發(fā)布時(shí)間：2018-05-24 16:37

  本文選題：超重肥胖 + 2型糖尿病　； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:近年來(lái)國(guó)內(nèi)外專家提出胰島素原(proinsulin insulinogen,PI)/胰島素比值可能對(duì)于評(píng)價(jià)胰島β細(xì)胞功能和判斷胰島素抵抗(insulin resistance,IR)程度有一定的參考價(jià)值。本文通過比較正常體重和超重及肥胖2型糖尿病(type2 diabetes mellitus,T2DM)患者的臨床資料,分析超重及肥胖與IR的相關(guān)性,并初步探討PI/胰島素比值對(duì)評(píng)估IR程度的作用。分析超重及肥胖T2DM患者中醫(yī)證型的特點(diǎn)與差異,為明確超重和肥胖T2DM患者的中醫(yī)證型及與IR的相關(guān)性,以盡早對(duì)超重和肥胖2型糖尿病IR患者采取針對(duì)性的干預(yù)措施提供參考依據(jù)。材料與方法:分析2016年8月1日至11月31日期間于遼寧中醫(yī)藥大學(xué)附屬醫(yī)院內(nèi)分泌科住院治療的T2DM患者住院資料。參照《中國(guó)成人超重和肥胖癥預(yù)防與控制指南》中提出的超重及肥胖的診斷標(biāo)準(zhǔn),分為超重組、肥胖組及正常體重組,比較各組間患者的一般資料包括年齡、性別比、病程等,胰島功能相關(guān)指標(biāo)包括空腹C肽、空腹胰島素(Fasting insulin,Fins)等,血脂及尿酸代謝情況,糖尿病相關(guān)并發(fā)癥情況,計(jì)算胰島素抵抗指數(shù)(HOMA-IR)、胰島素敏感指數(shù)(ISI)、PI/Fins比值,分析各組之間理化指標(biāo)的區(qū)別聯(lián)系及與IR的相關(guān)性。再以中醫(yī)證型為分組依據(jù),比較超重及肥胖組患者臨床特征的差異,并分析探討不同中醫(yī)證型間各理化指標(biāo)的區(qū)別聯(lián)系及與IR的相關(guān)性。應(yīng)用SPSS17.0統(tǒng)計(jì)軟件將上述資料進(jìn)行分析,計(jì)數(shù)資料采用卡方檢驗(yàn),計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,滿足正態(tài)性及方差齊性采用單因素方差分析,不滿足正態(tài)性則采用非參數(shù)檢驗(yàn),計(jì)量資料以中位數(shù)±四分位數(shù)(M±Q)表示,相關(guān)因素分析使用直線相關(guān)和等級(jí)相關(guān)分析。結(jié)果:1.納入病例總數(shù)為237例,男性118例,女性119例,年齡在24-80歲之間,病程在1周-30年之間。在年齡、病程、性別構(gòu)成比、FBG及Hb A1C方面,三組間相互比較無(wú)明顯差異(P0.05)。2.肥胖組Fins、C肽及PI水平最高,與正常體重組和超重組比較有統(tǒng)計(jì)學(xué)意義(P0.01),超重組的C肽水平高于正常體重組(P0.01)。3.肥胖組HOMA-IR值最高,與正常體重組及超重組比較有統(tǒng)計(jì)學(xué)意義(P0.01)。肥胖組ISI值最低,與正常體重組及超重組比較有統(tǒng)計(jì)學(xué)意義(P0.01)。肥胖組及超重組PI/Fins比值高于正常體重組(P0.01或P0.05)。4.與正常體重組比較,超重組和肥胖組的TG及UA水平相對(duì)較高,HDL-C水平相對(duì)較低差異有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01),肥胖組UA水平高于超重組(P0.05)。5.在糖尿病相關(guān)并發(fā)癥的情況方面,正常體重組所占比例最高的是AS(52例,65.82%),其次是DPN(42例,53.16%)和CVD(39例,49.37%),DR(19例,24.05%)和DKD(10例,12.66%)。超重組所占比例最高的是AS(73例,69.52%),其次是CVD(52例,49.52%)和DPN(46例,43.81%),DR(21例,20%)和DKD(13例,12.38%)。肥胖組半數(shù)以上并發(fā)AS(32例,60.38%)和CVD(30例,56.60%),三組間相互比較無(wú)明顯差異(P0.05)。6.158例超重及肥胖的T2DM患者中,以證屬氣陰兩虛兼血瘀型(79例,50.00%)及濕熱困脾兼血瘀型(42例,26.58%)者所占比例較高,氣陰兩虛型次之(30例,18.99%),陰陽(yáng)兩虛兼血瘀型者(7例,4.43%)所占比例最低。7.在各證型組中,氣陰兩虛型患者平均年齡最小(50.60±11.16歲)、病程最短(3.03±4.09年),較少合并糖尿病相關(guān)并發(fā)癥;陰陽(yáng)兩虛兼血瘀型的平均年齡最大(72.86±6.44歲),病程最長(zhǎng)(20.71±6.90年),合并各種糖尿病相關(guān)并發(fā)癥的比例較高,除DR外,兩組之間比較有統(tǒng)計(jì)學(xué)意義(P0.05);濕熱困脾兼血瘀型患者BMI(29.22±3.40kg/m2)及WC值(97.13±8.81cm)均高于氣陰兩虛型和氣陰兩虛兼血瘀型患者(P0.05);在性別比方面各證型間相互比較無(wú)明顯差異(P0.05)。8.在各證型組中,氣陰兩虛型Fins水平最低,與濕熱困脾兼血瘀型、陰陽(yáng)兩虛兼血瘀型比較有統(tǒng)計(jì)學(xué)意義(P0.05);氣陰兩虛兼血瘀型PI水平最低,與陰陽(yáng)兩虛兼血瘀型比較有統(tǒng)計(jì)學(xué)意義(P0.05)。9.在各證型組中,氣陰兩虛型HOMA-IR值最低,與濕熱困脾兼血瘀型和陰陽(yáng)兩虛兼血瘀型比較有統(tǒng)計(jì)學(xué)意義(P0.05);與氣陰兩虛兼血瘀型比較,濕熱困脾兼血瘀型和陰陽(yáng)兩虛兼血瘀型有統(tǒng)計(jì)學(xué)意義(P0.05)。氣陰兩虛型ISI值最高,與濕熱困脾兼血瘀型和陰陽(yáng)兩虛兼血瘀型比較有統(tǒng)計(jì)學(xué)意義(P0.05)。在PI/Fins方面,與氣陰兩虛型比較,氣陰兩虛兼血瘀型有統(tǒng)計(jì)學(xué)意義(P0.05)。在脂代謝方面,陰陽(yáng)兩虛兼血瘀型TG水平最高,與氣陰兩虛兼血瘀型比較有統(tǒng)計(jì)學(xué)意義(P0.05)。10.HOMA-IR與BMI、PI、TG、CHOL呈正相關(guān)關(guān)系(P0.01),ISI與BMI、PI、TG、CHOL呈負(fù)相關(guān)關(guān)系(P0.01),PI/Fins與BMI呈正相關(guān)關(guān)系(P0.05)。結(jié)論:1.2型糖尿病IR的發(fā)生可能與肥胖有關(guān);PI/Fins比值可大致評(píng)估體內(nèi)IR的程度,PI/Fins比值越高IR程度越重。2.超重及肥胖的T2DM患者較易出現(xiàn)血脂及尿酸代謝紊亂。3.超重及肥胖T2DM患者的證型分布特點(diǎn)如下:氣陰兩虛兼血瘀型濕熱困脾兼血瘀型氣陰兩虛型陰陽(yáng)兩虛兼血瘀型;氣陰兩虛兼血瘀型是超重及肥胖T2DM患者中最常見的中醫(yī)證型,且與IR、TG關(guān)系密切;濕熱困脾兼血瘀型也較為常見;陰陽(yáng)兩虛兼血瘀型合并各種糖尿病相關(guān)并發(fā)癥的比例較高。
