基于少阳太阴病机辩治糖尿病合并血脂异常的临床研究
摘要
研究目的
2010年中国人的糖尿病患病率研究结果：年龄标化的总糖尿病患病率(包括既往诊断的糖尿病和既往未诊断的糖尿病)和糖尿病前期患病率分别为9.7%(在男性中为10.6%以及在女性中为8.8%)和15.5%(在男性中为16.1%以及在女性中为14.9%)。糖尿病代谢紊乱导致机体内紊乱,脂代谢造成高脂蛋白血症如此逐步形成动脉硬化、冠心病及脑血管病发生的主要危险因素之一。
中医药重视人体自我的调节能力,以整体观念和辩证论治作为指导原则,而中药的复方能通过多种环节、多向靶点来调节机体机能状态,进而逆转疾病的本身修复的病理状态。加上中药具有天然、且低毒、无副作用的优点,透过辩证施治,个体化治疗能明显改善患者临床症状,生活质量,延缓糖尿病及其并发症的进展,疗效好,患者依从性高,在临床上的应用视野非常辽阔,取得更好的效果。
以《伤寒论》作为指导原则下调查研究糖尿病合并血脂异常的患者,基于少阳太阴病机辩治糖尿病合并血脂异常辩治研究,及中药复方的治疗作用效果,能为糖尿病合并血脂异常的规范治疗提供新思路和方法,对提高糖尿病临床疗效和有重要意义。
研究方法一：血脂异常与载脂蛋白B/LDL-C比值的变化调查研究
符合标准糖尿病合并血脂异常病例分为200例,从中整理观察组100例与对照组100例,按照1997年中华心血管杂志编辑委员会血脂异常防治对策专题组《血脂异常防》标准。抽查空腹血脂总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL_C)、低密度脂蛋白胆固醇(LDL_C)、载体蛋白(APOA)、载体蛋白(APOB)等指标。
研究方法二：基于少阳太阴病机论治2型糖尿患者合并血脂异常疗效研究调查
符合标准糖尿病合并血脂异常中医少阳太阴病机病例分为30例,依据调查内容填选个人基本调查表、实验室检查血糖、血脂等等想关性指标,血脂异常临床症状量表、胆郁脾虚临床症状量表,并在门诊、随访治疗前后疗效变化及关系。
研究结果
国外学者已经证实LDL_C颗粒的大小可作为心血管疾病发生和冠心病进程的预示指标。有研究表明apo B与小LDL_C颗粒数量具有高度相关性。小LDL_C颗粒与血脂异常患者的致动脉粥样硬化因素有关。对于血脂异常和胰岛素抵抗患者来说,检测apo B可代替检测LDL_C的颗粒数量。本研究结果进一步表明了apo B/LDL_C比值可作为血脂异常患者脂代谢紊乱的一个指标。LDL C的颗粒大小、亚型、数量可用超速离心法和聚丙烯酰胺凝胶电泳法测定。但这些技术难度较大,不能常规应用于临床实验室。学者们正在寻找一种替代物,如血清中的血脂参数(TG、apo B、 LDL_C、HDL_C等)。高脂血症会伴随apo B升高,是高脂血症最有代表性的替代物,而TC/HDL_C比值也可用于反映LDL_C颗粒的大小。本研究apo B/LDL_C比值的变化与Altan Onat等的结果一致。
传统医学认为,血脂紊乱及高凝状态属中医学中的“痰湿”、“瘀血”范畴,脾为生痰之源,肥人多痰多湿,肺为贮痰之器,肺主水之上源,土不生金,则肺虚不治水反凝为痰。肝主疏泄,肝郁气滞,气不化津而成痰。三焦不利,聚饮而成痰。再者,脾虚气血生化无源,气虚推动乏力而血瘀；肝郁气滞而成瘀,痰凝脉络而酿瘀。日久阴阳不调,气血不和,发为痰瘀互结。
总之,载脂蛋白B(apo B)和低密度脂蛋白胆固醇(LDL_C)是常规血脂检测项目之一,但观察apo B/LDL_C的比值变化及其在血脂异常中应用的研究资料较少。故本研究着重观察血脂异常患者与健康人群中的apo B/LDL_C比值的变化。从研究结果中也证实了载脂蛋白与血脂异常的相互关系,并且高脂血症会伴随apo B升高,与多篇国外研究结果相同。
经中医辩证治疗后,糖尿病合并血脂异常的患者实验室检查中的空腹血糖、糖化血红蛋白明显改善,血脂六项各项指标亦明显改善血脂,中医证型的观察少阳太阴病机(胆郁脾虚或称肝郁脾虚)症状明显减轻；血脂异常的临床症状也逐步改善。从导师李赛美教授门诊跟诊学习中发现,从少阳太阴论治糖尿病合并血脂异常有良好的效果。“健脾降脂方”是以“四逆散+四君子汤”为基础方更加“降脂四味药”其药物分析如下所叙述。病机观点是从少阳与太阴启发,少阳为枢,太阴为三阴病首入的脏腑,邪气初入里,邪气未达少阴、厥阴。因此以疏理少阳枢机,健运太阴的思路,在此次调查治疗前后对比有临床参考意义。
临床上发现糖尿病初发阶段,患者多从体检发现,在临床并无典型的消渴病“三多一少”症状,因外食、应酬逐步形成营养过剩,加上国人饮食习惯离不开“酒”,甚至终日如此醇酒厚味,进而滋生湿热者不乏其人。因此“湿热致消”学说愈来愈受到重视,目前在临床上已逐渐成为当今糖尿病的中医发病观、及治疗观的一大特点。
临床上门诊及住院患者发现糖尿病患者有轻到中度抑郁的情况,此时因糖尿病患者在发病前,都有不同程度的精神创伤。长期过度的精神紧张、工作压力等因素的影响,加上传统不正确的观念使得他们一旦得知自己罹患糖尿病后,开始会出现烦恼、失望、甚至绝望、忧虑、焦虑、害怕恐惧、沮丧、忧心忡忡、诸如此类的精神抑郁症状等。次皆由肝失疏泄的表现。据心身医学的观念,糖尿病患者的性格、情绪是与糖尿病有关的重要因素。此时临床上可运用中医疏肝解郁法来治疗。依据《内经》“木郁达之”的指导原则,五行中肝属木,脾胃属土,肝主疏泄,脾主运化,胃主受纳和降。正常生理状态下,肝木条达可以疏泄中焦脾土的壅滞,此即肝气得疏则脾胃之气升降得宜。在病理情况下周身脏腑之间是可以互相影响的,肝病可以传至脾胃,即是木乘土,反之则为土旺而侮木。肝郁犯胃,胃阴被伤,出现口干多饮多食的胃热炽盛,消谷善饥,此则成为“中消”。因此不少医家认为“以肝为中心”调理脏腑气血津液,辨治消渴,往往每每有其疗效。
导师李赛美教授辩治糖尿病合并血脂异常的临床经验总结
《内经》是奠定“脏腑辩证”学说的基础,仲景所著《伤寒论》中“六经辨证“是推动脏腑辩证学说发展,以营卫气血的理论,可以认识到六经是运行营卫的通路,病邪从表至里,即便是由透过六经从阳至阴,从实到虚,经传腑、脏的传变规律,从而反映了六经的生理状态与疾病的转归。
肝主疏泄,肝的疏泄功能正常,全身气机疏通畅达,有助于脾升胃降和两者之间的协调。而脾的升清和胃的降浊,即脾胃的生理功能,脾胃之气机升降,体现于脾胃对饮食物的消化,及将水谷精微吸收转输,将糟粕排出体外的功能。若枢机不利,升降失常,影响肝胆的疏泄,木失所养,肝开窍于目,而肝失疏泄形成肝血虚,肝血虚不能濡目则目眩眼花,临床症见头晕目眩,胆失决断,胆气上逆于咽喉则出现口苦、咽干。肝郁而化火则急躁易怒,肝气郁结成瘀结于脉络则出现胸胁胀满痛,肝气犯脾胃,肝木乘脾土。肝气盛则疏泄太过,易横逆犯脾胃,影响消化功能则脘腹不舒,腹胀,食少纳差,进而脾胃虚弱,脾主四肢,肌肉腠理失所养则体倦乏力,胆气上逆嗳气吞酸,肝木乘土,致脾胃升清降浊功能失常,则大便溏泄等肝郁犯脾,肝郁脾虚的证候。太阴病机”理念,于实证的病机以“少阳枢机不利”、太阴脾虚湿而致“湿热困脾”、久病致使“血瘀脉络”三个证型多见；“少阳证”治疗多用柴胡汤系列方药加减,如仲景《伤寒论》小柴胡汤、四逆散、柴胡桂枝汤、大柴胡汤、柴胡桂枝干姜汤、柴胡龙骨牡蛎汤…等等。太阴病“湿热困脾证”多用温胆汤、黄连温胆汤、三仁汤、甘露消毒丹…等等。“血瘀脉络证”多用桃红四物汤、桃核承气汤…等等。有时可见伤寒方与温病方合用,如柴胡温胆汤、小柴胡汤和三仁汤…等等。并不拘泥形式,只要病机符合即用。
此外虚证病机以六经传变病至三阴观点出发,但临床病证复杂,皆以虚实夹杂、寒热错杂多见；近年来导师甚至不拘泥古方,时以经方和局方合用；温阳派的理念在临床上导师用之也是甚尤其见效。笔者每每学习后,于临床上亦有其效。如仲景《伤寒论》麻黄附子细辛汤、麻黄附子细辛甘草汤、四逆汤、当归四逆汤、附子汤…等等加减,降至四味药甚至导师临证用方用药的心得；如时而见阳虚夹痰热病证,可从舌脉象可见出判断“舌淡薄黄”、“脉沉细滑或脉沉细弦”,脉沉细主里虚脉；《伤寒论》中,少因病提纲证“少阴之为病,脉微细,但欲寐；说明虚脉。滑脉主湿,弦脉主肝胆病、痛证、及痰饮。故用真武汤和温胆汤加减、茯苓四逆汤和温胆汤加减、真武汤和三仁汤加减…等等。病机符合则不局限。
糖尿病合并血脂异常的患者,少阳太阴证(胆郁脾虚或肝郁脾虚)症状程度明显减轻,糖尿病合并血脂异常的临床生理症状也逐渐缓解,相对空腹血糖、血脂、糖化血红蛋白随之改善。目前临床治疗上控制血糖、血脂、糖化血红蛋白等并不限定用中药治疗或西药治疗,而从门诊发现血脂可以单纯以中药控制,导师运用中医辨证,认为糖尿病合并血脂异常的证型与《伤寒论》“四逆散”证病机相同,皆属于少阳枢机不利；太阴证型并非选择“理中汤”或“理中丸”证,因太阴脾阳虚证并不明显,故选用《太平惠民和剂局方》里的“四君子汤”,此方比较平和,适合选用。根据导师临床用药心得或选用降脂中药药对“山楂、首乌、泽泻、草决明、丹参”并视患者临床而选用。
导师对糖尿病合并血脂异常患者予以中医六经辩证分型的规律性研究,对进一步提高消渴病中医临床疗效具有积极指导价值；对中医对糖尿病合并血脂异常规范化治疗体系的建立有重要参考意义。进一步拓展仲景方药的临床运用范围。
Research purposes
2010China's diabetes prevalence study:Age-standardized prevalence of di abetes in total (including previously diagnosed diabetes and undiagnosed diabetes previously) and pre-diabetes prevalence rates were9.7%(10.6in men%and8.8%in women) and15.5%(16.1%in men and14.9%in women). Di abetes causes the body metabolism disorders, lipid metabolism resulting i n hyperlipoproteinemia so gradually atherosclerosis, coronary heart disea se and cerebrovascular disease occurred in one of the major risk factors.
