2型糖尿病中医证型与CRP、脂代谢的关系
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摘要
背景：2型糖尿病的发生、发展与低度炎症反应密切相关。糖尿病血管病变与高血糖、高血压、高血脂、高血粘等众多因素有关，但在众多因素中脂代谢紊乱起着更为重要的作用。
目的：通过观察2型糖尿病中医证型与CRP、血脂等相关指标，探讨它们之间的相互关系，为中医证型的判断提供客观依据，并为2型糖尿病及其并发症的预防及治疗提供临床思路。
资料与方法：按WHO诊断标准，选择2型糖尿病患者101例为研究对象，按中医证型分为5组。阴虚热盛证24例，男11例，女13例，年龄54.41±6.32岁；气阴两虚31证例，男14例，女17例，年龄55.32±6.67岁；湿热困脾21证例，男9例，女12例，年龄55.04±7.03岁；血瘀脉络证18例，男11例，女7例，年龄55.72±4.76岁；阴阳两虚，血瘀水停证7例，男3例，女4例，年龄55.85±6.73岁；正常对照组31例，其中男17例，女14例，年龄55.85±6.73岁。CRP采用免疫增强的透射比浊法；血脂(甘油三酯TG、高密度脂蛋白HDL-C、总胆固醇TC)测定采用酶法；HbA_1C采用免疫增强胶乳浊度法；血糖测定采用葡萄糖氧化酶法。并在清晨测量血压。
结果：1．在2型糖尿病患者证型之间年龄、血压不具可比的情况下(阴阳两虚，血瘀水停型因例数太少未列入讨论)：(1)．CRP比较结果：CRP与TC、TG、LDL-C呈正相关(P＜0.01)，与HDL-C呈负相关(P＜0.05)，与HbA_1C不相关。2．(1)①4型之间TC、TG、LDL-C比较趋势：血瘀脉络、湿热困脾＞气阴两虚＞阴虚热盛；②4型之间HDL-C比较结果：阴虚热盛、气阴两虚＞血瘀脉络、湿热困脾。(2)．4型之间HbA_1C比较结果：血瘀脉络＞湿热困脾＞气阴两虚、阴虚热盛。
结论：在糖尿病中医证型中湿热、血瘀程度越严重，脂代谢紊乱程度越严重，且与炎症水平是相关的。
Background: The occurrence and development of Type 2 diabetes mellitus has closely related to low grade inflammation.The vasculopathy of Type 2 diabetes mellitus was caused by the factor such as high blood sugar、hypertension, high blood lipid、high blood stickness and so on,but lipid metabolic disturbance rose more importance function than other factors.
Objective: To provide objective evidence for the judgement of TCM's syndromes and clinical idea for the precaution and treament for T2DM and its complication by observing the relationship between the TCM syndromes and c-reative protein.
Materials and methods: According to WHO diagnosis criteria and TCM differentiation criteria, 101 cases were selected,and they were divided into 5 groups. Yin deficiency and heat excess syndrome (YDHES):24cases(11male,13 female), the average age was 54.41±6.32 years old; Qi and Yin deficiency syndrome (QYDS):31 cases(14 male,17 female), the average age was 55.32±6.67 years old; Moist Heat deficiency syndrome (MHDS):21 cases(9 male,12 female), the average age was 55.04±7.03 years old;Stagnated blood deficiency syndrome(SBDS): 18 cases (11 male,7 female), the average age was 55.72±4.67 years old ;Yin and Yang deficiency syndrome (YYDS):7 cases(3 male,4 female), the average age was 55.85±6.73 years old. Healthy people (17 male and 14 female) were taken as the control group, the average age was 55.85±6.73 years old. Then detected CRP by Elisa;triglyceride (TG)、high density lipoprotein-cholestcrol (HDL-C) and Total cholesterol(TC) by zymology; glycosylated hemoglobin(HbAiC) by microclumu chromatography ; fasting plasma glucose (FPG) by glucose oxidase.And measure blood presure in morning.
Results: 1. Under the premise that keeping the age ,blood pressures of 4 TCM Differention Syndromes with out comparation(YYDS was not in the discussion because its cases is too few):
(1).The degree of HbA_1C is as follow: SBDS〉MHDS〉QYDS、YDHES; (2)①. The degree of TG、TC、LDL are as follows: SBDS, MHDS〉QYDS〉YDHES;②. The degree of HDL is as follow: YDHES、QYDS〉SBDS、MHDS. 2. The level of CRP is closely positive correlated to TG、TC、LDL and negative correalated to HDL,but not correlated to HbA_1C.
Conclusion: The higher of the degree of Type 2 Diabetes' moist heat and stagnated blood,the more serious of lipid metabolic disturbance and inflamation.