[Abstract]:Objective: in recent years, domestic and foreign experts suggested that the proinsulin insulinogen (PI) / insulin ratio may be of reference value for evaluating islet beta cell function and determining the degree of insulin resistance (insulin resistance, IR). This article compares normal weight and overweight and obese type 2 diabetes mellitus (type2 diabetes mellitus, T2DM). The clinical data of the patients, analyzed the correlation between overweight and obesity and IR, and preliminarily explored the role of the ratio of PI/ insulin to evaluate the degree of IR. The characteristics and differences of TCM syndrome types of overweight and obese T2DM patients were analyzed to identify the TCM syndrome type of overweight and obese T2DM patients and the correlation with IR in order to determine the IR in overweight and obese type 2 diabetes as early as possible. Reference basis was provided for targeted interventions. Materials and methods: analysis of inpatient data of T2DM patients hospitalized at the Department of Endocrinology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from August 1, 2016 to November 31st. The diagnostic criteria for overweight and obesity in the guidelines for the prevention and control of overweight and obesity in Chinese adults were divided. The general data included age, sex ratio and course of disease were compared between the group and the obese group and the normal weight group. The islet function related indexes included fasting C peptide, fasting insulin (Fasting insulin, Fins), blood lipid and uric acid metabolism, diabetic complications, insulin resistance index (HOMA-IR), insulin. The sensitivity index (ISI) and the ratio of PI/Fins were analyzed and the correlation between the physical and chemical indexes and the correlation with IR were analyzed. The differences in the clinical characteristics of overweight and obese patients were compared with the TCM syndrome types, and the correlation between the physical and chemical indexes of different TCM syndromes and the correlation with the IR were analyzed and discussed. The SPSS17.0 statistical software was applied. The above data were analyzed with the chi square test, and the measurement data were expressed with mean number + standard deviation (x + s). The single factor variance analysis was used to satisfy the normality and the homogeneity of variance. The nonparametric test was used to satisfy the normality. The measurement data were expressed in the median of four (M + Q), and the correlation factors were analyzed using the linear correlation and the other factors. Results: 1. the total number of cases included in the 1. cases were 237 cases, 118 men, 119 women, 24-80 years of age, and between 1 weeks and 1 weeks. The three groups had no significant difference (P0.05).2. obesity group Fins, C peptide and PI level, compared with normal weight group and super recombination, in the age, course of disease, sex composition ratio, FBG and Hb A1C. There were statistical significance (P0.01), the level of super recombinant C peptide was higher than normal weight group (P0.01).3. obese group, HOMA-IR value was the highest, and compared with normal weight group and super recombination (P0.01). The lowest ISI value in obese group was statistically significant (P0.01) compared with normal weight group and super recombination (P0.01). The ratio of obese and super recombinant PI/Fins was higher than normal. The weight group (P0.01 or P0.05).4. compared with the normal weight group, the TG and UA levels were relatively high in the super recombinant and the obese group, and the HDL-C level was relatively low (P0.05 or P0.01). The UA level in the obese group was higher than that of the super recombination (P0.05).5. in the diabetes related complications, and the highest proportion of the normal body weight group was AS (52 cases, 6). 