中医对2型糖尿病合并非酒精性脂肪肝的认识和展望
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摘要
2型糖尿病人群非酒精性脂肪肝患病率显著增加,2型糖尿病和非酒精性脂肪肝两者常常相互影响,致使肝病进展、内分泌代谢紊乱加重和心血管疾病患病风险增加,从而使疾病的管理变得更加复杂。然而目前西医很少有治疗非酒精性脂肪肝炎安全有效的药物,而中医药整体综合调治优势,在2型糖尿病合并非酒精性脂肪肝治疗中发挥着重要作用。因此,文章通过系统检索和分析中国知网上有关中医药治疗2型糖尿病合并非酒精性脂肪肝的文献,总结了2型糖尿病合并非酒精性脂肪肝的病因病机、辨证分型、治疗等研究进展。并在综述基础上,提出了未来对中医药治疗2型糖尿病合并非酒精性脂肪肝研究的展望,以期更好发挥中医药整体综合调治的优势。
Patients with type 2 diabetes mellitus(T2DM) have a increased risk of nonalcoholic fatty liver disease(NAFLD).T2 DM and NAFLD usually influence each other.The coexistence of NAFLD and T2 DM appears to worsen the course of NAFLD,and leads to a worse metabolic profile and a higher cardiovascular risk,which makes disease management more challenging.In fact,there is few pharmacological agents with proven efficacy for nonalcoholic steatohepatitis(NASH).Traditional Chinese medicine(TCM) is charactered by holistic treatment and syndrome differentiation,which plays a more and more important role in the treatment of T2 DM with NAFLD.Therefore,we systematically analyzed articles concerning TCM treatment on T2 DM with NAFLD from Chinese National Knowledge Infrastructure,and summarized the etiology and pathogenesis,the syndrome differentiation and the treatment of T2 DM with NAFLD.Eventually,based on the analysis,we proposed some outlooks of TCM treatment on T2 DM with NAFLD,in order to take advantages of holistic treatment and syndrome differentiation of TCM well.
Patients with type 2 diabetes mellitus(T2DM) have a increased risk of nonalcoholic fatty liver disease(NAFLD).T2 DM and NAFLD usually influence each other.The coexistence of NAFLD and T2 DM appears to worsen the course of NAFLD,and leads to a worse metabolic profile and a higher cardiovascular risk,which makes disease management more challenging.In fact,there is few pharmacological agents with proven efficacy for nonalcoholic steatohepatitis(NASH).Traditional Chinese medicine(TCM) is charactered by holistic treatment and syndrome differentiation,which plays a more and more important role in the treatment of T2 DM with NAFLD.Therefore,we systematically analyzed articles concerning TCM treatment on T2 DM with NAFLD from Chinese National Knowledge Infrastructure,and summarized the etiology and pathogenesis,the syndrome differentiation and the treatment of T2 DM with NAFLD.Eventually,based on the analysis,we proposed some outlooks of TCM treatment on T2 DM with NAFLD,in order to take advantages of holistic treatment and syndrome differentiation of TCM well.
引文
[1] Limin Wang,Pei Gao,Mei Zhang,et al.Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013[J].JAMA,2017,317(24):2515-2523.
[2] Loomba R,Sanyal AJ.The global NAFLD epidemic[J].Nat Rev Gastroenterol Hepatol,2013,10(11):686-690.
[3] Rinella ME.Nonalcoholic fatty liver disease:a systematic review[J].JAMA,2015,313(22):2263-2273.
[4] Hazlehurst JM,Woods C,Marjot T,et al.Non-alcoholic fatty liver disease and diabetes[J].Metabolism,2016,65(8):1096-1108.
[5] Fernando Bril,Kenneth Cusi.Management of nonalcoholic fatty liver disease in patients with type 2 diabetes:a call to action[J].diabetes care,2017,40(3):419-430.
[6] 李志颖,丁亮,李慧金,等.糖尿病非酒精性脂肪肝的病因病机探讨[J].辽宁中医杂志,2015,42(1):52-54.
[7] 徐朝阳.2型糖尿病合并非酒精性脂肪肝的中医辨治思路与方法[J].中国医药指南,2012,10(36):293-295.
[8] 杨春华.从脾论治糖尿病探析[J].中医学报,2012,27(7):829-830.
[9] 金晓雯,王旭.2型糖尿病合并非酒精性脂肪肝中医临床研究进展[J].辽宁中医药大学学报,2012,14(4):99-100.
