【摘要】：背景:2型糖尿病的患病率逐年上升,是衛(wèi)生服務(wù)機(jī)構(gòu)管理的4種慢病之一,“社區(qū)防治”意義重大�！岸潘摹甭」芾砟Ｊ绞橇_仁教授課題組基于“治未病”和亞健康管理與干預(yù)的研究上首次提出來的以健康幫扶、健康促進(jìn)、體質(zhì)調(diào)理為特色的中西醫(yī)結(jié)合慢病管理模式,將此模式運(yùn)用于2型糖尿病管理,是社區(qū)慢病管理的一種方法創(chuàng)新與嘗試,在此模式中,“四”是4種干預(yù)措施,是以糾正不良生活習(xí)慣及偏頗中醫(yī)體質(zhì)為目的的干預(yù)措施。通過改善偏頗體質(zhì)狀況,顯現(xiàn)體質(zhì)干預(yù)對2型糖尿病患者的防治作用,對2型糖尿病的防治有積極意義。目的:1.了解2型糖尿病患者中醫(yī)體質(zhì)類型及其與常見心血管危險(xiǎn)因素的相關(guān)性。2.明確“二三九四”慢病管理模式體質(zhì)干預(yù)對偏頗體質(zhì)2型糖尿病患者的防治作用。3.探討氣虛和痰濕體質(zhì)2型糖尿病患者體質(zhì)干預(yù)代謝組學(xué)機(jī)制。方法:1.通過體檢和量表調(diào)查,對497例2型糖尿病患者進(jìn)行中醫(yī)體質(zhì)辨識(shí)和心血管危險(xiǎn)因素判定。2.將100例偏頗體質(zhì)2型糖尿病患者分干預(yù)和對照組,兩組維持原有降糖藥物治療。對照組予糖尿病生活方式指導(dǎo),干預(yù)組同時(shí)予糾正偏頗體質(zhì)的4種措施干預(yù)6個(gè)月,主要療效指標(biāo)為血糖水平和中醫(yī)體質(zhì)量表評(píng)分。3.從干預(yù)對象中選取最常見的2種偏頗體質(zhì)氣虛質(zhì)和痰濕質(zhì),采集患者干預(yù)前后血清標(biāo)本,進(jìn)行代謝組學(xué)檢測。結(jié)果:1.497例2型糖尿病患者平和體質(zhì)少(24.14%),偏頗體質(zhì)多(75.86%),偏頗體質(zhì)以痰濕、陰虛和氣虛質(zhì)為常見;超重和肥胖(58.35%)、血脂異常(54.93%)和高血壓(51.91%)是最常見的心血管危險(xiǎn)因素;高齡多見陽虛質(zhì),痰濕質(zhì)超重肥胖、血脂異常率高,濕熱質(zhì)吸煙、喝酒、超重肥胖率高,血瘀質(zhì)高血壓、心電圖異常、運(yùn)動(dòng)缺乏率高。2.干預(yù)后,體質(zhì)評(píng)分,干預(yù)組平和質(zhì)評(píng)分和偏頗質(zhì)總分與干預(yù)前及對照組比較,有顯著差異(P0.05);血糖值,干預(yù)組空腹血糖和糖化血紅蛋白值顯著低于干預(yù)前和對照組(P0.05);BMI、腰圍、血壓值,干預(yù)組BMI、收縮和舒張壓值顯著低于對照組(P0.05);生存質(zhì)量評(píng)分,干預(yù)組生理職能和生理機(jī)能評(píng)分顯著高于干預(yù)前(P0.05),一般健康狀況和生理機(jī)能評(píng)分顯著高于對照組(P0.05)。3.干預(yù)后,氣虛質(zhì)患者有22個(gè)血清分類貢獻(xiàn)較大的差異性代謝產(chǎn)物,痰濕質(zhì)患者有15個(gè)血清分類貢獻(xiàn)較大的差異性代謝產(chǎn)物,其共同差異代謝物為酪氨酸、α-亞麻酸、鳥嘌呤核苷、二磷酸腺苷、煙酰胺腺嘌呤二核苷酸、肌苷、煙堿、瓜氨酸、α-葡萄糖、β-葡萄糖。結(jié)論:1.2型糖尿病患者偏頗體質(zhì)多,偏頗體質(zhì)與心血管危險(xiǎn)因素有一定的相關(guān)性。2.“二三九四”慢病管理模式能夠改善2型糖尿病患者的偏頗體質(zhì)狀態(tài),增進(jìn)平和體質(zhì)狀態(tài),降低血糖水平,改善臨床異常指標(biāo),提高患者生存質(zhì)體。3.體質(zhì)干預(yù)可能通過能量代謝、脂代謝、氨基酸代謝、核苷酸代謝、腸道菌群等途徑發(fā)揮作用,且不同體質(zhì)干預(yù)其代謝譜變化有一些差異。
[Abstract]:Background: the prevalence of type 2 diabetes is increasing year by year. It is one of the four chronic diseases managed by health service institutions. Community prevention and treatment is of great significance. The "2394" chronic disease management model is the first time put forward by Professor Luo Ren's research group based on the research on "treating no disease" and sub-health management and intervention, which is characterized by health assistance, health promotion, and physical conditioning, which is characterized by integrated Chinese and western medicine and chronic disease management. Applying this model to the management of type 2 diabetes mellitus is a method innovation and attempt of community chronic disease management. In this model, "4" is four kinds of intervention measures, which aim at correcting bad living habits and biased traditional Chinese medicine constitution. The prevention and treatment of type 2 diabetes mellitus has positive significance by improving the biased physical condition and showing the preventive and therapeutic effect of physique intervention on type 2 diabetes mellitus patients. Purpose: 1. To understand the type of traditional Chinese medicine constitution in patients with type 2 diabetes mellitus and its correlation with common cardiovascular risk factors. 2. Clear "2394" chronic disease management model of physical intervention on the prevention and treatment of biased type 2 diabetes mellitus patients. 3. Objective: to explore the mechanism of physique intervention in type 2 diabetes mellitus with qi deficiency and phlegm dampness constitution. Methods: 1. Through physical examination and scale survey, 497 patients with type 2 diabetes mellitus were identified by traditional Chinese medicine physique and cardiovascular risk factors. 