代谢综合征中医辨证分型及其与临床检测指标的相关性研究
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摘要
目的:建立代谢综合征中医辨证分型及其证候的诊断标准;探讨代谢综合征各证候相对特异的临床检测指标。
方法:采用2005年国际糖尿病联盟(International Diabetes Federation,IDF)有关代谢综合征的定义的诊断标准;中医证候采用1997年中华人民共和国家标准《中医临床诊疗术语·证候部分》(GB/T16751.2-1997)诊断标准。选取代谢综合征患者323例为研究对象,收集67项症状、体征及舌脉象并量化计分,同时选取30例的正常健康对照组,检测多项相关临床指标,将他们输入SPSS13.0软件,建立数据库,通过SPSS13.0软件的聚类分析(classify analysis)方法对所有患者的症状、体征、舌脉等四诊信息进行聚类,归纳出代谢综合征的中医辨证分型。应用SPSS13.0软件的主成分分析(principal components analysis),综合分析代谢综合征各证候的症状、体征、舌脉等四诊信息,客观评价各症状等四诊信息对该证候的贡献度。找出主要症状与次要症状,优化各证型的辨证标准;应用SPSS13.0软件的方差分析(analysis of variance,ANON)等方法探讨代谢综合征的中医证型与检测指标如腰围(W)、腰臀比(W/H)、体重指数(BMI)、空腹血糖(FPG)、血脂(TG、TC、LDL-C、HDL-C)、血压(收缩压、舒张压)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hs-CRP)、纤溶酶原激活物抑制物-1(PAI-1)、脂联素(adiponectin)之间的关系。
结果:聚类分析和主成分分析的基础上辨为痰瘀互结、脾肾气虚及阴虚内热3个证型,初步拟定代谢综合征的辨证标准及其与临床检测指标的关系如下:
(1)痰瘀互结证
临床表现:形体肥胖、眩晕、头重如裹、肢体沉重、肢体麻木、头痛、呕恶痰涎、便溏、面紫、唇、胸胁胀闷痛、舌色淡红、舌质胖大、舌质齿痕、舌质紫暗、舌质瘀斑(点)、舌下脉络青紫曲张、舌苔厚、舌苔腻、舌苔水滑、脉弦、脉滑、脉沉、脉涩等24项。
辨证要点(标准):主要症状:头重如裹、眩晕、头痛、面紫、唇青、苔腻、舌质瘀斑(点)、脉滑、脉涩。次要症状:形体肥胖、胸胁胀闷痛、肢体麻木、便溏、苔厚、舌下脉络青紫曲张、脉弦。
代谢综合征各证型组的TG、TC、PAI-1均明显高于正常对照组(P＜0.01),痰瘀互结证组的TG、TC、PAI-1明显地高于脾肾气虚证组、阴虚内热证组,两两比较差异有统计学意义(P＜0.05)。
(2)阴虚热盛证
临床表现:面红、目赤、口苦、口臭、口干喜饮、多食易饥、溲赤、便秘、急躁易怒、舌质瘦薄、舌质裂纹、舌质芒刺、舌质红、舌苔黄、舌苔少津、苔少、苔薄、脉细、脉数等19项。
辨证要点(标准):主要症状:面红、口干喜饮、舌质红、舌质瘦薄、苔少、舌苔黄。次要症状:口苦、多食易饥、溲赤、舌苔薄、舌质芒刺。
代谢综合征各证型组的FPG、HOMA-IR、hs-CRP均明显高于正常对照组(P＜0.01),阴虚内热证组的FPG、HOMA-IR、hs-CRP高于脾肾气虚证组、痰瘀互结证组,两两比较差异有统计学意义(P＜0.05)
(3)脾肾气虚证
临床表现:神疲乏力,气短懒言,自汗,脘腹作胀,口淡,食少纳呆,失眠,畏寒肢冷,肢体疼痛,胸闷,心前区刺痛,腰酸腿软,耳鸣,心悸,五心烦热,小便频多,健忘,舌淡白,舌苔白,脉弱等20项。
辨证要点(标准):主要症状:神疲乏力、气短懒言、口淡、心悸、健忘、脉弱。次要症状:畏寒肢冷、耳鸣、小便频数、食少纳呆、脘腹胀满、舌淡白。
代谢综合征各证型组的脂联素则明显低于正常对照组(P＜0.01),脂联素水平高低顺序依次为正常对照组＞痰瘀互结组＞阴虚热盛组＞脾肾气虚组,其中以脾肾气虚组最低,与其他2证型间两两比较,差异有显著性意义(P＜0.05)。
结论:代谢综合征中医辨证分为痰瘀互结、脾肾气虚及阴虚热盛三型,其中痰瘀互结证最为常见,与血脂异常及纤溶异常关系密切;阴虚热盛证与胰岛素抵抗及慢性炎症反应关系密切;脾肾气虚与脂联素下降关系密切。
Objective:To establish and standardize the TCM syndrome differentiation classification of metabolic syndrome(MS),and explore the correlation between every TCM syndromes and its clinical diagnostic parameters of MS.
