代谢及胰岛功能产生更好的调节作用,同时还能减轻腹型肥胖,减少内脏脂肪蓄积,减轻肝脏脂肪病变,从而预防心血管并发症、减少糖尿病的发生。
Objective To observe the effect of catgut implantation at acupoint on glycolipid metabolism in patients of impaired glucose regulation( IGR)with abdominal obesity on the basis of lifestyle intervention or lifestyle intervention and metformin. Methods A total of 160 IGR patients with abdominal obesity were randomly divided into four groups with 40 cases in each group.The group A took general dietary control and exercise advice.In addition to dietary control and exercise advice,metformin or catgut implantation at acupoint or combination of two treatments were administrated in the group B,C,D respectively. The course of treatment in each group was 6 months. The outcome was observed of IGR patients' transition to the condition of diabetes mellitus( DM) or normal glucose tolerance( NGT) and the data were compared of the glycosylated hemoglobin( HbA1 c),serum lipids( TC,TG,LDLC,HDL-C),fasting blood glucose,plasma insulin,the relative indexes of liver function and the changes of waist circumference( WC),height and body mass level. The changes of insulin resistance index( HOMA-IR) and fatty liver index( FLI),) visceral fat index( VAI) were calculated and compared.Results(1)A total of 156 patients completed the trial,including 40 cases in the group A,37 cases in the group B,40 cases in the group C and 39 cases in the group D.(2)Compared with those before treatment,the levels of Hb Alc,HOMA-IR,TG,LDL,WC,BMI and FLI were significantly decreased in the group B,C,D( P<0.05,P<0.01).The level of BMI,FLI in the group A was significantly lower than that before treatment( P<0.05),and only the level of VAI in the group C and D was decreased( P<0.05). Compared with the group A after treatment,the levels of HbA1 c,TG were significantly lower in the group B,C and D( P<0.05,P<0.01) and the levels of WC,FLI,VAI were significantly lower in the group C and D( P<0.01). Only the level of HOMA-IR in the group D was significantly lower than that in the group A after treatment( P<0.01). The FLI,VAI of the group C and D were significantly lower than those of the group B after treatment( P<0.05,P<0.01).(3) Comparing two groups after treatment,the incidence of IGR reverse to NGT in the group B,C and D was significantly higher than that in the group A( P<0.01),and the incidence of IGR conversion to DM in the group B,C and D was significantly lower than that in the group A( P<0.01). Compared with the group B,the incidence of IGR reverse to NGT in the group C and D was significantly higher( P<0.01),and the incidence of IGR conversion to DM in the group D was significantly lower( P < 0. 01).(4) There was no significant difference in the incidence of adverse reactions among the groups( P>0.05). Conclusion Whether on the basis of lifestyle intervention or on the basis of lifestyle intervention and metformin,the catgut implantation at acupoint has a better regulating effect on glucose metabolism and pancreatic islet function in the treatment of IGR patients with abdominal obesity. At the same time,it can reduce abdominal obesity,the accumulation of visceral fat and hepatic fatty lesions,thereby preventing cardiovascular complications and reducing the incidence of diabetes.