TCM importance of human self-regulation, to the overall concept and diale ctical theory of governance as a guiding principle, and the compound thro ugh a variety of aspects of traditional Chinese medicine, and more to tar get the state to regulate body functions, thereby reversing the disease i tself, the pathological state of repair. Coupled with natural medicine, a nd low toxicity, no side effects advantages through dialectical therapy, individual therapy can significantly improve clinical symptoms, quality o f life, delaying the progress of diabetes and its complications, efficacy, patient compliance is high in clinical applications vision is very vast, and achieved better results.
In "Treatise on" as a guiding principle investigation in patients with di abetic dyslipidemia, lunar-based Shaoyang debate treat diabetes pathogene sis dyslipidemia debate governance research, and traditional Chinese medi cine treatment effect, able to regulate diabetes and dyslipidemia treatme nt to provide new ideas and methods to improve the clinical efficacy and diabetes are important.
Research Method One:dyslipidemia and apolipoprotein B/LDL-C ratio of t he change research
Standard diabetic dyslipidemia were divided into200cases,100cases fro m finishing the observation group and the control group of100patients, according to1997Journal of Cardiovascular Medicine Editorial Board Task Force dyslipidemia countermeasures "against dyslipidemia" standard. Rand om fasting lipid total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL_C), low-density lipoprotein cholesterol (LDL_C), carrier protein (APOA), carrier protein (APOB) and other indicators. Research Methods II:Based on the Treatment of Shaoyang lunar pathogenesi s of type2diabetes in patients with dyslipidemia study investigated the efficacy
Standard diabetic dyslipidemia Chinese lunar pathogenesis Shaoyang w ere divided into30cases, according to the survey content to fill select ed demographic questionnaire, laboratory blood glucose, blood lipids, and so want to turn off indicators, clinical symptoms scale dyslipidemia, ga llbladder Yu spleen clinical symptom scale, and in the outpatient follow-up after treatment efficacy and relationship changes.
Results
Foreign scholars have confirmed LDL_C particle size can be used as cardio vascular disease and coronary heart disease processes predictors. Studies have shown that apo B and the small number of particles LDL_C highly cor related. Small LDL_C particles and dyslipidemia in patients with atherosc lerosis induced factors. For patients with dyslipidemia and insulin resis tance, the detection of apo B can replace the number of particles detecte d LDL_C. The results further indicate that the apo B/LDL_C ratio of pat ients with dyslipidemia as an indicator of lipid metabolism. LDL_C partic le size, subtype, number of available ultracentrifugation and polyacrylam ide gel electrophoresis method. But these techniques is difficult, not ro utinely used in clinical laboratories. Scholars are looking for an altern ative, such as serum lipid parameters (TG, apo B, LDL_C, HDL_C etc.). Hyp erlipidemia accompanied by elevated apo B, is the most representative hyp erlipidemia alternative, the TC/HDL_C LDL_C ratios can also be used to reflect the size of the particles. In this study, apo B/LDL_C ratio cha nge and Altan Onat other results.
Traditional medicine, dyslipidemia and hypercoagulable state is a medicin e in the "phlegm","bleeding", the spleen is the source of phlegm, fat pe ople more wet phlegm, lung sputum for the storage device, lung water on t he source, the soil is not golden, then Feixu not flood retrograde as spu tum. Liver dispersion, qi stagnation, gas is not subsidized from sputum. Sanjiao negative, gather to drink from sputum. Furthermore, spleen blood biochemistry passive, weak and promote Qi stasis; liver Qi stagnation fro m stasis, phlegm stasis context and stuffed. Yin and Yang are not falling tone, blood feud, made for the phlegm.
In short, apolipoprotein B (apo B) and low-density lipoprotein cholestero1(LDL_C) is one of the conventional lipid testing, but the observation o f apo B/LDL_C ratio change and its application in the study of dyslipid emia less information. Therefore, this study focused on patients with dys lipidemia observed with healthy populations apo B/LDL_C ratio changes. Results from the study also confirmed the apolipoprotein relationship wit h dyslipidemia and hyperlipidemia is accompanied by elevated apo B, and m any articles foreign research results.
The Chinese dialectical therapy, diabetic dyslipidemia laboratory tests, fasting blood glucose, glycosylated hemoglobin significantly improved lip id six indicators also significantly improved blood lipids, TCM lunar obs ervation Shaoyang pathogenesis (bile Yu Spleen also known as liver spleen) to alleviate symptoms; dyslipidemia clinical symptoms gradually improved. From mentor Professor Li Saimei outpatient clinic with learning found th at from Shaoyang lunar Treating diabetes with dyslipidemia with good resu Its."Spleen lipid party" based on "Sini+Sijunzitang" based side more" lowering four herbs" their drug analysis as described. Pathogenesis view is from Shaoyang and lunar inspired Shaoyang as pivot, the first lunar as yin disease into the organs, evil entering the inside, less than evil Sh ao, Jue Yin. Therefore, in order to Reorganizing Shaoyang Cardinal health movement lunar ideas, before and after treatment in this investigation h ave clinical reference value.
Clinical detection of diabetes onset phase, most patients from the medica1examination found that there is no typical clinical Diabetes "a little" symptoms, because eating out, entertainment and gradually formed nutriti on, diet plus people can not do without "wine "and even all day so wine A tsumi, thus no shortage of hot and humid breeding. Therefore,"heat induc ed extinction" theory more and more attention, and is currently in clinic al has gradually become the onset of diabetes medicine concept, and the c oncept of a major feature of the treatment.
Outpatient and inpatient clinical findings with diabetes have mild to mod erate cases of depression, this time due to the onset of diabetes before, have varying degrees of mental trauma. Long-term excessive mental stress, work pressure and other factors, coupled with the traditional concept of making incorrect once they learned that his diabetes, it begins there wi11be trouble, disappointment, and even despair, worry, anxiety, fear of fear, frustration, anxiety that sort of mental depression symptoms. Times chosen by liver failure catharsis performance. According to the concept of psychosomatic medicine, diabetes personality, emotions are important f actors associated with diabetes. At this point the clinical method can us e Chinese medicine to treat liver qi stagnation. Based on "Nei Jing","St agnant Wood," the guiding principle of the five elements are wood liver, spleen and territories, Liver dispersion, transportation of spleen, stoma ch main receiving and drop. Under normal physiological conditions, the wo od is catharsis in the coke can be reached Pitu's Yongzhi, namely, the sp leen and stomach qi was sparse gas lift properly. In pathological cases a re interchangeable between the whole body organs affected, liver disease can spread to the stomach, which is the wood by soil, otherwise it is bus y and insult wood soil. Fan Wei liver, stomach yin was hurt, dry mouth po lydipsia food stomach flaming, eliminating Valley Bulimia, this has becom e "the consumer." So many physicians believe that the "liver-centric" con ditioning organs blood and body fluids, Treating diabetes, often tend to have their effect.
Instructor Professor Li Saimei debate diabetic dyslipidemia treatment of clinical experience
"Nei Jing" is laid out "organs dialectical" theory foundation Jhongjing b ook "Treatise on" in the "six meridians" is to promote the development of organs dialectical theory to the theory of blood camp guard, you can rec ognize the six camps run by yes Wei's path to where Evils from the table, even from the sun through the Six Classics from Yam, from the real to th e imaginary, by the mass organs, dirty mass change rule, thus reflecting the physiological state of the Six Classics and disease outcome. Liver dispersion, catharsis liver function is normal, the body to clear t he air-accessible, to help the spleen and stomach down and coordination b etween the two. The spleen1SD Jiangzhuo stomach, that the physiological function of the spleen and stomach, spleen and stomach qi movements, ref lected in the stomach for digestion of food material, and the water absor ption of grain refined transfusion, the dregs excreted functions. If Card inal adverse movements disorders, affecting hepatobiliary catharsis, wood failure has raised liver opens into the eyes, and liver failure catharsi s the formation of liver blood deficiency, liver deficiency can not moist en head is dizzy vertigo, clinical Zheng Jian dizziness, loss of bile dec isiveness, courage Shangni appeared in the throat, mouth pain, throat. Li ver-fire is irritability, liver qi stagnation into stasis knot in the con text of the emergence Xiong Xie fullness pain, liver guilty of the stomac h, liver wood by Pitu. Qi Sheng is catharsis too, easy tribulations guilt y stomach, affect the digestive function is abdominal discomfort, bloatin g, eat less anorexia, thus weak stomach, spleen limbs, muscle Cou failure has raised the body tired fatigue, courage Shangni belching Tunsuan, woo d is by soil, causing stomach Shengqingjiangzhuo dysfunction, then loose stool and other liver committing the spleen, liver and spleen deficiency syndromes.