5.82%), followed by DPN (42 cases, 53.16%) and CVD (39 cases, 49.37%), DR (19 cases, 24.05%) and DKD (10 cases, 12.66%). The highest proportion of super recombination is AS (73 cases, 69.52%), followed by CVD (52, 49.52%) and DPN, DR (instances, DKD) and AS. There was no significant difference in each other (P0.05).6.158 cases of overweight and obese T2DM patients, with the syndrome of Qi Yin deficiency and blood stasis type (79 cases, 50%) and damp heat trapped in the spleen and blood stasis type (42 cases, 26.58%), the proportion was higher, the Qi and Yin deficiency type (30 cases, 18.99%), the Yin and yang two deficiency and blood stasis type (7 cases, 4.43%) accounted for the lowest proportion of.7. in the various syndrome groups, The average age of the patients with Qi and yin deficiency (50.60 + 11.16 years) was the shortest (3.03 + 4.09 years), less complicated with diabetes related complications; the average age of the Yin and yang two deficiency and blood stasis type was the largest (72.86 + 6.44 years), the longest course (20.71 + 6.90 years). The proportion of the complications associated with various kinds of diabetic diseases was higher. Except for DR, the two groups were more common. Study significance (P0.05); BMI (29.22 + 3.40kg/m2) and WC value (97.13 + 8.81cm) in patients with damp heat and spleen and blood stasis were higher than those of Qi Yin deficiency type and Qi Yin deficiency and blood stasis type (P0.05). There was no significant difference (P0.05).8. in each syndrome type group, and the lowest level of Qi and yin deficiency type Fins, with damp and hot stranded spleen and blood. The blood stasis type, yin and yang two deficiency and blood stasis type had statistical significance (P0.05); the level of Qi Yin deficiency and blood stasis type PI was the lowest, and there was statistical significance (P0.05) with Yin and yang two deficiency and blood stasis type (P0.05), in each type of syndrome group, the value of Qi and yin deficiency type HOMA-IR was the lowest, and there were statistical significance (P0.05) with the type of damp heat trapped in spleen and blood stasis type and Yin Yang two deficiency and blood stasis type. Compared with the deficiency of Qi and Yin and blood stasis type, the damp heat trapped in spleen and blood stasis type and Yin Yang two deficiency and blood stasis type had statistical significance (P0.05). The ISI value of Qi Yin deficiency type was the highest, compared with the damp heat trapped spleen and blood stasis type and Yin yang two deficiency and blood stasis type (P0.05). In PI/Fins square, compared with Qi Yin deficiency type, Qi Yin deficiency and blood stasis type had unification. Study significance (P0.05). In lipid metabolism, yin and yang two deficiency and blood stasis type TG level was the highest, compared with Qi and yin deficiency and blood stasis type (P0.05),.10.HOMA-IR and BMI, PI, TG, CHOL were positively correlated (P0.01), ISI and BMI, PI, and had a negative correlation. Conclusion: type 1.2 diabetes mellitus The incidence of obesity may be related to obesity; the PI/Fins ratio can roughly evaluate the degree of IR in the body, the higher the PI/Fins ratio, the higher the IR degree, the more overweight and the obese, the T2DM patients are more susceptible to blood lipid and uric acid metabolic disorder,.3. is overweight and obese T2DM patients are distributed as follows: Qi Yin deficiency and blood stasis type damp heat trapped in spleen and blood stasis type Qi Yin deficiency and yin deficiency type Yin and yang two deficiency and blood stasis type, Qi Yin deficiency and blood stasis type is the most common type of TCM syndrome in overweight and obese T2DM patients, and is closely related to IR, TG; damp heat trapped in spleen and blood stasis type is also more common; the proportion of yin and yang deficiency and blood stasis type with various diabetes related complications is higher.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 程彥臻;陳宏;楊帆;宋青青;嚴(yán)婷;陳容平;;廣東省超重、肥胖2型糖尿病患者慢性并發(fā)癥及合并癥發(fā)病情況調(diào)查[J];山東醫(yī)藥;2016年31期

