2型糖尿病中医证型与胰岛素样生长因子-1、Homa-IR指数关系研究
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摘要
目的:观察2型糖尿病患者不同的中医证型与胰岛素样生长因子-1(IGF-1)、胰岛素抵抗(Homa-IR)指数的关系。方法:对确诊为2型糖尿病的195例患者进行辨证分型、数据统计,分析不同的中医证型与患者的病程、年龄、IGF-1、Homa-IR指数、糖化血红蛋白(HBA1c)、25羟基维生素D等的相关性。结果:(1)2型糖尿病患者的中医证型分布依次为气阴两虚证>湿热困脾证>阴虚热盛证>血瘀脉络证>阴阳两虚证。(2)2型糖尿病各中医证型与年龄有统计学意义,血瘀脉络证的平均年龄最高;各中医证型与病程相关,病程较短者以阴虚热盛证、湿热困脾证多见;而阴阳两虚、血瘀脉络证则多见于病程较长者。(3)2型糖尿病各中医证型分布与IGF-1、Homa-IR指数有统计学意义(P<0.05)。其中,阴虚热盛证的IGF-1最低,各证型按升序分别为阴虚热盛证<湿热困脾证<血瘀脉络证<阴阳两虚证<气阴两虚证;湿热困脾型患者的胰岛素抵抗指数最高,血瘀脉络证次之,而阴虚热盛证、气阴两虚证、阴阳两虚证的HomaIR指数较接近;各中医证型中HBA1c组间无统计学差异。(4)2型糖尿病五种证型分布与25羟基维生素D、高密度脂蛋白无相关性;低密度脂蛋白接近有统计学意义;与血脂水平有统计学意义(P<0.05),其中湿热困脾证的血脂最高。结论:2型糖尿病患者不同中医证型的IGF-1水平、胰岛素抵抗指数、血脂、病程长短、年龄分布差异显著。
Objective: To research the corresponding relationship of different traditional Chinese medicine( TCM) syndrome type and insulin-like growth factor-I( IGF-1),Homa-IR in type 2 diabetes mellitus( T2 DM). Methods: According to the syndrome differentiation and data statistics of 195 patients diagnosed as type 2 diabetes,analyzing the corresponding relationship of different TCM syndrome type and patient's course of disease,age,IGF-1,Homa-IR index,glycosylated hemoglobin( HBA1 c),25 hydroxy vitamin D and so on. Results:(1)TCM syndrome type distribution in patients with Type 2 diabetes followed by Qi and Yin deficiency syndrome,damp heat trapped spleen syndrome,Yin deficiency heat syndrome,blood stasis syndrome,Yin and Yang deficiency syndrome.(2)The TCM syndrome types with type 2 diabetes and age had statistical significance,the average age of blood stasis syndrome was the highest; The TCM syndrome types and the course of disease has statistical significance,Yin deficiency heat syndrome and damp heat trapped spleen syndrome was more common in shorter course of disease,while Yin and Yang deficiency syndrome and blood stasis syndrome was more common in the longer course of the disease.(3)TCM syndrome type distribution in patients with type 2 diabetes and IGF-1,Homa-IR index had statistical significance( P<0. 05). The IGF-1 lever of Yin deficiency heat syndrome was the lowest,the syndrome type in ascending order was Yin deficiency heat syndrome,damp heat trapped spleen syndrome,blood stasis syndrome,Yin and Yang deficiency syndrome,Qi and Yin deficiency syndrome; The insulin resistance index of damp heat trapped spleen syndrome in patients was the highest,followed by theblood stasis syndrome,the three data with Homa-IR index of Yin deficiency and heat syndrome,Qi and Yin deficiency syndrome,Yin and Yang deficiency syndrome was close to the TCM syndrome type in HBA1 c had no statistical difference.(4)There was no correlation between five types of syndrome with T2 DM and 25 hydroxy vitamin D,high density lipoprotein( HDL); Low density lipoprotein( LDL) approached the statistical significance; The TCM syndrome types and serum lipid had statistical significance,and the blood lipids of damp heat trapped spleen syndrome was highest. Conclusion: Different TCM syndrome types with T2 DM has significant difference in IGF-1 level,insulin resistance index,blood lipid,duration of disease and age distribution.
Objective: To research the corresponding relationship of different traditional Chinese medicine( TCM) syndrome type and insulin-like growth factor-I( IGF-1),Homa-IR in type 2 diabetes mellitus( T2 DM). Methods: According to the syndrome differentiation and data statistics of 195 patients diagnosed as type 2 diabetes,analyzing the corresponding relationship of different TCM syndrome type and patient's course of disease,age,IGF-1,Homa-IR index,glycosylated hemoglobin( HBA1 c),25 hydroxy vitamin D and so on. Results:(1)TCM syndrome type distribution in patients with Type 2 diabetes followed by Qi and Yin deficiency syndrome,damp heat trapped spleen syndrome,Yin deficiency heat syndrome,blood stasis syndrome,Yin and Yang deficiency syndrome.(2)The TCM syndrome types with type 2 diabetes and age had statistical significance,the average age of blood stasis syndrome was the highest; The TCM syndrome types and the course of disease has statistical significance,Yin deficiency heat syndrome and damp heat trapped spleen syndrome was more common in shorter course of disease,while Yin and Yang deficiency syndrome and blood stasis syndrome was more common in the longer course of the disease.(3)TCM syndrome type distribution in patients with type 2 diabetes and IGF-1,Homa-IR index had statistical significance( P<0. 05). The IGF-1 lever of Yin deficiency heat syndrome was the lowest,the syndrome type in ascending order was Yin deficiency heat syndrome,damp heat trapped spleen syndrome,blood stasis syndrome,Yin and Yang deficiency syndrome,Qi and Yin deficiency syndrome; The insulin resistance index of damp heat trapped spleen syndrome in patients was the highest,followed by theblood stasis syndrome,the three data with Homa-IR index of Yin deficiency and heat syndrome,Qi and Yin deficiency syndrome,Yin and Yang deficiency syndrome was close to the TCM syndrome type in HBA1 c had no statistical difference.(4)There was no correlation between five types of syndrome with T2 DM and 25 hydroxy vitamin D,high density lipoprotein( HDL); Low density lipoprotein( LDL) approached the statistical significance; The TCM syndrome types and serum lipid had statistical significance,and the blood lipids of damp heat trapped spleen syndrome was highest. Conclusion: Different TCM syndrome types with T2 DM has significant difference in IGF-1 level,insulin resistance index,blood lipid,duration of disease and age distribution.