Lunar sick machine "concept, in empirical pathogenesis of" Shaoyang Cardi nal unfavorable "lunar Spleen wet caused the" heat spleen,"chronic illne ss resulting in" Blood Vein "three syndromes common;" Shaoyang card " tre atment of multiple prescriptions subtraction with Xiaochaihutang series, such as Jhongjing "Treatise on" Xiao Chai Hu Tang, Sini, Chaihuguizhi sou p, Chai Hu Tang, Chaihuguizhi dried ginger, Chaihulonggumuli soup... and so on. lunar disease "damp spleen card" multi Wendantang, berberine Wend antang, San Ren Tang, mannose disinfection Dan... etc.."stasis context card" multi Taohongsiwutang, THCQT... etc. Sometimes visible Fang Fang t yphoid combined with febrile disease, such as Bupleurum Wendantang Xiaoch aihutang and San Ren Tang... etc. not formality, as long as the disease that is in line with the machine.
Furthermore deficiency in the pathogenesis of disease to six yin by mass change viewpoint, but clinical syndromes complex, tailor false is mixed, mixed cold and heat more common; recent informal mentor even Nigu party, when combined through and the Council; temperature Yang camp concept used in the clinical instructors also Shiyou its effective. I often learn lat er, in clinically has its effect. If Zhongjing "Treatise on" Mahuangfuzix ixin soup Mahuangfuzixixin licorice soup, SND, Dangguisini soup, soup etc. subtraction aconite, even down to four herbs Clinical Instructor sq uare medication experience; such as sometimes see yang clip phlegm syndro mes, tongue and pulse can be seen from the judgment "thin yellow tongue","smooth pulse or thin pulse string", pulse Lord imaginary veins;"Treati se on" in less illness outline card "Shao of the disease, pulse fine, but Yumei; description imaginary clock, primary wet slippery pulse, wiry pul se main Hepatology, pain syndrome, and phlegm, so with Zhen Wu Tang and W endan decoction, Poria SND and Wendantang addition and subtraction, and t hree Ren Zhen Wu Tang Decoction... and so on. pathogenesis meet not limi tations.
Diabetic dyslipidemia, Shaoyang lunar certificate (bile Yu spleen or live r spleen) significantly reduced the degree of symptoms, diabetic dyslipid emia clinical physiological symptoms gradually eased, relative fasting bl ood glucose, blood lipids, glycated hemoglobin will be improved. Current clinical treatment to control blood sugar, blood lipids, glycated hemoglo bin is not limited with traditional Chinese medicine or western medicine, and from the clinic found that lipids can be simply controlled by medici ne, tutors use TCM that diabetic dyslipidemia syndrome and "Treatise on Sini "card pathogenesis same belong Shaoyang Cardinal unfavorable; luna r syndrome is not a choice," Li Zhong Tang "or" Lizhong Wan "card, becaus e the lunar Spleen deficiency is not obvious, so the selection of" peace benefit people and agents Bureau "in the" Sijunzitang "this side more pea ceful, suitable for use. According to clinical treatment experience tutor or use drugs on lipid-lowering medicine,"hawthorn, Radix, Alisma, Cassi a, Salvia" and depending on the clinical use.
Instructors to be diabetic dyslipidemia by TCM six dialectical type of re gularity research on Diabetes medicine to further improve the clinical ef ficacy of positive guidance value; Chinese medicine for treatment of diab etic dyslipidemia standardized Establishment of significance. To further expand the scope of clinical application of Zhongjing prescription.
2010年中国人的糖尿病患病率研究结果：年龄标化的总糖尿病患病率(包括既往诊断的糖尿病和既往未诊断的糖尿病)和糖尿病前期患病率分别为9.7%(在男性中为10.6%以及在女性中为8.8%)和15.5%(在男性中为16.1%以及在女性中为14.9%)。糖尿病代谢紊乱导致机体内紊乱,脂代谢造成高脂蛋白血症如此逐步形成动脉硬化、冠心病及脑血管病发生的主要危险因素之一。
中医药重视人体自我的调节能力,以整体观念和辩证论治作为指导原则,而中药的复方能通过多种环节、多向靶点来调节机体机能状态,进而逆转疾病的本身修复的病理状态。加上中药具有天然、且低毒、无副作用的优点,透过辩证施治,个体化治疗能明显改善患者临床症状,生活质量,延缓糖尿病及其并发症的进展,疗效好,患者依从性高,在临床上的应用视野非常辽阔,取得更好的效果。
以《伤寒论》作为指导原则下调查研究糖尿病合并血脂异常的患者,基于少阳太阴病机辩治糖尿病合并血脂异常辩治研究,及中药复方的治疗作用效果,能为糖尿病合并血脂异常的规范治疗提供新思路和方法,对提高糖尿病临床疗效和有重要意义。
研究方法一：血脂异常与载脂蛋白B/LDL-C比值的变化调查研究
符合标准糖尿病合并血脂异常病例分为200例,从中整理观察组100例与对照组100例,按照1997年中华心血管杂志编辑委员会血脂异常防治对策专题组《血脂异常防》标准。抽查空腹血脂总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL_C)、低密度脂蛋白胆固醇(LDL_C)、载体蛋白(APOA)、载体蛋白(APOB)等指标。
研究方法二：基于少阳太阴病机论治2型糖尿患者合并血脂异常疗效研究调查
符合标准糖尿病合并血脂异常中医少阳太阴病机病例分为30例,依据调查内容填选个人基本调查表、实验室检查血糖、血脂等等想关性指标,血脂异常临床症状量表、胆郁脾虚临床症状量表,并在门诊、随访治疗前后疗效变化及关系。
研究结果
国外学者已经证实LDL_C颗粒的大小可作为心血管疾病发生和冠心病进程的预示指标。有研究表明apo B与小LDL_C颗粒数量具有高度相关性。小LDL_C颗粒与血脂异常患者的致动脉粥样硬化因素有关。对于血脂异常和胰岛素抵抗患者来说,检测apo B可代替检测LDL_C的颗粒数量。本研究结果进一步表明了apo B/LDL_C比值可作为血脂异常患者脂代谢紊乱的一个指标。LDL C的颗粒大小、亚型、数量可用超速离心法和聚丙烯酰胺凝胶电泳法测定。但这些技术难度较大,不能常规应用于临床实验室。学者们正在寻找一种替代物,如血清中的血脂参数(TG、apo B、 LDL_C、HDL_C等)。高脂血症会伴随apo B升高,是高脂血症最有代表性的替代物,而TC/HDL_C比值也可用于反映LDL_C颗粒的大小。本研究apo B/LDL_C比值的变化与Altan Onat等的结果一致。
传统医学认为,血脂紊乱及高凝状态属中医学中的“痰湿”、“瘀血”范畴,脾为生痰之源,肥人多痰多湿,肺为贮痰之器,肺主水之上源,土不生金,则肺虚不治水反凝为痰。肝主疏泄,肝郁气滞,气不化津而成痰。三焦不利,聚饮而成痰。再者,脾虚气血生化无源,气虚推动乏力而血瘀；肝郁气滞而成瘀,痰凝脉络而酿瘀。日久阴阳不调,气血不和,发为痰瘀互结。
总之,载脂蛋白B(apo B)和低密度脂蛋白胆固醇(LDL_C)是常规血脂检测项目之一,但观察apo B/LDL_C的比值变化及其在血脂异常中应用的研究资料较少。故本研究着重观察血脂异常患者与健康人群中的apo B/LDL_C比值的变化。从研究结果中也证实了载脂蛋白与血脂异常的相互关系,并且高脂血症会伴随apo B升高,与多篇国外研究结果相同。
经中医辩证治疗后,糖尿病合并血脂异常的患者实验室检查中的空腹血糖、糖化血红蛋白明显改善,血脂六项各项指标亦明显改善血脂,中医证型的观察少阳太阴病机(胆郁脾虚或称肝郁脾虚)症状明显减轻；血脂异常的临床症状也逐步改善。从导师李赛美教授门诊跟诊学习中发现,从少阳太阴论治糖尿病合并血脂异常有良好的效果。“健脾降脂方”是以“四逆散+四君子汤”为基础方更加“降脂四味药”其药物分析如下所叙述。病机观点是从少阳与太阴启发,少阳为枢,太阴为三阴病首入的脏腑,邪气初入里,邪气未达少阴、厥阴。因此以疏理少阳枢机,健运太阴的思路,在此次调查治疗前后对比有临床参考意义。
临床上发现糖尿病初发阶段,患者多从体检发现,在临床并无典型的消渴病“三多一少”症状,因外食、应酬逐步形成营养过剩,加上国人饮食习惯离不开“酒”,甚至终日如此醇酒厚味,进而滋生湿热者不乏其人。因此“湿热致消”学说愈来愈受到重视,目前在临床上已逐渐成为当今糖尿病的中医发病观、及治疗观的一大特点。
临床上门诊及住院患者发现糖尿病患者有轻到中度抑郁的情况,此时因糖尿病患者在发病前,都有不同程度的精神创伤。长期过度的精神紧张、工作压力等因素的影响,加上传统不正确的观念使得他们一旦得知自己罹患糖尿病后,开始会出现烦恼、失望、甚至绝望、忧虑、焦虑、害怕恐惧、沮丧、忧心忡忡、诸如此类的精神抑郁症状等。次皆由肝失疏泄的表现。据心身医学的观念,糖尿病患者的性格、情绪是与糖尿病有关的重要因素。此时临床上可运用中医疏肝解郁法来治疗。依据《内经》“木郁达之”的指导原则,五行中肝属木,脾胃属土,肝主疏泄,脾主运化,胃主受纳和降。正常生理状态下,肝木条达可以疏泄中焦脾土的壅滞,此即肝气得疏则脾胃之气升降得宜。在病理情况下周身脏腑之间是可以互相影响的,肝病可以传至脾胃,即是木乘土,反之则为土旺而侮木。肝郁犯胃,胃阴被伤,出现口干多饮多食的胃热炽盛,消谷善饥,此则成为“中消”。因此不少医家认为“以肝为中心”调理脏腑气血津液,辨治消渴,往往每每有其疗效。
导师李赛美教授辩治糖尿病合并血脂异常的临床经验总结
《内经》是奠定“脏腑辩证”学说的基础,仲景所著《伤寒论》中“六经辨证“是推动脏腑辩证学说发展,以营卫气血的理论,可以认识到六经是运行营卫的通路,病邪从表至里,即便是由透过六经从阳至阴,从实到虚,经传腑、脏的传变规律,从而反映了六经的生理状态与疾病的转归。