Methods:The study is based on the definition about Metabolic Syndrome(2005) stated by the International Diabetes Federation,IDF.TCM syndrome is based on diagnosis standard stated in Chinese Medical Terminology on Clinical Diagnosis and Treat-Syndrome complex(GB/T16751.2-1997).323 MS patients are selected as the studied objects,with 30 healthy people as a normal control group.The study is to survey and quantify scores of 67 symptoms,signs,tongue pictures and pulse conditions and healthy control group,in the meantime to examined several clinical diagnostic parameters.Used the SPSS13.0 statistics software package to carry out the input,the checking with the investigation materials to establish relevant database,and have the database analyzed by means of the description analysis,classify analysis,and principal components analysis methods carrying out the statistical analysis to summarize the TCM syndrome classification and their standards of MS.by means of Analysis of Variance it can be found the correlation between the TCM syndromes and the clinical diagnostic parameters such as waist circumference,W/H ratio,BMI, FPG,TG,TC,LDL-C,HDL-C,SBP,DBP,FINS,HOMA-IR,hs-CRP,PAI-1, adiponectin.
Results:According to the results of the cluster analysis,principal component analysis and analysis of variance combined TCM specialized knowledge,the TCM syndromes of MS and their standards are summarized,and their correlation with clinical diagnostic parameters of MS are as fellows:
(1) accumulation of phlegm and blood stasis syndrome clinical manifestations:including 24 symptoms and signs:obesity,dizziness, heaviness of head as enwrapping,numbness of limbs,heaviness of limbs,headache, vomiting sputum and saliva,loose stool,dim complexion,dark purple lips,distending full pain in chest and hypochondrium,pink tongue,enlarged tongue,teeth marked tongue,dark purple tongue,ecchymosis on tongue,purple tortuosity in subglossal collateral vessel,thick fur,greasy fur,watery slippery fur,stringy pulse,slippery pulse, sunken pulse or unsmooth pulse.
The standards of accumulation of phlegm and blood stasis syndrome: major symptoms and signs:heaviness of head as enwrapping,dizziness,headache, dim complexion,dark purple lips,(?)reasy fur,ecchymosis on tongue,smooth or unsmooth pulse.
minor symptoms and signs:obesity,distending full pain in chest and hypochondrium, numbness of limbs,loose stool,thick fur,purple tortuosity in subglossal collateral vessel or stingy pulse.
The level of serum TG、TC and plasma PAI-1 in every MS group is significantly higher than those in the normal group(P＜0.01).The level of serum TG、TC and plasma PAI-1 in the phlegm and blood stasis group is significantly higher than the other two groups,the spleen and kidney qi deficiency group or the extreme heat with yin deficiency group(P＜0.05).
(2) syndrome of extreme heat with yin deficiency clinical manifestations:including 19 symptoms and signs:flushed face,conjunctival congestion,bitter taste of mouth,halitosis,dry mouth and drink preference, polyphagia,dark urine,constipation,irritability,thin tongue,splitting tongue,pricky tongue,reddish tongue,yellowish fur,little fluid fur,little fur,thin fur,thready pulse or rapid pulse.
The standards of syndrome of extreme heat with yin deficiency: major symptoms and signs:flushed face,dry mouth and drink preference,reddish tongue,thin tongue,little fur or yellowish fur.
minor symptoms and signs:bitter taste of mouth,polyphagia,dark urine,thin fur or pricky tongue.
