祛痰活血解毒法对2型糖尿病胰岛素抵抗作用的研究
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摘要
本研究运用中医传统理论,结合古今临床经验,首次从“人群体质古今变异”这一全新角度,分析了现代人的生存环境,提出了湿热体质是现代2型糖尿病的重要体质背景和内在发病基础的新观点。由此确立了2型糖尿病湿热蕴结,变生痰浊、瘀血,化毒伤阴的病机假说,进而对祛痰活血解毒治法和方药进行了深入探讨。根据现代医学关于胰岛素抵抗是2型糖尿病发病的基本环节和显著特征的认识,还着力阐释了中医痰瘀毒与胰岛素抵抗的相关性,通过动物实验观察了祛痰活血解毒方对2型糖尿病大鼠胰岛素抵抗作用的影响。实验结果表明:祛痰活血解毒方能明显提高胰岛素敏感指数,改善胰岛素抵抗;改善血液高粘、高凝、高聚状态;调节脂质代谢;对2型糖尿病胰岛素抵抗在受体和受体后环节有显著的治疗作用。证明该方对2型糖尿病有多靶点、多环节的综合治疗作用,是治疗2型糖尿病的有效方药。深化了中医对2型糖尿病病机的认识,为临床治疗2型糖尿病提供了新思路,创新和丰富了2型糖尿病的病机学说和治疗学说。
By use of traditional theory about TCM and combination with ancient clinical experiences, this research suggests the new viewpoint that damp-heat physique is the important physique background and intrinsic becoming-sick basis of modern NIDDM through analysing the survival environment of modern person from such a brand-new angle of "the variation of crowd physique in ancient and modern" for the first time, further deduces a hypothesis: The damp-heat stagnation changes into the toxins of phlegm-damp and stasis, which impair yin. This is the pathogenesis of NIDDM. Basing on this, we proceed to deeply study the therapeutic method and recipe of dispelling sputum, quickening blood and removing toxin. According to modem medical science knowledge that insulin resistance is the basic link and notable feature leading to
    NEDDM, we research to concentrate on explaining the correlation between sputum, stasis, toxin and insulin resistance, and have observed the influence of recipe of dispelling sputum quickening blood and
     removing toxin to insulin resistance action of NIDDM mouse by means of animal experiment. Experiment result shows: it can raise insulin sensitive index obviously, improve insulin resistance, reduce the state of high blood viscosity, hypercoagulabilty and high aggregation, regulate lipid metabolism. All these confirm: For insulin resistance to NIDDM, the recipe has remarkable therapeutic effects on the receptor and post-receptor, is a effective recipe of treating NIDDM, and its therapeutic effects are comprehensive, poly-targets and poly-links. These deepen the understanding to pathogenesis of NIDDM of TCM , offer a new pathway for clinical therapy , blaze new trails and enrich the doctrines of pathogenesis and therapy.
引文
[1]范冠杰.糖尿病.北京:人民卫生出版社,2002,第1版:2~3.
    [2]同[1]
    [3]魏爱风,张爱华,郭战利.NIDDM患者冠心病流行率及其相关因素分析.医师进修杂志,1998;21(10):539~540.
    [4]David MN, James M, Daniedl ES. The epidemiology of cardiovascular disease in NIDDM: how sweet it is. or is it? The Lancet, 1997; (7) 14.
    [5]Stern MP. Diabetes and cardiovascular disease: The "Common soil" hypothesis. Diabetes, 1995;44(4):369~374.
    [6]李秀钧.胰岛素抵抗综合征.北京:人民卫生出版社,2001,第1版:94.
    [7]李泽逸.化瘀祛痰法治疗糖尿病60例.四川中医,1999;17(6):33.
    [8]郭教礼,陈竹林.糖尿病从毒论治初探.新疆中医药,1992;(2):9~12.
    [9]陈长青.消渴病(糖尿病)病机探讨—附32例病例报告.中医药研究,1997;13(5):4~6.
    [10]栗德林,宋福印,何玉信.降糖解毒胶囊治疗NIDDM60例.中医药学报,1996;(1):23.
    [11]王琦.中医体质学.北京:中国医药科技出版社,1995,第1版:5.
    [12]田代华.中医辨证要素分析.山东中医药大学学报,1998;22(2):87~91.
    [13]朱晓蕾.体质差异与个体病质辨析.中国中医基础医学杂志,1998;4(8):3~5.
    [14]胡焕章.岭南脾胃湿热病机与证治.中医杂志,1986;(7):17.
    [15]李连成.湿阻的流行病学调查.中医杂志,1992;(6):44.
    [16]王彦晖.中医湿病学.北京:人民卫生出版社,1997,第1版:6.
    [17]王如沾,曲卫毅.论毒与糖尿病.山东中医杂志,1999;18(8):339~341.
    [18]上海医科大学实用内科学编写组.实用内科学.北京:人民卫生出版社,1996,第9版:607~621.
    [19]会议记要.首届全国中医体质学及腹诊研讨会学术总结.中西医结合杂志,1987;(11):703.
    