肝主疏泄,肝的疏泄功能正常,全身气机疏通畅达,有助于脾升胃降和两者之间的协调。而脾的升清和胃的降浊,即脾胃的生理功能,脾胃之气机升降,体现于脾胃对饮食物的消化,及将水谷精微吸收转输,将糟粕排出体外的功能。若枢机不利,升降失常,影响肝胆的疏泄,木失所养,肝开窍于目,而肝失疏泄形成肝血虚,肝血虚不能濡目则目眩眼花,临床症见头晕目眩,胆失决断,胆气上逆于咽喉则出现口苦、咽干。肝郁而化火则急躁易怒,肝气郁结成瘀结于脉络则出现胸胁胀满痛,肝气犯脾胃,肝木乘脾土。肝气盛则疏泄太过,易横逆犯脾胃,影响消化功能则脘腹不舒,腹胀,食少纳差,进而脾胃虚弱,脾主四肢,肌肉腠理失所养则体倦乏力,胆气上逆嗳气吞酸,肝木乘土,致脾胃升清降浊功能失常,则大便溏泄等肝郁犯脾,肝郁脾虚的证候。太阴病机”理念,于实证的病机以“少阳枢机不利”、太阴脾虚湿而致“湿热困脾”、久病致使“血瘀脉络”三个证型多见；“少阳证”治疗多用柴胡汤系列方药加减,如仲景《伤寒论》小柴胡汤、四逆散、柴胡桂枝汤、大柴胡汤、柴胡桂枝干姜汤、柴胡龙骨牡蛎汤…等等。太阴病“湿热困脾证”多用温胆汤、黄连温胆汤、三仁汤、甘露消毒丹…等等。“血瘀脉络证”多用桃红四物汤、桃核承气汤…等等。有时可见伤寒方与温病方合用,如柴胡温胆汤、小柴胡汤和三仁汤…等等。并不拘泥形式,只要病机符合即用。
此外虚证病机以六经传变病至三阴观点出发,但临床病证复杂,皆以虚实夹杂、寒热错杂多见；近年来导师甚至不拘泥古方,时以经方和局方合用；温阳派的理念在临床上导师用之也是甚尤其见效。笔者每每学习后,于临床上亦有其效。如仲景《伤寒论》麻黄附子细辛汤、麻黄附子细辛甘草汤、四逆汤、当归四逆汤、附子汤…等等加减,降至四味药甚至导师临证用方用药的心得；如时而见阳虚夹痰热病证,可从舌脉象可见出判断“舌淡薄黄”、“脉沉细滑或脉沉细弦”,脉沉细主里虚脉；《伤寒论》中,少因病提纲证“少阴之为病,脉微细,但欲寐；说明虚脉。滑脉主湿,弦脉主肝胆病、痛证、及痰饮。故用真武汤和温胆汤加减、茯苓四逆汤和温胆汤加减、真武汤和三仁汤加减…等等。病机符合则不局限。
糖尿病合并血脂异常的患者,少阳太阴证(胆郁脾虚或肝郁脾虚)症状程度明显减轻,糖尿病合并血脂异常的临床生理症状也逐渐缓解,相对空腹血糖、血脂、糖化血红蛋白随之改善。目前临床治疗上控制血糖、血脂、糖化血红蛋白等并不限定用中药治疗或西药治疗,而从门诊发现血脂可以单纯以中药控制,导师运用中医辨证,认为糖尿病合并血脂异常的证型与《伤寒论》“四逆散”证病机相同,皆属于少阳枢机不利；太阴证型并非选择“理中汤”或“理中丸”证,因太阴脾阳虚证并不明显,故选用《太平惠民和剂局方》里的“四君子汤”,此方比较平和,适合选用。根据导师临床用药心得或选用降脂中药药对“山楂、首乌、泽泻、草决明、丹参”并视患者临床而选用。
导师对糖尿病合并血脂异常患者予以中医六经辩证分型的规律性研究,对进一步提高消渴病中医临床疗效具有积极指导价值；对中医对糖尿病合并血脂异常规范化治疗体系的建立有重要参考意义。进一步拓展仲景方药的临床运用范围。
Research purposes
2010China's diabetes prevalence study:Age-standardized prevalence of di abetes in total (including previously diagnosed diabetes and undiagnosed diabetes previously) and pre-diabetes prevalence rates were9.7%(10.6in men%and8.8%in women) and15.5%(16.1%in men and14.9%in women). Di abetes causes the body metabolism disorders, lipid metabolism resulting i n hyperlipoproteinemia so gradually atherosclerosis, coronary heart disea se and cerebrovascular disease occurred in one of the major risk factors.
TCM importance of human self-regulation, to the overall concept and diale ctical theory of governance as a guiding principle, and the compound thro ugh a variety of aspects of traditional Chinese medicine, and more to tar get the state to regulate body functions, thereby reversing the disease i tself, the pathological state of repair. Coupled with natural medicine, a nd low toxicity, no side effects advantages through dialectical therapy, individual therapy can significantly improve clinical symptoms, quality o f life, delaying the progress of diabetes and its complications, efficacy, patient compliance is high in clinical applications vision is very vast, and achieved better results.
In "Treatise on" as a guiding principle investigation in patients with di abetic dyslipidemia, lunar-based Shaoyang debate treat diabetes pathogene sis dyslipidemia debate governance research, and traditional Chinese medi cine treatment effect, able to regulate diabetes and dyslipidemia treatme nt to provide new ideas and methods to improve the clinical efficacy and diabetes are important.
Research Method One:dyslipidemia and apolipoprotein B/LDL-C ratio of t he change research
Standard diabetic dyslipidemia were divided into200cases,100cases fro m finishing the observation group and the control group of100patients, according to1997Journal of Cardiovascular Medicine Editorial Board Task Force dyslipidemia countermeasures "against dyslipidemia" standard. Rand om fasting lipid total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL_C), low-density lipoprotein cholesterol (LDL_C), carrier protein (APOA), carrier protein (APOB) and other indicators. Research Methods II:Based on the Treatment of Shaoyang lunar pathogenesi s of type2diabetes in patients with dyslipidemia study investigated the efficacy
Standard diabetic dyslipidemia Chinese lunar pathogenesis Shaoyang w ere divided into30cases, according to the survey content to fill select ed demographic questionnaire, laboratory blood glucose, blood lipids, and so want to turn off indicators, clinical symptoms scale dyslipidemia, ga llbladder Yu spleen clinical symptom scale, and in the outpatient follow-up after treatment efficacy and relationship changes.
Results
Foreign scholars have confirmed LDL_C particle size can be used as cardio vascular disease and coronary heart disease processes predictors. Studies have shown that apo B and the small number of particles LDL_C highly cor related. Small LDL_C particles and dyslipidemia in patients with atherosc lerosis induced factors. For patients with dyslipidemia and insulin resis tance, the detection of apo B can replace the number of particles detecte d LDL_C. The results further indicate that the apo B/LDL_C ratio of pat ients with dyslipidemia as an indicator of lipid metabolism. LDL_C partic le size, subtype, number of available ultracentrifugation and polyacrylam ide gel electrophoresis method. But these techniques is difficult, not ro utinely used in clinical laboratories. Scholars are looking for an altern ative, such as serum lipid parameters (TG, apo B, LDL_C, HDL_C etc.). Hyp erlipidemia accompanied by elevated apo B, is the most representative hyp erlipidemia alternative, the TC/HDL_C LDL_C ratios can also be used to reflect the size of the particles. In this study, apo B/LDL_C ratio cha nge and Altan Onat other results.
Traditional medicine, dyslipidemia and hypercoagulable state is a medicin e in the "phlegm","bleeding", the spleen is the source of phlegm, fat pe ople more wet phlegm, lung sputum for the storage device, lung water on t he source, the soil is not golden, then Feixu not flood retrograde as spu tum. Liver dispersion, qi stagnation, gas is not subsidized from sputum. Sanjiao negative, gather to drink from sputum. Furthermore, spleen blood biochemistry passive, weak and promote Qi stasis; liver Qi stagnation fro m stasis, phlegm stasis context and stuffed. Yin and Yang are not falling tone, blood feud, made for the phlegm.
In short, apolipoprotein B (apo B) and low-density lipoprotein cholestero1(LDL_C) is one of the conventional lipid testing, but the observation o f apo B/LDL_C ratio change and its application in the study of dyslipid emia less information. Therefore, this study focused on patients with dys lipidemia observed with healthy populations apo B/LDL_C ratio changes. Results from the study also confirmed the apolipoprotein relationship wit h dyslipidemia and hyperlipidemia is accompanied by elevated apo B, and m any articles foreign research results.
