2型糖尿病患者胰岛素抵抗与不寐不同中医证型之间的相关性研究
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摘要
目的:探讨2型糖尿病患者胰岛素抵抗与不寐不同中医证型的相关性,以及胰岛素抵抗指数与相关危险因素的关系。方法:对入选的90例2型糖尿病伴有不寐患者进行问卷调查,填写匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI),并进行中医证候学诊断,分析不同证型特点,对结果进行统计学方法。结果:2型糖尿病伴有不寐患者主要证型为阴虚火旺证(35.56%),其他依次为痰热内扰证(20.00%),肝郁化火证(17.78%),心脾两虚证(15.55%),心虚胆怯证(11.11%),阴虚火旺证与其他证型比较,差异均有统计学意义(P <0.05)。心脾两虚证患者的胰岛素抵抗指数(HOMA-IR)水平最高,肝郁化火证水平最低;患者的PSQI评分与胰岛素抵抗指数(HOMA-IR与)差异有统计学意义。此外,HOMA-IR与腰围(WC)、体重指数(BMI)、糖化血红蛋白(HAb1c)、三酰甘油(TG)、总胆固醇(CHOL)均呈正相关(P <0.05),与收缩压、舒张压差异无统计学意义(P> 0.05)。结论:2型糖尿病患者胰岛素抵抗与不寐具有相关性。
Objective: To explore the correlation between insulin resistance and different TCM syndromes of insomnia in type 2 diabetic patients,and the relationship between insulin resistance index and related risk factors. Methods: 90 patients with type 2 diabetes mellitus with insomnia were investigated by questionnaire, Pittsburgh Sleep quality index(PSQi) was filled out, and tcM syndromes were diagnosed. The characteristics of different syndromes were analyzed and the results were statistically analyzed. Results: The main syndromes of type 2 diabetes mellitus with insomnia were yin deficiency and fire hyperactivity syndrome(35.56%), other syndromes included phlegm heat and internal disturbance syndrome(20.00%), liver stagnation and fire syndrome(17.78%), heart and spleen deficiency syndrome(15.55%), heart deficiency and gallbladder syndrome(11.11%), and the difference between Yin deficiency and fire flourishing syndrome and other syndrome types was statistically significant(P < 0.05). The level of insulin resistance index(HOMA-IR) was the highest in the patients with deficiency of heart and spleen and the lowest level was in the patients with liver depression and fire, and there was significant difference between the PSQi score and the insulin resistance index(HOMa-iR and HOMa-iR). in addition, HOMa-iR was positively correlated with waist circumference(WC), body mass index(BMI), glycosylated hemoglobin(HAb1 c), triglyceride(TG), total cholesterol(Chol)(P < 0.05). there was no significant difference in systolic blood pressure and diastolic blood pressure(P > 0.05). Conclusion: There was a correlation between insulin resistance and insomnia in patients with type 2 diabetes mellitus.
Objective: To explore the correlation between insulin resistance and different TCM syndromes of insomnia in type 2 diabetic patients,and the relationship between insulin resistance index and related risk factors. Methods: 90 patients with type 2 diabetes mellitus with insomnia were investigated by questionnaire, Pittsburgh Sleep quality index(PSQi) was filled out, and tcM syndromes were diagnosed. The characteristics of different syndromes were analyzed and the results were statistically analyzed. Results: The main syndromes of type 2 diabetes mellitus with insomnia were yin deficiency and fire hyperactivity syndrome(35.56%), other syndromes included phlegm heat and internal disturbance syndrome(20.00%), liver stagnation and fire syndrome(17.78%), heart and spleen deficiency syndrome(15.55%), heart deficiency and gallbladder syndrome(11.11%), and the difference between Yin deficiency and fire flourishing syndrome and other syndrome types was statistically significant(P < 0.05). The level of insulin resistance index(HOMA-IR) was the highest in the patients with deficiency of heart and spleen and the lowest level was in the patients with liver depression and fire, and there was significant difference between the PSQi score and the insulin resistance index(HOMa-iR and HOMa-iR). in addition, HOMa-iR was positively correlated with waist circumference(WC), body mass index(BMI), glycosylated hemoglobin(HAb1 c), triglyceride(TG), total cholesterol(Chol)(P < 0.05). there was no significant difference in systolic blood pressure and diastolic blood pressure(P > 0.05). Conclusion: There was a correlation between insulin resistance and insomnia in patients with type 2 diabetes mellitus.