目的：通过观察2型糖尿病中医证型与CRP、血脂等相关指标，探讨它们之间的相互关系，为中医证型的判断提供客观依据，并为2型糖尿病及其并发症的预防及治疗提供临床思路。
资料与方法：按WHO诊断标准，选择2型糖尿病患者101例为研究对象，按中医证型分为5组。阴虚热盛证24例，男11例，女13例，年龄54.41±6.32岁；气阴两虚31证例，男14例，女17例，年龄55.32±6.67岁；湿热困脾21证例，男9例，女12例，年龄55.04±7.03岁；血瘀脉络证18例，男11例，女7例，年龄55.72±4.76岁；阴阳两虚，血瘀水停证7例，男3例，女4例，年龄55.85±6.73岁；正常对照组31例，其中男17例，女14例，年龄55.85±6.73岁。CRP采用免疫增强的透射比浊法；血脂(甘油三酯TG、高密度脂蛋白HDL-C、总胆固醇TC)测定采用酶法；HbA_1C采用免疫增强胶乳浊度法；血糖测定采用葡萄糖氧化酶法。并在清晨测量血压。
结果：1．在2型糖尿病患者证型之间年龄、血压不具可比的情况下(阴阳两虚，血瘀水停型因例数太少未列入讨论)：(1)．CRP比较结果：CRP与TC、TG、LDL-C呈正相关(P＜0.01)，与HDL-C呈负相关(P＜0.05)，与HbA_1C不相关。2．(1)①4型之间TC、TG、LDL-C比较趋势：血瘀脉络、湿热困脾＞气阴两虚＞阴虚热盛；②4型之间HDL-C比较结果：阴虚热盛、气阴两虚＞血瘀脉络、湿热困脾。(2)．4型之间HbA_1C比较结果：血瘀脉络＞湿热困脾＞气阴两虚、阴虚热盛。
结论：在糖尿病中医证型中湿热、血瘀程度越严重，脂代谢紊乱程度越严重，且与炎症水平是相关的。
Background: The occurrence and development of Type 2 diabetes mellitus has closely related to low grade inflammation.The vasculopathy of Type 2 diabetes mellitus was caused by the factor such as high blood sugar、hypertension, high blood lipid、high blood stickness and so on,but lipid metabolic disturbance rose more importance function than other factors.
Objective: To provide objective evidence for the judgement of TCM's syndromes and clinical idea for the precaution and treament for T2DM and its complication by observing the relationship between the TCM syndromes and c-reative protein.
Materials and methods: According to WHO diagnosis criteria and TCM differentiation criteria, 101 cases were selected,and they were divided into 5 groups. Yin deficiency and heat excess syndrome (YDHES):24cases(11male,13 female), the average age was 54.41±6.32 years old; Qi and Yin deficiency syndrome (QYDS):31 cases(14 male,17 female), the average age was 55.32±6.67 years old; Moist Heat deficiency syndrome (MHDS):21 cases(9 male,12 female), the average age was 55.04±7.03 years old;Stagnated blood deficiency syndrome(SBDS): 18 cases (11 male,7 female), the average age was 55.72±4.67 years old ;Yin and Yang deficiency syndrome (YYDS):7 cases(3 male,4 female), the average age was 55.85±6.73 years old. Healthy people (17 male and 14 female) were taken as the control group, the average age was 55.85±6.73 years old. Then detected CRP by Elisa;triglyceride (TG)、high density lipoprotein-cholestcrol (HDL-C) and Total cholesterol(TC) by zymology; glycosylated hemoglobin(HbAiC) by microclumu chromatography ; fasting plasma glucose (FPG) by glucose oxidase.And measure blood presure in morning.
Results: 1. Under the premise that keeping the age ,blood pressures of 4 TCM Differention Syndromes with out comparation(YYDS was not in the discussion because its cases is too few):
(1).The degree of HbA_1C is as follow: SBDS〉MHDS〉QYDS、YDHES; (2)①. The degree of TG、TC、LDL are as follows: SBDS, MHDS〉QYDS〉YDHES;②. The degree of HDL is as follow: YDHES、QYDS〉SBDS、MHDS. 2. The level of CRP is closely positive correlated to TG、TC、LDL and negative correalated to HDL,but not correlated to HbA_1C.
Conclusion: The higher of the degree of Type 2 Diabetes' moist heat and stagnated blood,the more serious of lipid metabolic disturbance and inflamation.