The Chinese dialectical therapy, diabetic dyslipidemia laboratory tests, fasting blood glucose, glycosylated hemoglobin significantly improved lip id six indicators also significantly improved blood lipids, TCM lunar obs ervation Shaoyang pathogenesis (bile Yu Spleen also known as liver spleen) to alleviate symptoms; dyslipidemia clinical symptoms gradually improved. From mentor Professor Li Saimei outpatient clinic with learning found th at from Shaoyang lunar Treating diabetes with dyslipidemia with good resu Its."Spleen lipid party" based on "Sini+Sijunzitang" based side more" lowering four herbs" their drug analysis as described. Pathogenesis view is from Shaoyang and lunar inspired Shaoyang as pivot, the first lunar as yin disease into the organs, evil entering the inside, less than evil Sh ao, Jue Yin. Therefore, in order to Reorganizing Shaoyang Cardinal health movement lunar ideas, before and after treatment in this investigation h ave clinical reference value.
Clinical detection of diabetes onset phase, most patients from the medica1examination found that there is no typical clinical Diabetes "a little" symptoms, because eating out, entertainment and gradually formed nutriti on, diet plus people can not do without "wine "and even all day so wine A tsumi, thus no shortage of hot and humid breeding. Therefore,"heat induc ed extinction" theory more and more attention, and is currently in clinic al has gradually become the onset of diabetes medicine concept, and the c oncept of a major feature of the treatment.
Outpatient and inpatient clinical findings with diabetes have mild to mod erate cases of depression, this time due to the onset of diabetes before, have varying degrees of mental trauma. Long-term excessive mental stress, work pressure and other factors, coupled with the traditional concept of making incorrect once they learned that his diabetes, it begins there wi11be trouble, disappointment, and even despair, worry, anxiety, fear of fear, frustration, anxiety that sort of mental depression symptoms. Times chosen by liver failure catharsis performance. According to the concept of psychosomatic medicine, diabetes personality, emotions are important f actors associated with diabetes. At this point the clinical method can us e Chinese medicine to treat liver qi stagnation. Based on "Nei Jing","St agnant Wood," the guiding principle of the five elements are wood liver, spleen and territories, Liver dispersion, transportation of spleen, stoma ch main receiving and drop. Under normal physiological conditions, the wo od is catharsis in the coke can be reached Pitu's Yongzhi, namely, the sp leen and stomach qi was sparse gas lift properly. In pathological cases a re interchangeable between the whole body organs affected, liver disease can spread to the stomach, which is the wood by soil, otherwise it is bus y and insult wood soil. Fan Wei liver, stomach yin was hurt, dry mouth po lydipsia food stomach flaming, eliminating Valley Bulimia, this has becom e "the consumer." So many physicians believe that the "liver-centric" con ditioning organs blood and body fluids, Treating diabetes, often tend to have their effect.
Instructor Professor Li Saimei debate diabetic dyslipidemia treatment of clinical experience
"Nei Jing" is laid out "organs dialectical" theory foundation Jhongjing b ook "Treatise on" in the "six meridians" is to promote the development of organs dialectical theory to the theory of blood camp guard, you can rec ognize the six camps run by yes Wei's path to where Evils from the table, even from the sun through the Six Classics from Yam, from the real to th e imaginary, by the mass organs, dirty mass change rule, thus reflecting the physiological state of the Six Classics and disease outcome. Liver dispersion, catharsis liver function is normal, the body to clear t he air-accessible, to help the spleen and stomach down and coordination b etween the two. The spleen1SD Jiangzhuo stomach, that the physiological function of the spleen and stomach, spleen and stomach qi movements, ref lected in the stomach for digestion of food material, and the water absor ption of grain refined transfusion, the dregs excreted functions. If Card inal adverse movements disorders, affecting hepatobiliary catharsis, wood failure has raised liver opens into the eyes, and liver failure catharsi s the formation of liver blood deficiency, liver deficiency can not moist en head is dizzy vertigo, clinical Zheng Jian dizziness, loss of bile dec isiveness, courage Shangni appeared in the throat, mouth pain, throat. Li ver-fire is irritability, liver qi stagnation into stasis knot in the con text of the emergence Xiong Xie fullness pain, liver guilty of the stomac h, liver wood by Pitu. Qi Sheng is catharsis too, easy tribulations guilt y stomach, affect the digestive function is abdominal discomfort, bloatin g, eat less anorexia, thus weak stomach, spleen limbs, muscle Cou failure has raised the body tired fatigue, courage Shangni belching Tunsuan, woo d is by soil, causing stomach Shengqingjiangzhuo dysfunction, then loose stool and other liver committing the spleen, liver and spleen deficiency syndromes.
Lunar sick machine "concept, in empirical pathogenesis of" Shaoyang Cardi nal unfavorable "lunar Spleen wet caused the" heat spleen,"chronic illne ss resulting in" Blood Vein "three syndromes common;" Shaoyang card " tre atment of multiple prescriptions subtraction with Xiaochaihutang series, such as Jhongjing "Treatise on" Xiao Chai Hu Tang, Sini, Chaihuguizhi sou p, Chai Hu Tang, Chaihuguizhi dried ginger, Chaihulonggumuli soup... and so on. lunar disease "damp spleen card" multi Wendantang, berberine Wend antang, San Ren Tang, mannose disinfection Dan... etc.."stasis context card" multi Taohongsiwutang, THCQT... etc. Sometimes visible Fang Fang t yphoid combined with febrile disease, such as Bupleurum Wendantang Xiaoch aihutang and San Ren Tang... etc. not formality, as long as the disease that is in line with the machine.
Furthermore deficiency in the pathogenesis of disease to six yin by mass change viewpoint, but clinical syndromes complex, tailor false is mixed, mixed cold and heat more common; recent informal mentor even Nigu party, when combined through and the Council; temperature Yang camp concept used in the clinical instructors also Shiyou its effective. I often learn lat er, in clinically has its effect. If Zhongjing "Treatise on" Mahuangfuzix ixin soup Mahuangfuzixixin licorice soup, SND, Dangguisini soup, soup etc. subtraction aconite, even down to four herbs Clinical Instructor sq uare medication experience; such as sometimes see yang clip phlegm syndro mes, tongue and pulse can be seen from the judgment "thin yellow tongue","smooth pulse or thin pulse string", pulse Lord imaginary veins;"Treati se on" in less illness outline card "Shao of the disease, pulse fine, but Yumei; description imaginary clock, primary wet slippery pulse, wiry pul se main Hepatology, pain syndrome, and phlegm, so with Zhen Wu Tang and W endan decoction, Poria SND and Wendantang addition and subtraction, and t hree Ren Zhen Wu Tang Decoction... and so on. pathogenesis meet not limi tations.
Diabetic dyslipidemia, Shaoyang lunar certificate (bile Yu spleen or live r spleen) significantly reduced the degree of symptoms, diabetic dyslipid emia clinical physiological symptoms gradually eased, relative fasting bl ood glucose, blood lipids, glycated hemoglobin will be improved. Current clinical treatment to control blood sugar, blood lipids, glycated hemoglo bin is not limited with traditional Chinese medicine or western medicine, and from the clinic found that lipids can be simply controlled by medici ne, tutors use TCM that diabetic dyslipidemia syndrome and "Treatise on Sini "card pathogenesis same belong Shaoyang Cardinal unfavorable; luna r syndrome is not a choice," Li Zhong Tang "or" Lizhong Wan "card, becaus e the lunar Spleen deficiency is not obvious, so the selection of" peace benefit people and agents Bureau "in the" Sijunzitang "this side more pea ceful, suitable for use. According to clinical treatment experience tutor or use drugs on lipid-lowering medicine,"hawthorn, Radix, Alisma, Cassi a, Salvia" and depending on the clinical use.
Instructors to be diabetic dyslipidemia by TCM six dialectical type of re gularity research on Diabetes medicine to further improve the clinical ef ficacy of positive guidance value; Chinese medicine for treatment of diab etic dyslipidemia standardized Establishment of significance. To further expand the scope of clinical application of Zhongjing prescription.
引文
[1]李岳,李明哲.糖尿病合并血脂代谢异常的中医药治疗研究进展[J].第十二届全国中医糖尿病大会论文汇编,2010,302.
[2]刘喜明,仝小林,王朋倩.试论“膏浊”致病论[J].世界中西医结合杂志,2009,4(12)：839-842.
[3]王素美.糖尿病合并高脂血症从痰癖论治体会[J].中医药信息,2005,12(11)：64-65.
[4]林月华,罗亲伟.从脾阴虚辨治2型糖尿病[J].The Practical Journal ofintegrating Chinese with Modem Medicine,1998,11(10):944.
[5]佟晓哲.从“治未病”探讨2型糖尿病合并高脂血症的诊疗方法[J].中华中医药学刊,2009,27(2)：415-416.
[6]郭美珠,肖燕倩,杨志新.浅谈糖尿病高脂血症的基本病机与治疗[J].中医药信息,2005,22(3)：4-5.
[7]卢秀莺,曲竹秋,贾锡莲.降糖克脂饮治疗老年糖尿病合并高脂血症68例疗效观察[J].中草药,2000,31(5)：368-369.
[8]龙新胜,郑晓东.浅析代谢综合征的中西医病因病机[J].天津中药,2008,25(1)：32-33.
[9]王素美.糖尿病合并高脂血症从痰癖论治体会[J].中医药信息,2005,12(11)：64-65.
[10]林月华,罗亲伟.从脾阴虚辨治2型糖尿病[J].The Practical Journal ofintegrating Chinese with Modem Medicine,1998,11(10):944.
[11]佟晓哲.从“治未病”探讨2型糖尿病合并高脂血症的诊疗方法[J].中华中医药学刊,2009,27(2)：415-416.
[12]郭美珠,肖燕倩,杨志新.浅谈糖尿病高脂血症的基本病机与治疗[J].中医药信息,2005,22(3)：4-5.
[13]卢秀莺,曲竹秋,贾锡莲.降糖克脂饮治疗老年糖尿病合并高脂血症68例疗效观察[J].中草药,2000,31(5)：368-369.