引文
[1]中华医学会糖尿病学分会.中国2型糖尿病防治指南[J].中华糖尿病杂志,2018,10(01):4.
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[8]黄广文,马敏,张建华,等.长沙市两个行政区2~6岁儿童睡眠问题与家庭环境初步研究[J].中国儿童保健杂志,2007,15(01):42-44.
[9]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:146.
[10]王中男.不寐证中医辩证综合治疗方案的选择[J].吉林中医药,2007,27(05):7-8.
[11]BuysseDJ,Reynolds CF 3rd,Monk TH,et al.The Pittsburgh sleep quality index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(02):193-213.
[12]Kita T,Yoshioka E,Satoh H,et al.Short sleep duration and poor sleep quality increase the risk of diabetes in Japanese workers with no family history of diabetes[J].Diabetes Care,2012,35(02):313-318.
[13]Buxton OM,Pavlova M,Reid EW,et al.Sleep restriction for 1 week reduces insulin sensitivity in healthy men[J].Diabetes,2010,59(09):2126-2133.
[14]Khoo CM,Sairazi S,Taslim S,et al.Ethnicity modifies the relationships of insulin resistance,inflammation,and adiponectin with obesity in a multiethnic Asian population[J].Diabetes Care,2011,34(05):1120-1126.
[15]Seidell JC.Obesity,insulin resistance and diabetes--a worldwide epidemic[J].Br J Nutr,2000,83(Suppl 1):S5-S8.
[2]Guariguata L,Whiting D,Hambleton I,et al.Global estimates of diabetes prevalence for 2013 and projections for 2035[J].Diabetes Res Clin Pracrt,2014,103(02):137-149.
[3]Shaw JE,Punjabi NM,Wilging JP,et al.Sleep-disordered breathing and type 2 diabetes:a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention[J].Diabetes Res Clin Pract,2008,81(01):2-12.
[4]葛军波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:733-737.
[5]Barone MT,Menna-Barreto L.Diabetes and sleep:a complex cause-andeffect relationship[J].Diabetes Res Clin Pract,2011,91(02):129-137.
[6]Spiegel K,Knutson K,Leproult R,et al.Sleep loss:a novei risk factor for insulin resistance and type 2 diabetes[J].J Appl Physiol,2005,99(05):2008-2019.
[7]朱冰倩,李小妹.2型糖尿病患者睡眠质量及其对血糖控制的影响[J].中华护理杂志,2014,09(49):9.
[8]黄广文,马敏,张建华,等.长沙市两个行政区2~6岁儿童睡眠问题与家庭环境初步研究[J].中国儿童保健杂志,2007,15(01):42-44.
[9]周仲瑛.中医内科学[M].北京:中国中医药出版社,2007:146.
[10]王中男.不寐证中医辩证综合治疗方案的选择[J].吉林中医药,2007,27(05):7-8.
[11]BuysseDJ,Reynolds CF 3rd,Monk TH,et al.The Pittsburgh sleep quality index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(02):193-213.
[12]Kita T,Yoshioka E,Satoh H,et al.Short sleep duration and poor sleep quality increase the risk of diabetes in Japanese workers with no family history of diabetes[J].Diabetes Care,2012,35(02):313-318.
[13]Buxton OM,Pavlova M,Reid EW,et al.Sleep restriction for 1 week reduces insulin sensitivity in healthy men[J].Diabetes,2010,59(09):2126-2133.
[14]Khoo CM,Sairazi S,Taslim S,et al.Ethnicity modifies the relationships of insulin resistance,inflammation,and adiponectin with obesity in a multiethnic Asian population[J].Diabetes Care,2011,34(05):1120-1126.
[15]Seidell JC.Obesity,insulin resistance and diabetes--a worldwide epidemic[J].Br J Nutr,2000,83(Suppl 1):S5-S8.