Objective To observe the effect of catgut implantation at acupoint on glycolipid metabolism in patients of impaired glucose regulation( IGR)with abdominal obesity on the basis of lifestyle intervention or lifestyle intervention and metformin. Methods A total of 160 IGR patients with abdominal obesity were randomly divided into four groups with 40 cases in each group.The group A took general dietary control and exercise advice.In addition to dietary control and exercise advice,metformin or catgut implantation at acupoint or combination of two treatments were administrated in the group B,C,D respectively. The course of treatment in each group was 6 months. The outcome was observed of IGR patients' transition to the condition of diabetes mellitus( DM) or normal glucose tolerance( NGT) and the data were compared of the glycosylated hemoglobin( HbA1 c),serum lipids( TC,TG,LDLC,HDL-C),fasting blood glucose,plasma insulin,the relative indexes of liver function and the changes of waist circumference( WC),height and body mass level. The changes of insulin resistance index( HOMA-IR) and fatty liver index( FLI),) visceral fat index( VAI) were calculated and compared.Results(1)A total of 156 patients completed the trial,including 40 cases in the group A,37 cases in the group B,40 cases in the group C and 39 cases in the group D.(2)Compared with those before treatment,the levels of Hb Alc,HOMA-IR,TG,LDL,WC,BMI and FLI were significantly decreased in the group B,C,D( P<0.05,P<0.01).The level of BMI,FLI in the group A was significantly lower than that before treatment( P<0.05),and only the level of VAI in the group C and D was decreased( P<0.05). Compared with the group A after treatment,the levels of HbA1 c,TG were significantly lower in the group B,C and D( P<0.05,P<0.01) and the levels of WC,FLI,VAI were significantly lower in the group C and D( P<0.01). Only the level of HOMA-IR in the group D was significantly lower than that in the group A after treatment( P<0.01). The FLI,VAI of the group C and D were significantly lower than those of the group B after treatment( P<0.05,P<0.01).(3) Comparing two groups after treatment,the incidence of IGR reverse to NGT in the group B,C and D was significantly higher than that in the group A( P<0.01),and the incidence of IGR conversion to DM in the group B,C and D was significantly lower than that in the group A( P<0.01). Compared with the group B,the incidence of IGR reverse to NGT in the group C and D was significantly higher( P<0.01),and the incidence of IGR conversion to DM in the group D was significantly lower( P < 0. 01).(4) There was no significant difference in the incidence of adverse reactions among the groups( P>0.05). Conclusion Whether on the basis of lifestyle intervention or on the basis of lifestyle intervention and metformin,the catgut implantation at acupoint has a better regulating effect on glucose metabolism and pancreatic islet function in the treatment of IGR patients with abdominal obesity. At the same time,it can reduce abdominal obesity,the accumulation of visceral fat and hepatic fatty lesions,thereby preventing cardiovascular complications and reducing the incidence of diabetes.
引文
[1] XU Y,WANG L,HE J,et al. Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
[2] EADES C E,FRANCE E F,EVANS J M. Prevalence of impaired glucose regulation in Europe:a meta-analysis[J].Eur J Public Health,2016,26(4):699-706.
[3] SCHINNER S,FUTH R,KEMPF K,et al. A progressive increase in cardiovascular risk assessed by coronary angiography in non-diabetic patients at sub-diabetic glucose levels[J]. Cardiovasc Diabetol,2011,24(10):56.
[4] CURRIE G,ANGELYN BETHEL M,HOLZHAUER B,et al. Effect of valsartan on kidney outcomes in people with impaired glucose tolerance[J].Diabetes Obes Metab,2017,19(6):791-799.
[5] KONG A P,LUK A O,CHAN J C.Detecting people at high risk of type2 diabetes-How do we find them and who should be treated?[J].Best Pract Res Clin Endocrinol Metab,2016,30(3):345-355.
[6] BOOTH A,MAGNUSON A,FOUTS J,et al.Adipose tissue,obesity and adipokines:role in cancer promotion[J].Horm Mol Biol Clin Investig,2015,21(1):57-74.
[7]许蕾,储浩然,程楚.针灸治疗肥胖症的临床研究[J].长春中医药大学学报,2016,32(1):75-77.
[8]张小丽.穴位埋线与穴位注射对2型糖尿病大鼠pander及Caspase-3表达影响的比较研究[J].中医学报,2015,11(9):443-446.
[9]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013)[J].中华糖尿病杂志,2014,6(7):447-498.
[10]中华中医药学会.糖尿病中医防治指南[J].中国中医药现代远程教育,2011,9(4):148-151.
[11]李益,洒玉萍.穴位埋线对肥胖模型大鼠脂联素及其受体的影响[J].世界中医药,2015,10(11):1752-1759.
[12]管志敏,柏晓辉,屈璐,等.穴位埋线与糖通饮对早期糖尿病肾病大鼠血清TGF和IGF-1的影响[J].贵阳医学院学报,2015,40(12):1352-1355.
[13] GAO L,KONG X J,SHI X.Effects of electroacupuncture and acupoint catgut-embedding on mRNA expression of lipid metabolism gene PPAR-gamma and related lipase of rats with simple obesity[J]. Chin Acupunct&Moxibust,2011,31(6):535-538.