[14]龙新胜,郑晓东.浅析代谢综合征的中西医病因病机[J].天津中药,2008,25(1)：32-33.
[15]王德伟,华晓珊.金新返.疏肝降糖汤对糖尿病患者血糖和血脂的影响[J].天津中药,2008,12(8)：2334-2335.
[16]张德贵,贺建丽,王富珍.消痒汤对2型糖尿病患者糖脂代谢紊乱的影响[J].上海中医药杂志,2007,42(1)：35-36.
[17]刘敏华,胡小梅,丹泽七地方治疗糖尿病高血脂症42例[J].中国中医药杂志,2005,3(6)：773-774.
[18]黄河清.黄骏.麦韵屏.交泰丸加味复方治疗2型糖尿病并发高血脂症的临床研究[J].中国中医药科技,2006,13(3)：141-42.
[19]李乐愚.调理三焦法治疗2型糖尿病合并血脂代谢异常34例[J].Chinese Archives of Traditional Chinese Medicine,2002,20(4):514.
[20]王艳芳,肖海静.温脾补肾舒肝法治疗糖尿病高脂血症临床观察[J].中国中医急症,2009,18(7)：1041-1042.
[21]林晨.补肾健脾化痰祛癖法治疗2型糖尿病高脂血症40例[J].福建中医药,2008,39(2)：40-41.
[22]梁永.调脂降糖汤治疗2型糖尿病高脂血症临床观察[J].中国中医急症,2005,14(4)：304-305.
[23]章联欢.中西医结合治疗2型糖尿病合并高脂血症[J].浙江中西医杂志,2006,16(1)：15-16.
[24]顾婉莹.滋阴益气、活血祛痰法治疗老年性糖尿病高脂血症40例疗效观察[J].实用中西医结合临床,2003,3(3)：37.
[25]孙炜.祛疲化痰通络论治糖尿病高脂血症56例[J].中国医药学报,2003,18(8)：508.
[26]邬渊敏,田俊.降脂通脉饮治疗糖尿病高脂血症临床研究[J].中国中医急症,2007,16(7)：796-797
[27]朱永苹,林寿宁,刘鹏.降脂汤治疗2型糖尿病伴高脂血症疗效观察[J].广西中医药,2001,24(3)：8.
[28]张德贵,贺建丽,王富珍等.消瘅汤对2型糖尿病患者糖脂代谢紊乱的影响[J].上海中医药杂志,2007,41(1)：35-37.
[29]高雷,林海平,王超.补肾通脉丸治疗糖尿病并发高脂血症368例[J].辽宁中医杂志,2003,30(8)：616.
[30]尚文斌,程海波,司晓晨等.清脂健胰胶囊改善2型糖尿病胰岛素抵抗的研究[J].南京中医药大学学报,2003,19(4)：210.
[31]洒荣桂,朱置聋.益气养阴颗粒治疗2型糖尿病合并高脂血症的临床研究[J].南京中医药大学学报,2004,20(6)：339-340.
[32]范立娟,李贵生,王秀英.中药三参饮辅助治疗2型糖尿病并发高脂血症临床观察[J].中华临床与卫生,2003,2(2)：31-32.
[33]程红.2型糖尿病合并高脂血症的中西医结合治疗临床观察[J].中国医药导报,2008,5(33)：25.
[34]陈梅.益气养阴活血方治疗2型糖尿病血脂异常26例临床观察[J].广东医学院学报,2006,24(2)：152-153.
[35]韩英,杨西霞.糖脂康治疗糖尿病脂代谢异常36例疗效观察[J].山东中医杂志,2004,23(8)：465-467
[36]李朝敏,文俊.安一胶囊治疗2型糖尿病合并高脂血症及肥胖的临床观察30[J].中药药理与临床,2003,19(4)：45-46.
[37]王湘郴,何莉,范紫香等.健康教育对二型糖尿病病人的影响[J].现代临床护理,2006,5：12-14.
[38]潘长玉.中国糖尿病控制现状一一指南与实践的差距亚洲糖尿病治疗现状调查1998,2001及2003年中国区结果介绍[M].国外医学内分泌学分册,2005,25(3)：174.
[39]Mc Garry. JD. Dysregulation of fatty acid metabolism in the etiology of type 2 diabetes [J]. Diabetes,2002,51(1):7-18.
[40]P. Zimmet et al.Bulletin of the International Diabetes Federation.2003,48(3): 13.
[41]中国糖尿病防治指南编写组.中国糖尿病防治指南[M].北京大学医学出版社,2004.
[42]向红丁.我国糖尿病及其慢性并发症的流行病学现状及防治策略[J].医学研究通讯,2005,34(6)：6-8.
[43]Wenying Yan, JumingLu, Jianping Weng, et al. Prevalenee of Diabetes among Men and Women in China[J]. The new England journal of medicine,2010,362(12):1090-1100.
[44]李理.2型糖尿病合并血脂代谢异常200例糖脂关系分析[J].中国中医基础医学杂志,2008,14(3)：224.
[45]中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5)：393-394.
[46]王学美,杨丽华.糖尿病脂代谢异常的治疗策略[J].北京中医,2002,26(11)：706.
[48]徐成斌.糖尿病血脂异常与冠心病[J].中国糖尿病杂志,2002,20(5)：319-320.
[49]Kou W R1 The basic and clinic study of X uez h ikang(Review)[J].1 Ch ina P rescr D rug,2005,40 (7):62-671.
[50]赵水平.糖尿病血脂异常及其治疗[J].中华内科杂志,2002,41(5)：356.
[51]Lamarche B, Tchernof A, Moorjani S, et al. Small, dense low-density 1 ipoprot ein part icles as a predictor of the risk of ischemic heart disease in men. Prospect ive results from the Quebec Cardiovascular Study. Circulat ion,1997,95:69-75.
[52]Festa A, D Agostino R Jr, Mykkanen L, et al. LDL part icle size in relat ion to insulin, proinsul in, and insulin sensit ivity. The Insulin Resistance Atheriosclerosis Study. Diabetes Care,1999,22:1688-1693.
[53]Lagrost L, Gambert P, Lallemant C. Combined eff ects of lipid transfers and lipolysis on gradient gel patt erns of human plasma LDL.Arterioscler Thromb,1994,14:1327-1336.
[54]王湘郴,何莉,范紫香等.健康教育对二型糖尿病病人的影响[J].现代临床护理,2006,5：12-14.
[55]赵水平.糖尿病血脂异常及其治疗[J].中华内科杂志,2002,41(5)：357.
[56]王艳军.糖尿病血脂异常的治疗[J].使用药物与临床,2005,8(2)：6.
[57]隋春华,叶林,杨裕国等.罗格列酮对胰岛素抵抗和脂代谢异常作用的临床研究[J].上海医学,2004,27(6)：400-402
[58]张昌玉,席光明,庄茂友等.二甲双胍对高脂蛋白血症患者血清载脂蛋白B及AI的影响[J].中华内分泌代谢杂志,2001,17(1)：35-3
[59]蔡德鸿.2型糖尿病血脂紊乱治疗指南[M].国外医学内分泌分册,2004,24(3)：附录1-7.
[60]Rizzo M, Berneis K. Low-densitylipoproteins size and cardiovascular prevention [J].Eur J Intern Med,2006,17(2):77-80.
[61]St-Pierre AC, Cantin B, Dagenais GR, et al. Low-density lipoprotein subfractions and the long-term risk of ischemic heart diease in men:13-year follow-up data from the Quebec cardiovascular study [J]. Arterioscler Thromb Vase Biol, 2005,25(3):553-559.
[62]Sung KC, Hwang ST. Association between insulin resistance and apolipoprotein B in normoglycemic Koreans [J].Atherosclerosis,2005,180(1):161-169.
[63]Mora S, Otvos JD, Rifai N, et al. Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women [J].Circulation,2009,119(7):931-939.
[64]Onat A, Can G, Cicek G, et al. Predictive value of serum apolipoprotein B/LDL-cholesterol ratio in cardiometabolic risk:population-based cohort study [J].Clin Biochem,2010,43(18):1381-1386.
[65]李赛美,糖尿病中医“湿热致消”研研究近况[J].浙江中医杂志,2006-41(4)：41
[66]吴俊宽,王保华,李赛美,糖尿病抑郁症六经辨证规律临床观察,仲景医学求真(续一)中华中医药学会第十五届仲景学说学术研讨会论文集,2007年
[67]于志强,高风琴.酸泻肝木法治疗消渴.四川中医,1994,12(2)：2425
[68]杨晓晖,吕仁和.四逆散加味治疗消渴病肝气郁结证：附34例临床分析.上海中医药杂志,1997,(5)：1113
[69]祝谌予.糖尿病证治：专题笔谈.中医杂志,1986,27(6)：1012
[70]柳红芳.仝小林应用仲景方治疗糖尿病的经验.北京中医药大学学报,2001,24(1)：5153
[71]冯津萍,陈星,陈敏荔等.血管内皮损伤平滑肌细胞增殖机的制[J].中华急诊学杂志,2005,14(9)：727-730.