    
    [20]松泽正俊(日).近来日本糖尿病的临床特点分析.南京中医药大学学报,2001;(2):131.
    [21]王宏才,董建勇,何建成.糖尿病康复之路.北京:中医古籍出版社,1994,第1版:18.
    [22]American Diabetes Association, Diabetes 1996 vital Statistics[M]. Chicago: American Diabetes Association 1996: 29.
    [23]张永涛.论脾与NIDDM胰岛素抵抗的关系.河南中医,2001;21(6):3~5.
    [24]于俊生,王砚琳,等.痰瘀毒相关论.山东中医杂志,2000;(6):323.
    [25]林亚明.出血性中风的内生毒邪论.北京中医学院学报,1991;(11):15.
    [26]王永炎.关于提高脑血管疾病疗效难点的思考.中国中西医结合杂志,1997;(2):195.
    [27]王如沾,曲卫毅.论毒与糖尿病.山东中医杂志,1999;18(8):339~341.
    [28]宋福印.试论毒损脑络与糖尿病性脑病.北京中医药大学学报,2000;23(5):7~8.
    [29]Mbbs AG, Haffner SM. Insulin resistance and atherosclerosiS[J]. Diabetes Care, 1996; 19: 274.
    [30]Revean GM. Role of insulin resistance in human disease. Diabetes, 1988; 37: 1595.
    [31]同[23]
    [32]同[23]
    [33]刘艳骄.肥胖人痰湿体质与糖尿病相关性研究.山东中医学院学报,1993;17(2):34.
    [34]同[18]:889.
    [35]同[31]
    [36]孙刚,李晓玲.痰浊证型患者糖、脂等指标检测及其临床意义.贵阳中医学院学报,1997;19(3):59~60.
    [37]丁学屏,陆灏,虞芳华,等.非胰岛素依赖型糖尿病中医辨证分型与胰高糖素、胰岛素敏感性相关研究.上海中医药杂志,1999;33(9):18.
    [38]同[31]
    
    
    [39]姜兆顺,张胜兰,寇天芹等.NIDDM血瘀证患者血小板CD62p、CD63测定意义探讨.中国中西医结合杂志,1999;19(9):527~528.
    [40]陈贵海.肥胖与血瘀证形成的相关性研究.山东中医药大学学报,2001;26(2):129~139.
    [41]施赛珠,陈剑秋,张茂华,等.宏观与微观相结合研究糖尿病血瘀证.中医杂志,1997;38(4):233.
    [42]柴佩芳,胡德培,陈灏珠,等.糖尿病合并心脑血管疾病的多种因素.上海医科大学学报,1998;25(3):240.
    [43]冼慧.糖尿病从瘀治初探.中国医药学报,2000;15(2):132.
    [44]周国英,武雪萍,衡先培,等.NIDDM气阴两虚证与胰岛素抵抗的相关性研究.福建中医药,2000;31(2):7~8.
    [45]朱良争,钟家宝,徐蓉绢.降脂片改善NIDDM胰岛素抵抗的临床观察.新中医,1999;31(4):13~16.
    [46]朱章志,熊曼琪,林安钟,等.三黄降糖方对NIDDM患者外周胰岛素抵抗的影响.中国中西医结合杂志,1997;17(10):590~593.
    [47]朱立群,刘英华,王维兆.糖尿病患者中西医结合治疗前后HbA1C、TXB2及6-keto-PGF1α的变化观察.新中医,1998;30(3):40~42.
    [48]熊曼琪,林安钟,朱章志,等.加味桃核承气汤对NIDDM胰岛素抵抗的影响.中国中西医结合杂志,1997;17(3):165~168.
    [49]周则卫.NIDDM发生胰岛素抵抗机理的中医探讨.天津中医,2002;19(4):38~39.
    [50]谌剑飞.糖尿病缺血性中风中医证型与血清炎症细胞因子关系的研究.中国中西医结合急救杂志,2000;7(3):147~149.
    [51]赵天豫,郭改会.化瘀解毒法防治胰岛素抵抗NIDDM的研究.中国中西医结合急救杂志,2002;9(3):176.
    [52]黄燕飞.脂毒性与NIDDM及其并发症的关系.肾脏病与透析肾移植杂志.2002;11(1):58~62.
    [53]陆灏,朱宇清,唐静芬,等.三黄煎对NIDDM大鼠胰岛素分泌等功能的影响.辽宁中医杂志,2000;27(6):281~283.
    