[14] GARCIA-VIVAS J M,GALAVIZ-HERNANDEZ C,BECERRILCHAVEZ F,et al. Acupoint catgut embedding therapy with moxibustion reduces the risk of diabetes in obese women[J].J Res Med Sci,2014,19(7):610-616.
[15] CHEN I J,YEH Y H,HSU C H.Therapeutic effect of acupoint catgut embedding in abdominally obese women:a randomized,double-blind,placebo-controlled study[J]. J Womens Health(Larchmt),2018,27(6):782-790.
[16] DAGHRI N M,ATTAS O S,ALOKAIL M S,et a1.Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances[J].Eur J Clin Invest,2013,43(2):183-189.
[17] HIRATA A,SUGIYAMA D,KUWABARA K.Fatty liver index predicts incident diabetes in a Japanese general population with and without impaired fasting glucose[J].Hepatol Res,2018,48(9):708-716.
[2] EADES C E,FRANCE E F,EVANS J M. Prevalence of impaired glucose regulation in Europe:a meta-analysis[J].Eur J Public Health,2016,26(4):699-706.
[3] SCHINNER S,FUTH R,KEMPF K,et al. A progressive increase in cardiovascular risk assessed by coronary angiography in non-diabetic patients at sub-diabetic glucose levels[J]. Cardiovasc Diabetol,2011,24(10):56.
[4] CURRIE G,ANGELYN BETHEL M,HOLZHAUER B,et al. Effect of valsartan on kidney outcomes in people with impaired glucose tolerance[J].Diabetes Obes Metab,2017,19(6):791-799.
[5] KONG A P,LUK A O,CHAN J C.Detecting people at high risk of type2 diabetes-How do we find them and who should be treated?[J].Best Pract Res Clin Endocrinol Metab,2016,30(3):345-355.
[6] BOOTH A,MAGNUSON A,FOUTS J,et al.Adipose tissue,obesity and adipokines:role in cancer promotion[J].Horm Mol Biol Clin Investig,2015,21(1):57-74.
[7]许蕾,储浩然,程楚.针灸治疗肥胖症的临床研究[J].长春中医药大学学报,2016,32(1):75-77.
[8]张小丽.穴位埋线与穴位注射对2型糖尿病大鼠pander及Caspase-3表达影响的比较研究[J].中医学报,2015,11(9):443-446.
[9]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013)[J].中华糖尿病杂志,2014,6(7):447-498.
[10]中华中医药学会.糖尿病中医防治指南[J].中国中医药现代远程教育,2011,9(4):148-151.
[11]李益,洒玉萍.穴位埋线对肥胖模型大鼠脂联素及其受体的影响[J].世界中医药,2015,10(11):1752-1759.
[12]管志敏,柏晓辉,屈璐,等.穴位埋线与糖通饮对早期糖尿病肾病大鼠血清TGF和IGF-1的影响[J].贵阳医学院学报,2015,40(12):1352-1355.
[13] GAO L,KONG X J,SHI X.Effects of electroacupuncture and acupoint catgut-embedding on mRNA expression of lipid metabolism gene PPAR-gamma and related lipase of rats with simple obesity[J]. Chin Acupunct&Moxibust,2011,31(6):535-538.
[14] GARCIA-VIVAS J M,GALAVIZ-HERNANDEZ C,BECERRILCHAVEZ F,et al. Acupoint catgut embedding therapy with moxibustion reduces the risk of diabetes in obese women[J].J Res Med Sci,2014,19(7):610-616.
[15] CHEN I J,YEH Y H,HSU C H.Therapeutic effect of acupoint catgut embedding in abdominally obese women:a randomized,double-blind,placebo-controlled study[J]. J Womens Health(Larchmt),2018,27(6):782-790.
[16] DAGHRI N M,ATTAS O S,ALOKAIL M S,et a1.Visceral adiposity index is highly associated with adiponectin values and glycaemic disturbances[J].Eur J Clin Invest,2013,43(2):183-189.
[17] HIRATA A,SUGIYAMA D,KUWABARA K.Fatty liver index predicts incident diabetes in a Japanese general population with and without impaired fasting glucose[J].Hepatol Res,2018,48(9):708-716.