100 patients with type 2 diabetes mellitus with biased constitution were divided into two groups: intervention group and control group. The control group was given diabetes lifestyle guidance, and the intervention group was treated with 4 kinds of measures to correct the biased constitution for 6 months. The main therapeutic indexes were blood glucose level and TCM somatosomatic scale score. The two most common types of qi deficiency and phlegm dampness were selected from the intervention subjects, and the serum samples before and after intervention were collected for metabonomics examination. Results: 1.497 patients with type 2 diabetes mellitus had less mild constitution (24.14%) and more biased constitution (75.86%). Phlegm dampness, yin deficiency and qi deficiency were common in the biased constitution. Overweight and obesity (58.35%), dyslipidemia (54.93%) and hypertension (51.91%) were the most common cardiovascular risk factors. Yang deficiency, excessive obesity of phlegm and dampness, high abnormal rate of blood lipid, smoking of dampness and heat, drinking, overweight and obesity, high blood stasis hypertension, abnormal electrocardiogram and high rate of exercise deficiency were found in the elderly. After intervention, there were significant differences in physique score, level and quality score and partial quality score between the intervention group and the pre-intervention and control group (P0.05). The fasting blood glucose and hemin in the intervention group were significantly lower than those before intervention and in the control group (P0.05); BMI, waist circumference, blood pressure, systolic and diastolic blood pressure values of BMI, in the intervention group were significantly lower than those in the control group (P0.05); The scores of quality of life (QOL), physiological function and physiological function in the intervention group were significantly higher than those before intervention (P0.05), and the general health status and physiological function scores were significantly higher in the intervention group than those in the control group (P0.05). After intervention, 22 differential metabolites of serum classification were found in patients with Qi deficiency and 15 in patients with phlegm dampness, and their common differential metabolites were tyrosine, 偽-linolenic acid, and their common metabolites were tyrosine, 偽-linolenic acid, and 偽-linolenic acid (偽-linolenic acid). Guanine nucleoside, adenosine diphosphate, nicotinamide adenine dinucleotide, inosine, nicotine, citrulline, 偽-glucose, 尾-glucose. The patients with type 2 diabetes mellitus have more biased physique, and there is a certain correlation between the biased constitution and cardiovascular risk factors. 2. The "2394" chronic disease management model can improve the biased physique of type 2 diabetic patients, improve the level of calm physique, reduce the blood sugar level, improve the clinical abnormal indexes, and improve the survival body of the patients. 3. Physique intervention may play a role in energy metabolism, lipid metabolism, amino acid metabolism, nucleotide metabolism and intestinal microflora, and there are some differences in metabolic spectrum between different physique.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1

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