[10] 陈淼,周语平,刘臻华.2型糖尿病合并非酒精性脂肪性肝病的中医研究进展[J].甘肃中医药大学学报,2016,33(1):86-89.
[11] 柯斌,秦鉴.中医对2型糖尿病胰岛素抵抗的认识及治疗进展[J].中医杂志,2010,51(S2):257-259.
[12] 陈霞波.糖耐量低减与脾不散精[J].浙江中医杂志,2005,40(3):118-119.
[13] 朱章志,黄从强,何敏.健脾益气中药对脾气虚2型糖尿病大鼠胰岛素介体的影响[J].中药新药与临床药理,2004,15(2):107-109.
[14] 杨钦河,凌家生,平换换,等.非酒精性脂肪肝的中医药防治思路与对策[J].中医杂志,2007,48(8):746-748.
[15] 唐智敏,茹清静,张振鄂,等.肝血瘀阻与肝纤维化关系的临床研究[J].中国中西医结合杂志,1997,17(2):81-83.
[16] 齐洪军,胡蔓菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J].四川中医,2004,22(4):26-28.
[17] 魏华凤,季光,邢练军.脂肪肝辨证分型规律的初步研究[J].辽宁中医杂志,2002,29(11):655-656.
[18] 高天舒,晏丽丽,王英娜.新诊断2型糖尿病常见中医证型与非酒精性脂肪肝及其相关危险因素分析[J].辽宁中医杂志,2011,38(2):200-202.
[19] 赵晨.社区人群非酒精性脂肪肝并Ⅱ型糖尿病中医证候特点分析[D].北京:北京中医药大学,2015.
[20] 张强,朱磊,权兴苗,等.2型糖尿病合并非酒精性脂肪肝的辨证分型[J].海南医学,2013,24(12):1717-1722.
[21] 陈嘉嘉.2型糖尿病合并非酒精性脂肪肝中医证候及体质研究[D].广州:广州中医药大学,2012.
[22] 陈筑红,夏城东,黄佳娜,等.2型糖尿病并发非酒精性脂肪肝患者证素分析[J].中国中西医结合杂志,2008,28(10):879-881.
[23] 周建扬,翁思颖.2型糖尿病合并非酒精性脂肪肝患者的肝脏脂肪变性程度与中医体质相关性研究[J].新中医,2016,48(11):51-53.
[24] 翁思颖,柴可夫,周建扬.2型糖尿病合并非酒精性脂肪肝中医体质分布规律与基因多态性关系研究[J].中华中医药杂志,2017,32(5):2216-2218.
[25] 郝宗艳.2型糖尿病伴非酒精性脂肪肝患者中医体质研究[D].杭州:浙江中医药大学,2013.
[26] 张增祥.2型糖尿病合并非酒精性脂肪性肝病患者血浆同型半胱氨酸和中医体质类型的相关性研究[D].杭州:浙江中医药大学,2014.
[27] 詹惠娟.疏肝健脾颗粒剂在肝郁脾虚型2型糖尿病合并非酒精性脂肪肝治疗中的增效观察[D].南京:南京中医药大学,2016.
[28] 肖凤英,张压西,崔金涛,等.茵芩清肝汤治疗2型糖尿病伴非酒精性脂肪肝病的临床观察[J].中西医结合研究,2012,4(6):281-284.
[29] 沈均,高书荣,梁爱宝.补肾健脾化瘀方治疗2型糖尿病併非酒精性脂肪肝病的临床研究[J].中国中西医结合消化杂志,2012,20(7):318-321.
[30] 张卫星,吴忆东.补肝肾法治疗2型糖尿病性非酒精性脂肪肝50例[J].浙江中医杂志,2009,44(4):269.
[31] 黄召谊,屠庆年,陈广,等.益气通阳化痰方治疗2型糖尿病合并非酒精性脂肪肝的临床研究[J].现代中西医结合杂志,2012,21(20):2181-2183.
[32] 程莉娟,成细华,喻嵘,等.滋阴益气活血解毒法治疗32例2型糖尿病合并非酒精性脂肪肝的临床观察[J].中华中医药杂志,2013,28(9):2807-2809.
[33] 梅峰,钱春平.天麦消渴片对2型糖尿病合并非酒精性脂肪肝患者胰岛素抵抗的改善作用[J].中国药业,2014,23(24):54-55.