The level of serum FPG、HOMA-IR、hs-CRP in every MS group is significantly higher than those in the normal group(P＜0.01).The level of serum FPG、HOMA-IR、hs-CRP in the extreme heat with yin deficiency group is significantly higher than the other two groups,the accumulation of phlegm and blood stasis group or the spleen and kidney qi deficiency group(P＜0.05).
(3) syndrome of spleen and kidney qi deficiency clinical manifestations:including 20 symptoms and signs:mental fatigue and weakness,shortness of breath with disinclination to talk,spontaneous perspiration, abdominal distension,dysgeusia,poor appetite,insomnia,intolerance of cold and cold limbs,pain of limbs,chest distress,twinge in the chest,pain and lassitude of the loins and legs,tinnitus,palpitation,five feverish centers,frequent and profuse urination, amnesia,pale tongue,whitish fur or weak pulse.
The standards of syndrome of spleen and kidney qi deficiency: major symptoms and signs:mental fatigue and weakness,shortness of breath with disinclination to talk,dysgeusia,palpitation,amnesia or weak pulse.
minor symptoms and signs:intolerance of cold and cold limbs,tinnitus,frequent and profuse urination,poor appetite,abdominal distension or pale tongue.
The level of serum adiponectin in the MS group is significantly lower than it in the normal group(P＜0.01),The level of serum adiponectin from top to bottom is the normal group,the accumulation phlegm and blood stasis group,the yin deficiency with heat excess group,the spleen and kidney qi deficiency group.It is the lowest in the spleen and kidney qi difficiency group and is significantly lower than that of the other two groups(P＜0.05).
Conclusion:the TCM syndromes of MS are classified as three types:accumulation of phlegm and stagnated blood,spleen and kidney qi deficiency and extreme heat with yin deficiency.The syndrome of phlegm and stagnated blood is the most frequent syndrome in MS,and it is closely related with the high level of serum TC、TG and plasma PAI-1.The syndrome of spleen and kidney qi deficiency is closely related with the low level of serum adiponectin and the syndrome of extreme heat with yin deficiency is closely related with high level serum FPG,hs-CRP and HOMA-IR.
方法:采用2005年国际糖尿病联盟(International Diabetes Federation,IDF)有关代谢综合征的定义的诊断标准;中医证候采用1997年中华人民共和国家标准《中医临床诊疗术语·证候部分》(GB/T16751.2-1997)诊断标准。选取代谢综合征患者323例为研究对象,收集67项症状、体征及舌脉象并量化计分,同时选取30例的正常健康对照组,检测多项相关临床指标,将他们输入SPSS13.0软件,建立数据库,通过SPSS13.0软件的聚类分析(classify analysis)方法对所有患者的症状、体征、舌脉等四诊信息进行聚类,归纳出代谢综合征的中医辨证分型。应用SPSS13.0软件的主成分分析(principal components analysis),综合分析代谢综合征各证候的症状、体征、舌脉等四诊信息,客观评价各症状等四诊信息对该证候的贡献度。找出主要症状与次要症状,优化各证型的辨证标准;应用SPSS13.0软件的方差分析(analysis of variance,ANON)等方法探讨代谢综合征的中医证型与检测指标如腰围(W)、腰臀比(W/H)、体重指数(BMI)、空腹血糖(FPG)、血脂(TG、TC、LDL-C、HDL-C)、血压(收缩压、舒张压)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、超敏C反应蛋白(hs-CRP)、纤溶酶原激活物抑制物-1(PAI-1)、脂联素(adiponectin)之间的关系。