    
    [54]刘永玉,毛良,莫启忠,等.实验性NIDDM大鼠的胰岛素抗性.中国病理生理杂志,1991;7(4):422~425.
    [55]黄翟玲,李才,邓义斌,等.大黄对糖尿病大鼠肾组织非酶促糖基化的影响.中国糖尿病杂志,1996;(4):103.
    [56]刘永玉,毛良,莫启忠,等.实验性NIDDM大鼠的胰岛素抗性.中国病理生理杂志,1991;7(4):422.
    [57]杨俊伟,黎磊石,刘志红.大黄治疗实验性糖尿病的作用和机制.中华内分泌代谢杂志,1994;10(4):244.
    [58]Storlien LH, Oakes ND, Pan DA, et al. Syndrom of insulin resistancein the rat: inducement by diet and a melioration with Benfluorex. Diabetes, 1993; 42: 457.
    [59]郭啸华,刘志红,李恒,等.实验性NIDDM大鼠模型的建立.肾脏病与透析肾移植杂志,2000;9(4):351~355.
    [60]梁兴伦,韩明向.胰岛素抵抗模型大鼠的中医证候研究.中国中西医结合杂志,2001;21(7):528~530.
    [61]张兆鹏,刘娜.BMI与胰岛素抵抗及血脂异常的关系(附260例报告).辽宁实用糖尿病杂质,2001;9(4):17~18.
    [62]Paresh Dandona, Ruth Weinstock, Kuldip Thusu, et al. Tumor necrosis factor-α in sera of obese patients:fall with weight loss[J]J Clin Endocrinol Metab, 1998;83(2):907~910.
    [63]Oletsky JM, Reaven GM. Insulin and giucose responses to identical oral glucose tolerance tests performed 48 hours apart. Diabetes, 1974; 23: 449~453.
    [64]李光伟,潘孝仁,Peter HB.血浆葡萄糖、胰岛素比值是可靠的IAI吗?中华心血管病杂志,1996;24:57~62.
    [65]Duncan MH, Singh BM, Wise PH, et al.A simple measure of insulin resistance. Lancet, 1995; 346: 120~121.
    [66]Del Prato S. Pozzilli P. FIRI: fasting or false insulin resistance index? Lancet, 1996; 347: 132.
    
    
    [67]朱禧星.胰岛素抵抗代谢综合征与胰岛素增敏剂.中华内分泌代谢杂志,2000;16:333~334
    [68]吴飞飞,张栋.二甲双胍与格列吡嗪降低NIDDM患者胰岛素抵抗的临床观察.长治医学院学报,2001;15(2):98~99.
    [69]Wiernsperger NF. Membrane physiology as a basis for the cellular effects of metformin insulin resistance and diabetes. Diabete-Metab, 1999;25(2): 110~127.
    [70]陆菊明.葡萄糖失敏感性和葡萄糖毒性.人民军医,1997;40(6):340~341.
    [71]陈答理,梁子钧.中医基础理论研究.上海:上海中医学院出版社,1989,第1版:113.
    [72]施赛珠,王倩,董彩云.NIDDM中瘀血证和益气活血药预防其血管病变的疗效观察.中医杂志,1989;30(6):341.
    [73]王静怡,王晓燕,刘安群,等.痰湿及痰湿瘀证305例血液流变学观察.中国医药学报,1993;9(4):54.
    [74]刘泽霖,等.血栓性疾病的诊断与治疗.北京:人民卫生出版社,2000,第1版:28.
    [75]李家增.血液实验学.上海:上海科学技术出版社,1997,第1版:583.
    [76]朱晓宏.糖尿病从瘀论治的理论及临床进展概况.国医论坛,2001;16(5):53~54.
    [77]Mariella Trovati, Elena M, Serenella Burzacca, et al. Impaed insulininduced platelet antiaggregating effect in obesity and obese NIDDM patients. Diabetes, 1995;44(11):1318.
    [78]谢良地,邬大元.高血压、冠心病和心功能不全患者血小板游离钙的变化.中国高血压杂志,1998;3(4):282.
    [79]Sagel J, etal. Ineneased Platelet aggregation in eakly diabetes mellitus. Am Intem Med, 1975;(8):733.
    [80]颜晓东.胰岛素抵抗和血小板聚集在糖尿病伴冠心病中作用.实用老年医学,1999;13(4):201~202.
    [81]徐一甄,沈稚舟.胰岛素抵抗与血脂异常.国外医学(内科学分册)1998;28(1):12.
    