[34] 吴坚,竺春玲,沈晓喻,等.金芪降糖片对2型糖尿病合并非酒精性脂肪肝胰岛素抵抗及血管活性因子的影响[J].湖北中医杂志,2015,37(12):4-6.
[35] 王晓蕴,张忠勇,祁月英,等.清热祛浊胶囊治疗2型糖尿病合并非酒精性脂肪肝观察[J].成都中医药大学学报,2014,37(3):43-45.
[36] 郑仲萍,田峰,郑志刚,等.二甲双胍联用六味地黄丸对新诊断2型糖尿病合并非酒精性脂肪肝疗效观察[J].辽宁中医药大学学报,2015,17(7):123-126.
[37]葛晓春,王英南,刘晓燕,等.血脂康胶囊治疗绝经后女性2型糖尿病合并非酒精性脂肪肝的临床观察[J].中国药房,2016,27(33):4641-4643.
[38]魏敬,吴锦丹,蒋建东.盐酸小檗碱治疗2型糖尿病合并脂肪肝的临床研究[J].中西医结合肝病杂志,2004,14(6):334-336.
[39]薛莉,陈宏,张萍,等.调理脾胃针法治疗2型糖尿病合并非酒精性脂肪肝30例[J].辽宁中医杂志,2011,14(6):334-336.
[40]卢颖. 2型糖尿病合并非酒精性脂肪肝诊断及针刺疗效研究[D].广州:广州中医药大学,2016.
[41]钱静娟,华忠,刘霞英,等.针灸治疗非酒精性脂肪肝疗效观察与护理[J].现代中西医结合杂志,2012,21(9):998-999.
[2] Loomba R,Sanyal AJ.The global NAFLD epidemic[J].Nat Rev Gastroenterol Hepatol,2013,10(11):686-690.
[3] Rinella ME.Nonalcoholic fatty liver disease:a systematic review[J].JAMA,2015,313(22):2263-2273.
[4] Hazlehurst JM,Woods C,Marjot T,et al.Non-alcoholic fatty liver disease and diabetes[J].Metabolism,2016,65(8):1096-1108.
[5] Fernando Bril,Kenneth Cusi.Management of nonalcoholic fatty liver disease in patients with type 2 diabetes:a call to action[J].diabetes care,2017,40(3):419-430.
[6] 李志颖,丁亮,李慧金,等.糖尿病非酒精性脂肪肝的病因病机探讨[J].辽宁中医杂志,2015,42(1):52-54.
[7] 徐朝阳.2型糖尿病合并非酒精性脂肪肝的中医辨治思路与方法[J].中国医药指南,2012,10(36):293-295.
[8] 杨春华.从脾论治糖尿病探析[J].中医学报,2012,27(7):829-830.
[9] 金晓雯,王旭.2型糖尿病合并非酒精性脂肪肝中医临床研究进展[J].辽宁中医药大学学报,2012,14(4):99-100.
[10] 陈淼,周语平,刘臻华.2型糖尿病合并非酒精性脂肪性肝病的中医研究进展[J].甘肃中医药大学学报,2016,33(1):86-89.
[11] 柯斌,秦鉴.中医对2型糖尿病胰岛素抵抗的认识及治疗进展[J].中医杂志,2010,51(S2):257-259.
[12] 陈霞波.糖耐量低减与脾不散精[J].浙江中医杂志,2005,40(3):118-119.
[13] 朱章志,黄从强,何敏.健脾益气中药对脾气虚2型糖尿病大鼠胰岛素介体的影响[J].中药新药与临床药理,2004,15(2):107-109.
[14] 杨钦河,凌家生,平换换,等.非酒精性脂肪肝的中医药防治思路与对策[J].中医杂志,2007,48(8):746-748.
[15] 唐智敏,茹清静,张振鄂,等.肝血瘀阻与肝纤维化关系的临床研究[J].中国中西医结合杂志,1997,17(2):81-83.
[16] 齐洪军,胡蔓菁.从“痰瘀”角度浅析肝纤维化的病因病机及治疗[J].四川中医,2004,22(4):26-28.
[17] 魏华凤,季光,邢练军.脂肪肝辨证分型规律的初步研究[J].辽宁中医杂志,2002,29(11):655-656.
[18] 高天舒,晏丽丽,王英娜.新诊断2型糖尿病常见中医证型与非酒精性脂肪肝及其相关危险因素分析[J].辽宁中医杂志,2011,38(2):200-202.