结果:聚类分析和主成分分析的基础上辨为痰瘀互结、脾肾气虚及阴虚内热3个证型,初步拟定代谢综合征的辨证标准及其与临床检测指标的关系如下:
(1)痰瘀互结证
临床表现:形体肥胖、眩晕、头重如裹、肢体沉重、肢体麻木、头痛、呕恶痰涎、便溏、面紫、唇、胸胁胀闷痛、舌色淡红、舌质胖大、舌质齿痕、舌质紫暗、舌质瘀斑(点)、舌下脉络青紫曲张、舌苔厚、舌苔腻、舌苔水滑、脉弦、脉滑、脉沉、脉涩等24项。
辨证要点(标准):主要症状:头重如裹、眩晕、头痛、面紫、唇青、苔腻、舌质瘀斑(点)、脉滑、脉涩。次要症状:形体肥胖、胸胁胀闷痛、肢体麻木、便溏、苔厚、舌下脉络青紫曲张、脉弦。
代谢综合征各证型组的TG、TC、PAI-1均明显高于正常对照组(P＜0.01),痰瘀互结证组的TG、TC、PAI-1明显地高于脾肾气虚证组、阴虚内热证组,两两比较差异有统计学意义(P＜0.05)。
(2)阴虚热盛证
临床表现:面红、目赤、口苦、口臭、口干喜饮、多食易饥、溲赤、便秘、急躁易怒、舌质瘦薄、舌质裂纹、舌质芒刺、舌质红、舌苔黄、舌苔少津、苔少、苔薄、脉细、脉数等19项。
辨证要点(标准):主要症状:面红、口干喜饮、舌质红、舌质瘦薄、苔少、舌苔黄。次要症状:口苦、多食易饥、溲赤、舌苔薄、舌质芒刺。
代谢综合征各证型组的FPG、HOMA-IR、hs-CRP均明显高于正常对照组(P＜0.01),阴虚内热证组的FPG、HOMA-IR、hs-CRP高于脾肾气虚证组、痰瘀互结证组,两两比较差异有统计学意义(P＜0.05)
(3)脾肾气虚证
临床表现:神疲乏力,气短懒言,自汗,脘腹作胀,口淡,食少纳呆,失眠,畏寒肢冷,肢体疼痛,胸闷,心前区刺痛,腰酸腿软,耳鸣,心悸,五心烦热,小便频多,健忘,舌淡白,舌苔白,脉弱等20项。
辨证要点(标准):主要症状:神疲乏力、气短懒言、口淡、心悸、健忘、脉弱。次要症状:畏寒肢冷、耳鸣、小便频数、食少纳呆、脘腹胀满、舌淡白。
代谢综合征各证型组的脂联素则明显低于正常对照组(P＜0.01),脂联素水平高低顺序依次为正常对照组＞痰瘀互结组＞阴虚热盛组＞脾肾气虚组,其中以脾肾气虚组最低,与其他2证型间两两比较,差异有显著性意义(P＜0.05)。
结论:代谢综合征中医辨证分为痰瘀互结、脾肾气虚及阴虚热盛三型,其中痰瘀互结证最为常见,与血脂异常及纤溶异常关系密切;阴虚热盛证与胰岛素抵抗及慢性炎症反应关系密切;脾肾气虚与脂联素下降关系密切。
Objective:To establish and standardize the TCM syndrome differentiation classification of metabolic syndrome(MS),and explore the correlation between every TCM syndromes and its clinical diagnostic parameters of MS.
Methods:The study is based on the definition about Metabolic Syndrome(2005) stated by the International Diabetes Federation,IDF.TCM syndrome is based on diagnosis standard stated in Chinese Medical Terminology on Clinical Diagnosis and Treat-Syndrome complex(GB/T16751.2-1997).323 MS patients are selected as the studied objects,with 30 healthy people as a normal control group.The study is to survey and quantify scores of 67 symptoms,signs,tongue pictures and pulse conditions and healthy control group,in the meantime to examined several clinical diagnostic parameters.Used the SPSS13.0 statistics software package to carry out the input,the checking with the investigation materials to establish relevant database,and have the database analyzed by means of the description analysis,classify analysis,and principal components analysis methods carrying out the statistical analysis to summarize the TCM syndrome classification and their standards of MS.by means of Analysis of Variance it can be found the correlation between the TCM syndromes and the clinical diagnostic parameters such as waist circumference,W/H ratio,BMI, FPG,TG,TC,LDL-C,HDL-C,SBP,DBP,FINS,HOMA-IR,hs-CRP,PAI-1, adiponectin.