引文
1．李秀钧，邬云红．糖尿病是一种炎症性疾病?[J]．中华内分泌代谢杂志．2003，19：251-253．
2. Barzilay J I, AbrabamL, Heckbert SR, et al. The relation of markers of inflammation to the development of glucose disorders in the elderly: the cardiovascular health study[J]. Diabetes, 2001, 50: 2384
3. Pradhan AD, Manson JE, Rifai N, et al. C-reactive protein, inter leukin 6, and risk of developing type 2 diabetes mellitus[J]. JAM, 2001, 286: 327
4．杨金奎，成金罗等 家族性2型糖尿病遗传方式及血糖血脂代谢的研究[J]．江苏临床医学杂志，2002，6(4)：322-324
5．卢薇，汪晓云，杨正平等2型糖尿病患者餐后血糖、血脂与凝血及血小板活性关系[J]．临床内科杂志，2002，19(6)：472-473
6．[WHO Dept．of Noncommunicable Disease surveillance Geneva，1999]．糖尿病的诊断与分类[J]．中国糖尿病杂志，2000，8(1)：5—6．
7. Volanakis JE. Human C-reactive protein: expression, structure, and function[J]. Mol Immunol, 2001, 38 (223): 189-197.
8. Cavusoglu Y, Gorenek B, AIpsoy S, et al. Evaluation of C—reactive protein fibrinogen and antithrombin—2 as risk factor for coronary artery disease [J]. Isr med Assoc J 2001; 3: 13—16.
9. Ford ES. Body masa index, diabetes, and C-reactive protein among US adults[J]. Diabetes Care 2000: 22(12): 1971—1977.
10．杨文英．2型糖尿病，一种糖脂代谢病[J]．国外医学内分泌学分册2001，21(6)：284-285．
11．李光伟 2型糖尿病的胰岛素抵抗及其临床评估和处理[J]．实用糖尿病杂志，1999，7(4)：6
12．徐一甄，沈稚舟．胰岛素抵抗与血脂异常[J] 国外医学内科学分册，2003，25(1)：12
13．千正琦，沈更新，金惠玲2型糖尿病脂肪肝与胰岛素抵抗、脂代谢的关系[J]．浙江 临床医学，2002，7(5)：270—271
14．王琦．中医体质学说研究现状与展望[J]．中国中医基础医学杂志，2002，8(2)：86—95
15．王忆黎、严余明．试述2型糖尿病炎症发病说对中医临床的意义[J]．浙江中医学院学报，2003，27(3)：20—21
16．刘萍，张静生，郑菲．中药对低密度脂蛋白受体基因表达的影响[J]．中国中西医结合急救杂志，2000，7(3)：141—143．
17．金智生，何建成．健脾降脂灵对高脂血症大鼠血脂的影响[J]．中国中西医结合急救杂志，2002，9(1)：41．
18．宋家瑛．2型糖尿病患者血脂变化与中医分型的关系[J]．天津中医，2001，18(4)：27-28．
19．孙丰雷，朗江明，魏爱生等．2型糖尿病血瘀证患者脂质代谢变化的相关研究[J]．山东中医杂志，2004，23(1)：13-15
20．尹波，关晓宏．糖尿病微循环障碍程度与慢性并发症的关系[J]．人民军医．1999，42：(31)，59—160
21．石志芸，施赛珠，陈剑秋，等．中医血瘀证与血栓相关分子标志物的研究[J]．中医研究．2003，16(6)：21～23
22．钱秋海．活血化瘀防治糖尿病及其慢性并发症机制探讨[J]．山东中医杂志，2002，(3)：131—133
23．刘玉华．糖尿病患者体外血栓模拟试验的初步观察．辽宁中医杂志，2001，18(5)：15～17
24．阿衣努尔，张红．从瘀论治糖尿病并发症[J]．新疆中医药，2003，21(3)：69-70
25．王和．老年人糖尿病(消渴病)的治疗—附724例分析[J]．中医杂志．2002．(4)：24．
26．彭万年．消渴病湿热证治探讨[J]．新中医，1999，30(12)：3—4．
27．徐正正．不同病程糖尿病患者的证候特征[J]．中医杂志，2001，41(1)：15．
28．冷三华，陆付耳，屠庆年．黄连解毒汤对2型糖尿病大鼠血糖和血脂代谢的影响等实验研究[J]．中国中医基础医学杂志，2003，9(4)：25．
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3．高桥伯夫．高敏感性C反应蛋白(CRP)测定法在疾病诊断中的实用性[J]．日本医学介绍，2003，24(6)：274．
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12. Barzilay Jl, Abraham L, Heekbert SR, etal. The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study. Diabetes, 2001, 50: 2384-2389.
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14. Ford ES. Body masa index, diabetes, and C-reactive protein among US adults [J]. Diabetes Care 1999: 22(12): 1971—1977
15. Cavusoglu Y, Gorenek B, AIpsoy S, et al. Evaluation of C—reactive protein fibrinogen and antithrombin—2 as risk factor for coronary artery disease [J]. Isr med Assoc J 2001: 3: 13—16.
16. Yudkin JS, Panahloo A, Stehouwer C, et al. The influence of improved glycaemic control with insulin and sulphonylureas on acute phase and endothelial markers in Type Ⅱ diabetic subjects. Diabetologia, 2000, 43(9): 1099—1106.