    
    [82]彭志华,陈桂丽,伍于斌.NIDDM患者血脂异常与胰岛素抵抗的关系.华夏医学,1999;12(4):380~381.
    [83]支忠继,康胜群,李英.NIDDM中胰岛素抵抗与血脂异常的关系.现代中西医结合杂质,1999;8(8):1233~1234.
    [84]张锦.胰岛素抵抗与脂质代谢异常.辽宁医学杂质,1996;10(3):118.
    [85]田浩明.FFA与肥胖和糖尿病.实用糖尿病杂质,2000;2(2):8.
    [86]周鹏,陈南衡,王其民.高甘油三酯血症与胰岛素抵抗及糖代谢异常的关系.中华内科杂志,1998;37(7):447~450.
    [87]Reaven GM. Role of insulin resistance in disease (syndrome X): an expandded definition. Annu Rev Med, 1993; 44: 121~131.
    [88]Sane T, Taskinen MR. Does familial hypertriglyceride mia predispose to NIDDM? Diabetes Care, 1993; 16: 1494~1501.
    [89]迟家敏,孙美珍.肥胖症病人的高胰岛素血症与内科疾病.中华内科杂志,1993;32:661~663
    [90]Haffner SM, Stern MP, Hazuda HP, et al. Cardiovascular risk factors in confirmed prediabetic individuals. Dose the clock for coronary heart disease start ticking Before the onset of clinical diabetes? JAMA, 1990; 263: 2893~2898.
    [91]傅晓英,鲁平,马书平,等.IDDM患者餐后TG水平与血管并发症关系的研究.中国糖尿病杂志,2000;88(4):204.
    [92]Graaf JD, Heidi LM, Hak Lemmers, et al. Enhanced susceptibility to in vitro oxidation of the dense low density lipoprotein subfraction in healthy subjects. Arteriosclersis Thrombosis, 1991; 11: 298.
    [93]Roheim PS. Atheros clerosis and lipoprotein metabolism:role of reverse cholesterol transport. Am J Cardiol, 1986; 57: 3.
    [94]Ebara T, Xu Y, Kraemer FB, et al. Hyperglycemia and hypertrigly ceridemia in hormone-sensitive Lipase-overexpressing transgenic mice. Diabetes, 1998;47(suppl 1A):32.
    [95]Randle PJ, Garland PB, Hales CN, et al. The glucose fatty acid cycle: its
    
    role in insulin sensitivity and metabolic disturbance of diabetes mellitus. LANCET, 1963; 1: 785~789.
    [96]Tsao TS, Burcelin R, Katz EB, et al. Enbanced insulin action due to targeted Glut_4 overexpression exclusively in muscle. Diabetes, 1996; 45: 28~36.
    [97]Wu MS, Johnston P,-Shen WH, et al. Effect of metformin on carbohydrate and lipoprotein metabolism in NIDDM patients. Diabetes Care, 1990; 13: 1~4.
    [98]Naw roth P P, Stern D M. Modulation of endothelial cell hem ostatic properties by tumor necrosis factor. J Exp Med, 1986; 163: 740.
    [99]Hotamisligil GS, Amer P, Caro JF, et al. Increased adipose tissue expression of tumor necrosis factor-α in human obesity and insulin resistance [J]. J clin Invest, 1995; 95: 2409~2415.
    [100]Kern PA, Mehrnoosh S, John M, et al. The Expression of TNF in human adipose tissue: regulation by obesity, weight loss and relationship to lipoprotein lipase [J]. J Clin Invest, 1995; 95: 2111~2119.
    [101]Saghizadeh M, Ong JM, Garvey WT, et al. The expression of TNF-α by human muscle [J]. J Clin Invest, 1996;97(4):1111~1116.
    [102]Kawalcami M, Murase T, Ogawa H, et al. Human recombinant TNF suppresses lipoprotein lipase activity and stimulates lipolysis in 3T3-L1 cells. Biochemistry, 1987;101:331~338.
    [103]Saxena U, Witte LD, Goldberg IJ. Tumor necrosis factor induced release of endothelial cell lipoprotein lipase. Arteriosclerosis, 1990;10: 470~476.
    [104]Paolisso G, Rizzo MR, MazziottiG. Am J hysiol, 1998; 275(38): E294~299.
    [105]Feingold KR, Gnmfeld C. Diabetes, 1992; 41(Supp12): 97~101.
    [106]Willa AH, Thomas AB. Obesity and hypertension. Endocrinol Metab Clin North AM, 1994; 23(4): 405.
    [107]陈小铭,倪立,黄晨,等.糖尿病大鼠红细胞和组织胰岛素受体相关性研究.中
    
    国药理学通报,1999;15(4):319~321.
    [108]周红,张玉华,黄振国,等.NIDDM患者红细胞胰岛素受体的变化特点及临床意义(附51例报告).河北医科大学学报,2000;21(4):205~207.

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