Results:According to the results of the cluster analysis,principal component analysis and analysis of variance combined TCM specialized knowledge,the TCM syndromes of MS and their standards are summarized,and their correlation with clinical diagnostic parameters of MS are as fellows:
(1) accumulation of phlegm and blood stasis syndrome clinical manifestations:including 24 symptoms and signs:obesity,dizziness, heaviness of head as enwrapping,numbness of limbs,heaviness of limbs,headache, vomiting sputum and saliva,loose stool,dim complexion,dark purple lips,distending full pain in chest and hypochondrium,pink tongue,enlarged tongue,teeth marked tongue,dark purple tongue,ecchymosis on tongue,purple tortuosity in subglossal collateral vessel,thick fur,greasy fur,watery slippery fur,stringy pulse,slippery pulse, sunken pulse or unsmooth pulse.
The standards of accumulation of phlegm and blood stasis syndrome: major symptoms and signs:heaviness of head as enwrapping,dizziness,headache, dim complexion,dark purple lips,(?)reasy fur,ecchymosis on tongue,smooth or unsmooth pulse.
minor symptoms and signs:obesity,distending full pain in chest and hypochondrium, numbness of limbs,loose stool,thick fur,purple tortuosity in subglossal collateral vessel or stingy pulse.
The level of serum TG、TC and plasma PAI-1 in every MS group is significantly higher than those in the normal group(P＜0.01).The level of serum TG、TC and plasma PAI-1 in the phlegm and blood stasis group is significantly higher than the other two groups,the spleen and kidney qi deficiency group or the extreme heat with yin deficiency group(P＜0.05).
(2) syndrome of extreme heat with yin deficiency clinical manifestations:including 19 symptoms and signs:flushed face,conjunctival congestion,bitter taste of mouth,halitosis,dry mouth and drink preference, polyphagia,dark urine,constipation,irritability,thin tongue,splitting tongue,pricky tongue,reddish tongue,yellowish fur,little fluid fur,little fur,thin fur,thready pulse or rapid pulse.
The standards of syndrome of extreme heat with yin deficiency: major symptoms and signs:flushed face,dry mouth and drink preference,reddish tongue,thin tongue,little fur or yellowish fur.
minor symptoms and signs:bitter taste of mouth,polyphagia,dark urine,thin fur or pricky tongue.
The level of serum FPG、HOMA-IR、hs-CRP in every MS group is significantly higher than those in the normal group(P＜0.01).The level of serum FPG、HOMA-IR、hs-CRP in the extreme heat with yin deficiency group is significantly higher than the other two groups,the accumulation of phlegm and blood stasis group or the spleen and kidney qi deficiency group(P＜0.05).
(3) syndrome of spleen and kidney qi deficiency clinical manifestations:including 20 symptoms and signs:mental fatigue and weakness,shortness of breath with disinclination to talk,spontaneous perspiration, abdominal distension,dysgeusia,poor appetite,insomnia,intolerance of cold and cold limbs,pain of limbs,chest distress,twinge in the chest,pain and lassitude of the loins and legs,tinnitus,palpitation,five feverish centers,frequent and profuse urination, amnesia,pale tongue,whitish fur or weak pulse.
The standards of syndrome of spleen and kidney qi deficiency: major symptoms and signs:mental fatigue and weakness,shortness of breath with disinclination to talk,dysgeusia,palpitation,amnesia or weak pulse.
minor symptoms and signs:intolerance of cold and cold limbs,tinnitus,frequent and profuse urination,poor appetite,abdominal distension or pale tongue.
The level of serum adiponectin in the MS group is significantly lower than it in the normal group(P＜0.01),The level of serum adiponectin from top to bottom is the normal group,the accumulation phlegm and blood stasis group,the yin deficiency with heat excess group,the spleen and kidney qi deficiency group.It is the lowest in the spleen and kidney qi difficiency group and is significantly lower than that of the other two groups(P＜0.05).
Conclusion:the TCM syndromes of MS are classified as three types:accumulation of phlegm and stagnated blood,spleen and kidney qi deficiency and extreme heat with yin deficiency.The syndrome of phlegm and stagnated blood is the most frequent syndrome in MS,and it is closely related with the high level of serum TC、TG and plasma PAI-1.The syndrome of spleen and kidney qi deficiency is closely related with the low level of serum adiponectin and the syndrome of extreme heat with yin deficiency is closely related with high level serum FPG,hs-CRP and HOMA-IR.
引文
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