痰热互结证T_2DM合并非酒精性脂肪肝病的动态血糖特点
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摘要
目的：
分析初诊2型糖尿病合并非酒精性脂肪肝病(NAFLD non-alcoholic fatty liver disease)痰热互结证的一般情况临床特点及24小时动态血糖特点。
方法：
收集资料完整的初诊2型糖尿病合并非酒精性脂肪肝病和初诊单纯2型糖尿病患者病例,辨证分型,其中为痰热互结证者入组,各15例。比较合并NAFLD (N=15)与不合并NAFLD (N=15)的初诊2型糖尿病病人之间的临床特征及血糖、胰岛素敏感性、血脂、肝酶等代谢指标的不同,并分析24小时动态血糖特点。
结果：
1. NAFLD+组的体重指数(BMI)、甘油三脂(TG)、空腹胰岛素(FINS)、空腹C肽(FCPS)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、胰岛素抵抗指数(Homa-IR)、收缩压(SBP)、尿酸(UA)、C反应蛋白(CRP)水平均高于NAFLD组(p<0.05)；而病程、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、舒张压、血清胰岛β细胞功能、糖化血红蛋白(HbAlc)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)等因素无统计学差异(P>0.05)。2.两组患者的动态血糖参数Max-BG、 Mix-BG、AUC、PT2(%)、早餐前1hMBG、早餐后3hMBG、午餐前1hMBG、晚餐前1hMBG、晚餐后3hMBG、PPGE3经t检验,均无显著性差异。而24hMBG、SDBG、LAGE、NGE、PT1(%)、 PT3(%)、PPGE1、午餐后3hMBG、PPGE2经t检验,P<0.05,均有显著性差异,即NAFLD+组的24hMBG、SDBG、LAG、NGE、PT1(%)、PPGE1、午餐后3hMBG、PPGE2均比NAFLD-组高,而PT3(%)比之短。3.24小时整体血糖图中,两组患者0-3点比3-6点时间段的血糖稍低,血糖谷值集中在3-6点,峰值集中在12-15点。NAFLD+组整条血糖曲线均处于NAFLD组之上,且6-9点和12-15点两段时间里两组患者血糖均值经t检验,p<0.05,均有显著性差异。
结论：
初诊2型糖尿病合并NAFLD病以痰热互结证多见,痰热互结证与肥胖相关,常有BMI偏高,血糖、血脂、血压、尿酸代谢紊乱更加严重,胰岛素抵抗更加严重,且不仅表现为慢性高血糖状态,还存在波动性高血糖,即日间血糖处于高水平,以早、午餐后血糖波动明显,夜间比空腹血糖稍高,可能与胰岛素抵抗严重,且葡萄糖负荷后胰岛素分泌模式已失常有关。
Objective:
To analysis the clinical characteristics of24-hour dynamic glycemic excursion of the patients of the first diagnosed type Ⅱ Diabetic combined with NAFLD with the symptoms of phlegm and heat.
Methods:
30patients were measured by continuous glucose monitoring system (CGMS) for72hours, and were divided into two groups (one is the first diagnosed type II Diabetic combined with NAFLD, the other is the first diagnosed type II Diabetic but not combined with NAFLD), whom as well were diagnosed as the symptoms of phlegm and heat in TCM.30completed the test. Make a comparison by T-test between the two groups by the age、course of disease、body mass index (BMI)、blood pressure、the levels of glucolipid metabolism and of the fasting insulin and the peptide、the homeostatic model assessment (HOMA) index (Homa-β&Homa-IR)、hepatic enzymes, Uric acid、C reactive protein and the CGMS parameters.