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2. Barzilay J I, AbrabamL, Heckbert SR, et al. The relation of markers of inflammation to the development of glucose disorders in the elderly: the cardiovascular health study[J]. Diabetes, 2001, 50: 2384
3. Pradhan AD, Manson JE, Rifai N, et al. C-reactive protein, inter leukin 6, and risk of developing type 2 diabetes mellitus[J]. JAM, 2001, 286: 327
4．杨金奎，成金罗等 家族性2型糖尿病遗传方式及血糖血脂代谢的研究[J]．江苏临床医学杂志，2002，6(4)：322-324
5．卢薇，汪晓云，杨正平等2型糖尿病患者餐后血糖、血脂与凝血及血小板活性关系[J]．临床内科杂志，2002，19(6)：472-473
6．[WHO Dept．of Noncommunicable Disease surveillance Geneva，1999]．糖尿病的诊断与分类[J]．中国糖尿病杂志，2000，8(1)：5—6．
7. Volanakis JE. Human C-reactive protein: expression, structure, and function[J]. Mol Immunol, 2001, 38 (223): 189-197.
8. Cavusoglu Y, Gorenek B, AIpsoy S, et al. Evaluation of C—reactive protein fibrinogen and antithrombin—2 as risk factor for coronary artery disease [J]. Isr med Assoc J 2001; 3: 13—16.
9. Ford ES. Body masa index, diabetes, and C-reactive protein among US adults[J]. Diabetes Care 2000: 22(12): 1971—1977.
10．杨文英．2型糖尿病，一种糖脂代谢病[J]．国外医学内分泌学分册2001，21(6)：284-285．
11．李光伟 2型糖尿病的胰岛素抵抗及其临床评估和处理[J]．实用糖尿病杂志，1999，7(4)：6
12．徐一甄，沈稚舟．胰岛素抵抗与血脂异常[J] 国外医学内科学分册，2003，25(1)：12
13．千正琦，沈更新，金惠玲2型糖尿病脂肪肝与胰岛素抵抗、脂代谢的关系[J]．浙江 临床医学，2002，7(5)：270—271
14．王琦．中医体质学说研究现状与展望[J]．中国中医基础医学杂志，2002，8(2)：86—95
15．王忆黎、严余明．试述2型糖尿病炎症发病说对中医临床的意义[J]．浙江中医学院学报，2003，27(3)：20—21
16．刘萍，张静生，郑菲．中药对低密度脂蛋白受体基因表达的影响[J]．中国中西医结合急救杂志，2000，7(3)：141—143．
17．金智生，何建成．健脾降脂灵对高脂血症大鼠血脂的影响[J]．中国中西医结合急救杂志，2002，9(1)：41．
18．宋家瑛．2型糖尿病患者血脂变化与中医分型的关系[J]．天津中医，2001，18(4)：27-28．
19．孙丰雷，朗江明，魏爱生等．2型糖尿病血瘀证患者脂质代谢变化的相关研究[J]．山东中医杂志，2004，23(1)：13-15
20．尹波，关晓宏．糖尿病微循环障碍程度与慢性并发症的关系[J]．人民军医．1999，42：(31)，59—160
21．石志芸，施赛珠，陈剑秋，等．中医血瘀证与血栓相关分子标志物的研究[J]．中医研究．2003，16(6)：21～23
22．钱秋海．活血化瘀防治糖尿病及其慢性并发症机制探讨[J]．山东中医杂志，2002，(3)：131—133
23．刘玉华．糖尿病患者体外血栓模拟试验的初步观察．辽宁中医杂志，2001，18(5)：15～17
24．阿衣努尔，张红．从瘀论治糖尿病并发症[J]．新疆中医药，2003，21(3)：69-70
25．王和．老年人糖尿病(消渴病)的治疗—附724例分析[J]．中医杂志．2002．(4)：24．
26．彭万年．消渴病湿热证治探讨[J]．新中医，1999，30(12)：3—4．
27．徐正正．不同病程糖尿病患者的证候特征[J]．中医杂志，2001，41(1)：15．
28．冷三华，陆付耳，屠庆年．黄连解毒汤对2型糖尿病大鼠血糖和血脂代谢的影响等实验研究[J]．中国中医基础医学杂志，2003，9(4)：25．
1. Volanakis JE. Human C-reactive protein: expression, structure, and function. Mol Immunol, 2001, 38 (223): 189-197
2. Clyne B, Olshaker JS. The C—Reative protein [J]. J Emerg Med, 1999, 17(6): 1019.
3．高桥伯夫．高敏感性C反应蛋白(CRP)测定法在疾病诊断中的实用性[J]．日本医学介绍，2003，24(6)：274．
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