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(2013版),中华糖尿病杂志,2014.6(7):447~498
[2]World Health Organization.Definition,Diagnosis and Classification of Diabetes Mellitus and its Coplication[C].In:Report of a WHO Con-sultation,1999
[3]M.T.Rosato,1S.H.Schneider,2S.A.Shapses.Bone Turnover and Insulin-like Growth Factor I Levels Increase After Improved Glycemic Control in Noninsulin-dependent Diabetes Mellitus.Calcif Tissue Int(1998)63:107–111
[4]I.Kanazawa,T.Yamaguchi,and T.Sugimoto.Effects of intensive glycemic control on serum levels of insulin-like growth factor-I and dehydroepiandrosterone sulfate in Type 2diabetes mellitus.J.Endocrinol.Invest.35:469~472,2012
[5]Hitomi Miyake,Ippei Kanazawa and Toshitsugu Sugimoto.Decreased serum insulin-like growth factor-I level is associated with the increased mortality in type 2diabetes mellitus.Endocr J,2016Sep 30;63(9):811~818
[6]Fiona M.Regan,*Rachel M.Williams,*Anna Mc Donald,A.Margot Umpleby,Carlo L.Acerini,Stephen O’Rahilly,Roman Hovorka,Robert K.Semple,and David B.Dunger,Treatment with Recombinant Human Insulin-Like Growth Factor(rh IGF)-I/rh IGF Binding Protein-3Complex Improves Metabolic Control in Subjects with Severe Insulin Resistance,J Clin Endocrinol Metab,May 2010,95(5):2113–2122
[7]Anna Mc Donald,Rachel M Williams,Fiona M Regan,Robert K Semple 1and David B Dunger.IGF-I treatment of insulin resistance.European Journal of Endocrinology(2007)157S51–S56
[8]陈家伦,宁光,孟迅吾.临床内分泌学[M].上海科学技术出版社,2011:979
[9]师林,柯斌,罗晓莉,从脾虚痰湿角度探讨2型糖尿病胰岛素抵抗的中医研究思路[J].广州中医药大学学报,2015(02):336~338
[10]黄菲,王纯庠,中医证型与2型糖尿病患者胰岛素抵抗及B细胞功能的关系[J].临床与病理杂志,2015,35(10):1816~1820
[2]World Health Organization.Definition,Diagnosis and Classification of Diabetes Mellitus and its Coplication[C].In:Report of a WHO Con-sultation,1999
[3]M.T.Rosato,1S.H.Schneider,2S.A.Shapses.Bone Turnover and Insulin-like Growth Factor I Levels Increase After Improved Glycemic Control in Noninsulin-dependent Diabetes Mellitus.Calcif Tissue Int(1998)63:107–111
[4]I.Kanazawa,T.Yamaguchi,and T.Sugimoto.Effects of intensive glycemic control on serum levels of insulin-like growth factor-I and dehydroepiandrosterone sulfate in Type 2diabetes mellitus.J.Endocrinol.Invest.35:469~472,2012
[5]Hitomi Miyake,Ippei Kanazawa and Toshitsugu Sugimoto.Decreased serum insulin-like growth factor-I level is associated with the increased mortality in type 2diabetes mellitus.Endocr J,2016Sep 30;63(9):811~818
[6]Fiona M.Regan,*Rachel M.Williams,*Anna Mc Donald,A.Margot Umpleby,Carlo L.Acerini,Stephen O’Rahilly,Roman Hovorka,Robert K.Semple,and David B.Dunger,Treatment with Recombinant Human Insulin-Like Growth Factor(rh IGF)-I/rh IGF Binding Protein-3Complex Improves Metabolic Control in Subjects with Severe Insulin Resistance,J Clin Endocrinol Metab,May 2010,95(5):2113–2122
[7]Anna Mc Donald,Rachel M Williams,Fiona M Regan,Robert K Semple 1and David B Dunger.IGF-I treatment of insulin resistance.European Journal of Endocrinology(2007)157S51–S56
[8]陈家伦,宁光,孟迅吾.临床内分泌学[M].上海科学技术出版社,2011:979
[9]师林,柯斌,罗晓莉,从脾虚痰湿角度探讨2型糖尿病胰岛素抵抗的中医研究思路[J].广州中医药大学学报,2015(02):336~338
[10]黄菲,王纯庠,中医证型与2型糖尿病患者胰岛素抵抗及B细胞功能的关系[J].临床与病理杂志,2015,35(10):1816~1820