[19] 赵晨.社区人群非酒精性脂肪肝并Ⅱ型糖尿病中医证候特点分析[D].北京:北京中医药大学,2015.
[20] 张强,朱磊,权兴苗,等.2型糖尿病合并非酒精性脂肪肝的辨证分型[J].海南医学,2013,24(12):1717-1722.
[21] 陈嘉嘉.2型糖尿病合并非酒精性脂肪肝中医证候及体质研究[D].广州:广州中医药大学,2012.
[22] 陈筑红,夏城东,黄佳娜,等.2型糖尿病并发非酒精性脂肪肝患者证素分析[J].中国中西医结合杂志,2008,28(10):879-881.
[23] 周建扬,翁思颖.2型糖尿病合并非酒精性脂肪肝患者的肝脏脂肪变性程度与中医体质相关性研究[J].新中医,2016,48(11):51-53.
[24] 翁思颖,柴可夫,周建扬.2型糖尿病合并非酒精性脂肪肝中医体质分布规律与基因多态性关系研究[J].中华中医药杂志,2017,32(5):2216-2218.
[25] 郝宗艳.2型糖尿病伴非酒精性脂肪肝患者中医体质研究[D].杭州:浙江中医药大学,2013.
[26] 张增祥.2型糖尿病合并非酒精性脂肪性肝病患者血浆同型半胱氨酸和中医体质类型的相关性研究[D].杭州:浙江中医药大学,2014.
[27] 詹惠娟.疏肝健脾颗粒剂在肝郁脾虚型2型糖尿病合并非酒精性脂肪肝治疗中的增效观察[D].南京:南京中医药大学,2016.
[28] 肖凤英,张压西,崔金涛,等.茵芩清肝汤治疗2型糖尿病伴非酒精性脂肪肝病的临床观察[J].中西医结合研究,2012,4(6):281-284.
[29] 沈均,高书荣,梁爱宝.补肾健脾化瘀方治疗2型糖尿病併非酒精性脂肪肝病的临床研究[J].中国中西医结合消化杂志,2012,20(7):318-321.
[30] 张卫星,吴忆东.补肝肾法治疗2型糖尿病性非酒精性脂肪肝50例[J].浙江中医杂志,2009,44(4):269.
[31] 黄召谊,屠庆年,陈广,等.益气通阳化痰方治疗2型糖尿病合并非酒精性脂肪肝的临床研究[J].现代中西医结合杂志,2012,21(20):2181-2183.
[32] 程莉娟,成细华,喻嵘,等.滋阴益气活血解毒法治疗32例2型糖尿病合并非酒精性脂肪肝的临床观察[J].中华中医药杂志,2013,28(9):2807-2809.
[33] 梅峰,钱春平.天麦消渴片对2型糖尿病合并非酒精性脂肪肝患者胰岛素抵抗的改善作用[J].中国药业,2014,23(24):54-55.
[34] 吴坚,竺春玲,沈晓喻,等.金芪降糖片对2型糖尿病合并非酒精性脂肪肝胰岛素抵抗及血管活性因子的影响[J].湖北中医杂志,2015,37(12):4-6.
[35] 王晓蕴,张忠勇,祁月英,等.清热祛浊胶囊治疗2型糖尿病合并非酒精性脂肪肝观察[J].成都中医药大学学报,2014,37(3):43-45.
[36] 郑仲萍,田峰,郑志刚,等.二甲双胍联用六味地黄丸对新诊断2型糖尿病合并非酒精性脂肪肝疗效观察[J].辽宁中医药大学学报,2015,17(7):123-126.
[37]葛晓春,王英南,刘晓燕,等.血脂康胶囊治疗绝经后女性2型糖尿病合并非酒精性脂肪肝的临床观察[J].中国药房,2016,27(33):4641-4643.
[38]魏敬,吴锦丹,蒋建东.盐酸小檗碱治疗2型糖尿病合并脂肪肝的临床研究[J].中西医结合肝病杂志,2004,14(6):334-336.
[39]薛莉,陈宏,张萍,等.调理脾胃针法治疗2型糖尿病合并非酒精性脂肪肝30例[J].辽宁中医杂志,2011,14(6):334-336.
[40]卢颖. 2型糖尿病合并非酒精性脂肪肝诊断及针刺疗效研究[D].广州:广州中医药大学,2016.
[41]钱静娟,华忠,刘霞英,等.针灸治疗非酒精性脂肪肝疗效观察与护理[J].现代中西医结合杂志,2012,21(9):998-999.