[72]Willens HJ,Byers PM, Sornaraj AA, et al. Pericardial fat predicts diabetes mellitus inpatients withsevereobesity[J]lSurgObes Relat Dis,2007,3(3):3401
[73]刘淑敏等.决明子提取物对高血脂模型小鼠聚脂基因表达的影响[J]中草药Chinese Traditional andHerbal Drugs,2009,4 (40):385
[74]Patil UK, Saraf S, Dixit V K1 Hypolipidemic activity of seeds of Cassia tora Linn [J]1 J Ethnopharmacol,2004,(90):24922521
[75]Willens HJ, Byers PM, Sornaraj AA, et al. Pericardial fat predicts diabetes mellitus inpatients withsevereobesity[J]lSurgObes Relat Dis,2007,3(3):3401
[76]Kohjima M, Higuchi N, Kato M, et al. SREBP21c, regula2 tedbytheinsulinandAMPKsignalingpathways, plays arole innonalcoholicfattyliver disease[J]1 Int J Mol Med,2008,21 (4):50725111
[77]RaghowR, YellaturuC, DengX, et al. SREBPs:thecross2 roads of physiological andpathological lipidhomeostasis [J]1 Trends Endocrinol Metab,2008,19(2):652731
[78]PangJ S, Choi YS, Park TS1 Ilex paraguariensis extractamelio2ratesobesityinducedbyhigh2fat diet:Potential roleof AMPKinthevisceral adiposetissue [J]1 ArchBiochemBio2 phy,2008,476(2):17821851
[79]Matsubara Y, Sato K, Ishii H, et al. Changes inmRNAex2 pressionof regulatoryfactors involvedinadipocytedifferenti2 ationduringfatty acid induced adipogenesis in chicken [J]1 CompBioehemPhysiol Mol Integr Physiol,2005,141(1) 10821151
[80]Bullo M, Salas Salvado J, Garcia Lorda P1 Adiponectin ex2 pressionandadiposetissuelipolyticactivityinleanandobese women [J] 1 Obes Surg,2005, 15(3):38223861
[81]Qiao Y, Huang ZG, Li QF, et al. Developmental changes of the FASand HSL mRNAexpression and their effects on thecontent of intramuscular fat in Kazakand Xinjiang sheep[J]1 J Genet Genom,2007,34(10):90929171
[82]豆甲泰等.中药泽泻对心血管系统作用的发展研究[J].中外医疗,2012,20：191-191
[1]中华人民共和国药典委员会.中国药典2010年版一部[S].中国医药科技出版社,2010：29.
[83]李洁,石俊英,张岱洲等.山楂的现代研究与应用[J].中草药,1999,30(增刊)：193-95.
[84]王云彩,袁秉祥,李发正.沙棘总黄酮和山楂总黄酮及其混合液对大鼠高血脂的影响[J].中国药理学通报,1992,8(2)：85.
[85]李贵海,孙敬勇,张希林等. 山楂降血脂有效成分的实验研究[J].中草药,2002,32(1)：50-52.
[86]常翠青,陈吉棣.山楂总黄酮对人血管内皮细胞的作用[J].中国公共卫生,2002,18(4)：390-392.
[87]常翠青,陈吉棣.山楂对人血管内皮细胞的作用[J].营养学报,2001,23(1)：5861.
[88]叶希韵,王耀发.山楂叶总黄酮对血管内皮细胞氧化损伤的保护作用[J].中国现代应用药学杂志,2002,19(4)：265-268.
[89]詹琤琤,段时振,李杰.中药山楂的化学成分与药理作用研究概况[J].湖北中医杂志,2012,12：77-79
[90]叶翠飞,张兰,李斌,艾厚喜,李雅丽,张丽等.二苯乙烯苷对胆碱能损伤拟老年性痴呆大鼠学习记忆功能和兴奋性的影响.中国康复理论与实践,2003,9(10)：5932595
[91]方微,张慧信,王绿娅,秦彦文,刘斌,武迎,何继强,王伟,杜兰平[J].中国动脉硬化杂志,2005,2：175-178
[92]薛洁, 谢梅林,顾振纶,张克平[J].中草药Chinese Traditional and Herbal Drugs 2007,1:38
[93]Peet D J, Turley S D, M aW, et al. Cho lestero 1 and bile acid metabo lism are impaired in m ice lack ing the nuclear oxystero 1 recep to r LXR alpha [J]1 Cell 1998,93:69327041
[94]N ieso r E J, F lach J, Lopes2A ntoni I, et al. The nuclear re2 cep to r FXR and LXR alpha:po tential targets fo r the develop2 ment of drugs affecting lip id metabo lism and neop lastic dis2 eases [J]1 Cu rr P harm D es,2001,7:23122591
[95]L u T T, M ak ish imaM, Repa J J, et al. Mo lecular basis fo r feedback regulation of bile acid synthesis by nuclear recep to rs [J]1Mol Cell,2000,6:50725151
[2]刘喜明,仝小林,王朋倩.试论“膏浊”致病论[J].世界中西医结合杂志,2009,4(12)：839-842.
[3]王素美.糖尿病合并高脂血症从痰癖论治体会[J].中医药信息,2005,12(11)：64-65.
[4]林月华,罗亲伟.从脾阴虚辨治2型糖尿病[J].The Practical Journal ofintegrating Chinese with Modem Medicine,1998,11(10):944.
[5]佟晓哲.从“治未病”探讨2型糖尿病合并高脂血症的诊疗方法[J].中华中医药学刊,2009,27(2)：415-416.
[6]郭美珠,肖燕倩,杨志新.浅谈糖尿病高脂血症的基本病机与治疗[J].中医药信息,2005,22(3)：4-5.
[7]卢秀莺,曲竹秋,贾锡莲.降糖克脂饮治疗老年糖尿病合并高脂血症68例疗效观察[J].中草药,2000,31(5)：368-369.
[8]龙新胜,郑晓东.浅析代谢综合征的中西医病因病机[J].天津中药,2008,25(1)：32-33.
[9]王素美.糖尿病合并高脂血症从痰癖论治体会[J].中医药信息,2005,12(11)：64-65.
[10]林月华,罗亲伟.从脾阴虚辨治2型糖尿病[J].The Practical Journal ofintegrating Chinese with Modem Medicine,1998,11(10):944.
[11]佟晓哲.从“治未病”探讨2型糖尿病合并高脂血症的诊疗方法[J].中华中医药学刊,2009,27(2)：415-416.
[12]郭美珠,肖燕倩,杨志新.浅谈糖尿病高脂血症的基本病机与治疗[J].中医药信息,2005,22(3)：4-5.
[13]卢秀莺,曲竹秋,贾锡莲.降糖克脂饮治疗老年糖尿病合并高脂血症68例疗效观察[J].中草药,2000,31(5)：368-369.
[14]龙新胜,郑晓东.浅析代谢综合征的中西医病因病机[J].天津中药,2008,25(1)：32-33.
[15]王德伟,华晓珊.金新返.疏肝降糖汤对糖尿病患者血糖和血脂的影响[J].天津中药,2008,12(8)：2334-2335.
[16]张德贵,贺建丽,王富珍.消痒汤对2型糖尿病患者糖脂代谢紊乱的影响[J].上海中医药杂志,2007,42(1)：35-36.
[17]刘敏华,胡小梅,丹泽七地方治疗糖尿病高血脂症42例[J].中国中医药杂志,2005,3(6)：773-774.
[18]黄河清.黄骏.麦韵屏.交泰丸加味复方治疗2型糖尿病并发高血脂症的临床研究[J].中国中医药科技,2006,13(3)：141-42.
[19]李乐愚.调理三焦法治疗2型糖尿病合并血脂代谢异常34例[J].Chinese Archives of Traditional Chinese Medicine,2002,20(4):514.
[20]王艳芳,肖海静.温脾补肾舒肝法治疗糖尿病高脂血症临床观察[J].中国中医急症,2009,18(7)：1041-1042.
[21]林晨.补肾健脾化痰祛癖法治疗2型糖尿病高脂血症40例[J].福建中医药,2008,39(2)：40-41.
[22]梁永.调脂降糖汤治疗2型糖尿病高脂血症临床观察[J].中国中医急症,2005,14(4)：304-305.
[23]章联欢.中西医结合治疗2型糖尿病合并高脂血症[J].浙江中西医杂志,2006,16(1)：15-16.
[24]顾婉莹.滋阴益气、活血祛痰法治疗老年性糖尿病高脂血症40例疗效观察[J].实用中西医结合临床,2003,3(3)：37.
[25]孙炜.祛疲化痰通络论治糖尿病高脂血症56例[J].中国医药学报,2003,18(8)：508.
[26]邬渊敏,田俊.降脂通脉饮治疗糖尿病高脂血症临床研究[J].中国中医急症,2007,16(7)：796-797
[27]朱永苹,林寿宁,刘鹏.降脂汤治疗2型糖尿病伴高脂血症疗效观察[J].广西中医药,2001,24(3)：8.
[28]张德贵,贺建丽,王富珍等.消瘅汤对2型糖尿病患者糖脂代谢紊乱的影响[J].上海中医药杂志,2007,41(1)：35-37.
[29]高雷,林海平,王超.补肾通脉丸治疗糖尿病并发高脂血症368例[J].辽宁中医杂志,2003,30(8)：616.
[30]尚文斌,程海波,司晓晨等.清脂健胰胶囊改善2型糖尿病胰岛素抵抗的研究[J].南京中医药大学学报,2003,19(4)：210.
[31]洒荣桂,朱置聋.益气养阴颗粒治疗2型糖尿病合并高脂血症的临床研究[J].南京中医药大学学报,2004,20(6)：339-340.
[32]范立娟,李贵生,王秀英.中药三参饮辅助治疗2型糖尿病并发高脂血症临床观察[J].中华临床与卫生,2003,2(2)：31-32.
[33]程红.2型糖尿病合并高脂血症的中西医结合治疗临床观察[J].中国医药导报,2008,5(33)：25.
[34]陈梅.益气养阴活血方治疗2型糖尿病血脂异常26例临床观察[J].广东医学院学报,2006,24(2)：152-153.
[35]韩英,杨西霞.糖脂康治疗糖尿病脂代谢异常36例疗效观察[J].山东中医杂志,2004,23(8)：465-467
[36]李朝敏,文俊.安一胶囊治疗2型糖尿病合并高脂血症及肥胖的临床观察30[J].中药药理与临床,2003,19(4)：45-46.
[37]王湘郴,何莉,范紫香等.健康教育对二型糖尿病病人的影响[J].现代临床护理,2006,5：12-14.
[38]潘长玉.中国糖尿病控制现状一一指南与实践的差距亚洲糖尿病治疗现状调查1998,2001及2003年中国区结果介绍[M].国外医学内分泌学分册,2005,25(3)：174.