2 房萬(wàn)菊;魏剛;;糖尿病伴肥胖患者胰島素抵抗程度評(píng)估及與血清學(xué)指標(biāo)的關(guān)系[J];海南醫(yī)學(xué)院學(xué)報(bào);2015年10期

3 李冰;;中醫(yī)藥治療2型糖尿病胰島素抵抗的研究進(jìn)展[J];中國(guó)醫(yī)藥指南;2015年19期

4 陸菊明;;中國(guó)2型糖尿病防治指南(2013年版)更新要點(diǎn)的解讀[J];中國(guó)糖尿病雜志;2014年10期

5 季明;鄒大進(jìn);;“高�！狈逝值淖R(shí)別與研究[J];中國(guó)實(shí)用內(nèi)科雜志;2014年10期

6 張瑞;;阿卡波糖治療2型糖尿病改善胰島素抵抗作用的前瞻性研究[J];中國(guó)實(shí)用醫(yī)藥;2014年09期

7 韋俊杰;;二甲雙胍改善2型糖尿病胰島素抵抗的臨床研究[J];中外醫(yī)學(xué)研究;2014年09期

8 汪朝振;葉翔;張?zhí)?yáng);;酸苦克甘方對(duì)改善2型糖尿病大鼠胰島素抵抗的影響[J];中國(guó)中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2014年04期

9 周煥嬌;王靜芝;劉建民;楊豐;吳松;梁鳳霞;王華;;“標(biāo)本配穴”電針對(duì)胰島素抵抗大鼠下丘腦磷酸化糖原合成酶激酶3β表達(dá)的影響[J];湖北中醫(yī)藥大學(xué)學(xué)報(bào);2014年01期

10 張曉英;王鵬翔;張致英;賀學(xué);;紅景天苷改善胰島素抵抗HepG2細(xì)胞糖代謝及分子機(jī)制初探[J];中藥藥理與臨床;2014年01期

，

本文編號(hào)：1929800