Results:
1. The levels of BMI、TG、FINS、FCPS、FPG、2hPG、Homa-IR、SBP、UA, CRP of NAFLD+group are higher than those of the NAFLD-group (p<0.05);2. Compared with the NAFLD-group, the following detected targets including twenty-four hours mean blood glucose、standard deviation of blood glucose、largest amplitude of glycemic excursions、numbers of glycemic excursions、percentage of time with glucose above l0mmol/L、the postprandial glycemic excursions after breakfast and lunch (PPGE1、PPGE2)、three hours mean plasma glucose after lunch are much higher, and percentage of time with glucose within3.9-10mmol/L is lower(p<0.05);3. In the whole blood glucose figure of24hours, In two groups of patients the blood glucose in0-3points of a. m. is a bit lower than in3-6a. m. The peak of blood glucose concentrated in the time section of12~15pm, and the nadir in3~6a. m.The whole blood glucose curve with NAFLD+was upper on the other one with NAFLD-, and the blood glucose in0-3and3-6points of a. m between the two groups had significant difference by T-test (P<0.05)
Gonelusion:
The Symptoms of Phlegm and heat in TCM are much more common in patients of the first diagnosed type II Diabetic combined with NAFLD, and usually are associated with obesity. Such as BM、blood glucose、blood fat、blood pressure and uric acid, both metabolic disorder and insulin resistance are much more serious. It not only manifestates for chronic high glucose state, but also fluctuating high blood glucose. CGMS reveales the fluctuating hyperglycosemia in daytime, especially after the breakfast and lunch, and the blood glucose in night is higher than the one with an empty belly. It maybe relates with the more severe insulin resistance, and dyfunction of Insulin secretion mode when glucose stress.
分析初诊2型糖尿病合并非酒精性脂肪肝病(NAFLD non-alcoholic fatty liver disease)痰热互结证的一般情况临床特点及24小时动态血糖特点。
方法：
收集资料完整的初诊2型糖尿病合并非酒精性脂肪肝病和初诊单纯2型糖尿病患者病例,辨证分型,其中为痰热互结证者入组,各15例。比较合并NAFLD (N=15)与不合并NAFLD (N=15)的初诊2型糖尿病病人之间的临床特征及血糖、胰岛素敏感性、血脂、肝酶等代谢指标的不同,并分析24小时动态血糖特点。
结果：
1. NAFLD+组的体重指数(BMI)、甘油三脂(TG)、空腹胰岛素(FINS)、空腹C肽(FCPS)、空腹血糖(FPG)、餐后2小时血糖(2hPG)、胰岛素抵抗指数(Homa-IR)、收缩压(SBP)、尿酸(UA)、C反应蛋白(CRP)水平均高于NAFLD组(p<0.05)；而病程、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、舒张压、血清胰岛β细胞功能、糖化血红蛋白(HbAlc)、丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)等因素无统计学差异(P>0.05)。2.两组患者的动态血糖参数Max-BG、 Mix-BG、AUC、PT2(%)、早餐前1hMBG、早餐后3hMBG、午餐前1hMBG、晚餐前1hMBG、晚餐后3hMBG、PPGE3经t检验,均无显著性差异。而24hMBG、SDBG、LAGE、NGE、PT1(%)、 PT3(%)、PPGE1、午餐后3hMBG、PPGE2经t检验,P<0.05,均有显著性差异,即NAFLD+组的24hMBG、SDBG、LAG、NGE、PT1(%)、PPGE1、午餐后3hMBG、PPGE2均比NAFLD-组高,而PT3(%)比之短。3.24小时整体血糖图中,两组患者0-3点比3-6点时间段的血糖稍低,血糖谷值集中在3-6点,峰值集中在12-15点。NAFLD+组整条血糖曲线均处于NAFLD组之上,且6-9点和12-15点两段时间里两组患者血糖均值经t检验,p<0.05,均有显著性差异。
结论：
初诊2型糖尿病合并NAFLD病以痰热互结证多见,痰热互结证与肥胖相关,常有BMI偏高,血糖、血脂、血压、尿酸代谢紊乱更加严重,胰岛素抵抗更加严重,且不仅表现为慢性高血糖状态,还存在波动性高血糖,即日间血糖处于高水平,以早、午餐后血糖波动明显,夜间比空腹血糖稍高,可能与胰岛素抵抗严重,且葡萄糖负荷后胰岛素分泌模式已失常有关。
Objective:
To analysis the clinical characteristics of24-hour dynamic glycemic excursion of the patients of the first diagnosed type Ⅱ Diabetic combined with NAFLD with the symptoms of phlegm and heat.
Methods:
30patients were measured by continuous glucose monitoring system (CGMS) for72hours, and were divided into two groups (one is the first diagnosed type II Diabetic combined with NAFLD, the other is the first diagnosed type II Diabetic but not combined with NAFLD), whom as well were diagnosed as the symptoms of phlegm and heat in TCM.30completed the test. Make a comparison by T-test between the two groups by the age、course of disease、body mass index (BMI)、blood pressure、the levels of glucolipid metabolism and of the fasting insulin and the peptide、the homeostatic model assessment (HOMA) index (Homa-β&Homa-IR)、hepatic enzymes, Uric acid、C reactive protein and the CGMS parameters.
Results:
1. The levels of BMI、TG、FINS、FCPS、FPG、2hPG、Homa-IR、SBP、UA, CRP of NAFLD+group are higher than those of the NAFLD-group (p<0.05);2. Compared with the NAFLD-group, the following detected targets including twenty-four hours mean blood glucose、standard deviation of blood glucose、largest amplitude of glycemic excursions、numbers of glycemic excursions、percentage of time with glucose above l0mmol/L、the postprandial glycemic excursions after breakfast and lunch (PPGE1、PPGE2)、three hours mean plasma glucose after lunch are much higher, and percentage of time with glucose within3.9-10mmol/L is lower(p<0.05);3. In the whole blood glucose figure of24hours, In two groups of patients the blood glucose in0-3points of a. m. is a bit lower than in3-6a. m. The peak of blood glucose concentrated in the time section of12~15pm, and the nadir in3~6a. m.The whole blood glucose curve with NAFLD+was upper on the other one with NAFLD-, and the blood glucose in0-3and3-6points of a. m between the two groups had significant difference by T-test (P<0.05)
Gonelusion:
The Symptoms of Phlegm and heat in TCM are much more common in patients of the first diagnosed type II Diabetic combined with NAFLD, and usually are associated with obesity. Such as BM、blood glucose、blood fat、blood pressure and uric acid, both metabolic disorder and insulin resistance are much more serious. It not only manifestates for chronic high glucose state, but also fluctuating high blood glucose. CGMS reveales the fluctuating hyperglycosemia in daytime, especially after the breakfast and lunch, and the blood glucose in night is higher than the one with an empty belly. It maybe relates with the more severe insulin resistance, and dyfunction of Insulin secretion mode when glucose stress.
引文
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[2]郎江明,陈苹,魏爱生,等.新诊断2型糖尿病患者24小时血糖的波动特点.中华糖尿病杂志2005年第13卷第1期：43-45.
[3]陈发胜,郎江明,魏爱生,等.初诊2型糖尿病患者24小时动态血糖与胰岛β细胞功能及胰岛素抵抗的关系.中国临床康复.2005,1(9)：104-105
[4]娄霞英.2型糖尿病动态血糖监测系统监测的意义.上海预防医学杂志2005,(17)：602-603
[5]佚名.糖尿病篇,糖尿病中医防治指南http://www.Baidu.com.cn.2012.4.10.
[6]董振华.从中医痰湿论治糖尿病[J].中国临床医生杂志.2007,35(465)：65-66
[7]潘艳,侯建明.2型糖尿病合并非酒精性脂肪肝的中医证型及临床分析.硕士学位论文.福建中医学院,1-8.2008年
[8]Gupte P, Amarapurkar D, Agal S, et al. Non—alcoholic steatohepatitis in type 2 diabetes mellitus. J Gastroenterol Hepatol,2004。 19:854-858.
[9]Fan JG, Li F,Cai XB, et al. Effects of nonalcoholic fatty liver disease on the development of metabolic disordem. J Gestnmnterol Hepatol,2007,22:1086-1091.
[10]Fan JG, Farrell GC. Ep idemiology of non2alcoholic fatty liver disease in China [J]. J Hepatol,2009, 50:204-210.
[11]范竹萍,赵雄.糖尿病与非酒精性脂肪性肝病中华糖尿病杂志2009,8(1)：248-250
[12]Fan JG, Saibara T, Chitturi S, et al. What are the risk factors and settings of non-alcoholic fatty liver disease in Asia2Pacific [J]J Gas troenterol Hepatol,2007, 22:794-800.
[13]Day CP, James OF. Steatohepatitis:a tale of two" hits"? Gastroenterology,1998, 114:842-845.
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