[39]Mc Garry. JD. Dysregulation of fatty acid metabolism in the etiology of type 2 diabetes [J]. Diabetes,2002,51(1):7-18.
[40]P. Zimmet et al.Bulletin of the International Diabetes Federation.2003,48(3): 13.
[41]中国糖尿病防治指南编写组.中国糖尿病防治指南[M].北京大学医学出版社,2004.
[42]向红丁.我国糖尿病及其慢性并发症的流行病学现状及防治策略[J].医学研究通讯,2005,34(6)：6-8.
[43]Wenying Yan, JumingLu, Jianping Weng, et al. Prevalenee of Diabetes among Men and Women in China[J]. The new England journal of medicine,2010,362(12):1090-1100.
[44]李理.2型糖尿病合并血脂代谢异常200例糖脂关系分析[J].中国中医基础医学杂志,2008,14(3)：224.
[45]中国成人血脂异常防治指南制订联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5)：393-394.
[46]王学美,杨丽华.糖尿病脂代谢异常的治疗策略[J].北京中医,2002,26(11)：706.
[48]徐成斌.糖尿病血脂异常与冠心病[J].中国糖尿病杂志,2002,20(5)：319-320.
[49]Kou W R1 The basic and clinic study of X uez h ikang(Review)[J].1 Ch ina P rescr D rug,2005,40 (7):62-671.
[50]赵水平.糖尿病血脂异常及其治疗[J].中华内科杂志,2002,41(5)：356.
[51]Lamarche B, Tchernof A, Moorjani S, et al. Small, dense low-density 1 ipoprot ein part icles as a predictor of the risk of ischemic heart disease in men. Prospect ive results from the Quebec Cardiovascular Study. Circulat ion,1997,95:69-75.
[52]Festa A, D Agostino R Jr, Mykkanen L, et al. LDL part icle size in relat ion to insulin, proinsul in, and insulin sensit ivity. The Insulin Resistance Atheriosclerosis Study. Diabetes Care,1999,22:1688-1693.
[53]Lagrost L, Gambert P, Lallemant C. Combined eff ects of lipid transfers and lipolysis on gradient gel patt erns of human plasma LDL.Arterioscler Thromb,1994,14:1327-1336.
[54]王湘郴,何莉,范紫香等.健康教育对二型糖尿病病人的影响[J].现代临床护理,2006,5：12-14.
[55]赵水平.糖尿病血脂异常及其治疗[J].中华内科杂志,2002,41(5)：357.
[56]王艳军.糖尿病血脂异常的治疗[J].使用药物与临床,2005,8(2)：6.
[57]隋春华,叶林,杨裕国等.罗格列酮对胰岛素抵抗和脂代谢异常作用的临床研究[J].上海医学,2004,27(6)：400-402
[58]张昌玉,席光明,庄茂友等.二甲双胍对高脂蛋白血症患者血清载脂蛋白B及AI的影响[J].中华内分泌代谢杂志,2001,17(1)：35-3
[59]蔡德鸿.2型糖尿病血脂紊乱治疗指南[M].国外医学内分泌分册,2004,24(3)：附录1-7.
[60]Rizzo M, Berneis K. Low-densitylipoproteins size and cardiovascular prevention [J].Eur J Intern Med,2006,17(2):77-80.
[61]St-Pierre AC, Cantin B, Dagenais GR, et al. Low-density lipoprotein subfractions and the long-term risk of ischemic heart diease in men:13-year follow-up data from the Quebec cardiovascular study [J]. Arterioscler Thromb Vase Biol, 2005,25(3):553-559.
[62]Sung KC, Hwang ST. Association between insulin resistance and apolipoprotein B in normoglycemic Koreans [J].Atherosclerosis,2005,180(1):161-169.
[63]Mora S, Otvos JD, Rifai N, et al. Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women [J].Circulation,2009,119(7):931-939.
[64]Onat A, Can G, Cicek G, et al. Predictive value of serum apolipoprotein B/LDL-cholesterol ratio in cardiometabolic risk:population-based cohort study [J].Clin Biochem,2010,43(18):1381-1386.
[65]李赛美,糖尿病中医“湿热致消”研研究近况[J].浙江中医杂志,2006-41(4)：41
[66]吴俊宽,王保华,李赛美,糖尿病抑郁症六经辨证规律临床观察,仲景医学求真(续一)中华中医药学会第十五届仲景学说学术研讨会论文集,2007年
[67]于志强,高风琴.酸泻肝木法治疗消渴.四川中医,1994,12(2)：2425
[68]杨晓晖,吕仁和.四逆散加味治疗消渴病肝气郁结证：附34例临床分析.上海中医药杂志,1997,(5)：1113
[69]祝谌予.糖尿病证治：专题笔谈.中医杂志,1986,27(6)：1012
[70]柳红芳.仝小林应用仲景方治疗糖尿病的经验.北京中医药大学学报,2001,24(1)：5153
[71]冯津萍,陈星,陈敏荔等.血管内皮损伤平滑肌细胞增殖机的制[J].中华急诊学杂志,2005,14(9)：727-730.
[72]Willens HJ,Byers PM, Sornaraj AA, et al. Pericardial fat predicts diabetes mellitus inpatients withsevereobesity[J]lSurgObes Relat Dis,2007,3(3):3401
[73]刘淑敏等.决明子提取物对高血脂模型小鼠聚脂基因表达的影响[J]中草药Chinese Traditional andHerbal Drugs,2009,4 (40):385
[74]Patil UK, Saraf S, Dixit V K1 Hypolipidemic activity of seeds of Cassia tora Linn [J]1 J Ethnopharmacol,2004,(90):24922521
[75]Willens HJ, Byers PM, Sornaraj AA, et al. Pericardial fat predicts diabetes mellitus inpatients withsevereobesity[J]lSurgObes Relat Dis,2007,3(3):3401
[76]Kohjima M, Higuchi N, Kato M, et al. SREBP21c, regula2 tedbytheinsulinandAMPKsignalingpathways, plays arole innonalcoholicfattyliver disease[J]1 Int J Mol Med,2008,21 (4):50725111
[77]RaghowR, YellaturuC, DengX, et al. SREBPs:thecross2 roads of physiological andpathological lipidhomeostasis [J]1 Trends Endocrinol Metab,2008,19(2):652731
[78]PangJ S, Choi YS, Park TS1 Ilex paraguariensis extractamelio2ratesobesityinducedbyhigh2fat diet:Potential roleof AMPKinthevisceral adiposetissue [J]1 ArchBiochemBio2 phy,2008,476(2):17821851
[79]Matsubara Y, Sato K, Ishii H, et al. Changes inmRNAex2 pressionof regulatoryfactors involvedinadipocytedifferenti2 ationduringfatty acid induced adipogenesis in chicken [J]1 CompBioehemPhysiol Mol Integr Physiol,2005,141(1) 10821151
[80]Bullo M, Salas Salvado J, Garcia Lorda P1 Adiponectin ex2 pressionandadiposetissuelipolyticactivityinleanandobese women [J] 1 Obes Surg,2005, 15(3):38223861
[81]Qiao Y, Huang ZG, Li QF, et al. Developmental changes of the FASand HSL mRNAexpression and their effects on thecontent of intramuscular fat in Kazakand Xinjiang sheep[J]1 J Genet Genom,2007,34(10):90929171
[82]豆甲泰等.中药泽泻对心血管系统作用的发展研究[J].中外医疗,2012,20：191-191
[1]中华人民共和国药典委员会.中国药典2010年版一部[S].中国医药科技出版社,2010：29.
[83]李洁,石俊英,张岱洲等.山楂的现代研究与应用[J].中草药,1999,30(增刊)：193-95.
[84]王云彩,袁秉祥,李发正.沙棘总黄酮和山楂总黄酮及其混合液对大鼠高血脂的影响[J].中国药理学通报,1992,8(2)：85.
[85]李贵海,孙敬勇,张希林等. 山楂降血脂有效成分的实验研究[J].中草药,2002,32(1)：50-52.
[86]常翠青,陈吉棣.山楂总黄酮对人血管内皮细胞的作用[J].中国公共卫生,2002,18(4)：390-392.
[87]常翠青,陈吉棣.山楂对人血管内皮细胞的作用[J].营养学报,2001,23(1)：5861.
[88]叶希韵,王耀发.山楂叶总黄酮对血管内皮细胞氧化损伤的保护作用[J].中国现代应用药学杂志,2002,19(4)：265-268.
[89]詹琤琤,段时振,李杰.中药山楂的化学成分与药理作用研究概况[J].湖北中医杂志,2012,12：77-79
[90]叶翠飞,张兰,李斌,艾厚喜,李雅丽,张丽等.二苯乙烯苷对胆碱能损伤拟老年性痴呆大鼠学习记忆功能和兴奋性的影响.中国康复理论与实践,2003,9(10)：5932595
[91]方微,张慧信,王绿娅,秦彦文,刘斌,武迎,何继强,王伟,杜兰平[J].中国动脉硬化杂志,2005,2：175-178
[92]薛洁, 谢梅林,顾振纶,张克平[J].中草药Chinese Traditional and Herbal Drugs 2007,1:38
[93]Peet D J, Turley S D, M aW, et al. Cho lestero 1 and bile acid metabo lism are impaired in m ice lack ing the nuclear oxystero 1 recep to r LXR alpha [J]1 Cell 1998,93:69327041
[94]N ieso r E J, F lach J, Lopes2A ntoni I, et al. The nuclear re2 cep to r FXR and LXR alpha:po tential targets fo r the develop2 ment of drugs affecting lip id metabo lism and neop lastic dis2 eases [J]1 Cu rr P harm D es,2001,7:23122591
[95]L u T T, M ak ish imaM, Repa J J, et al. Mo lecular basis fo r feedback regulation of bile acid synthesis by nuclear recep to rs [J]1Mol Cell,2000,6:50725151
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |