中医证型与2型糖尿病患者胰岛素抵抗及B细胞功能的关系

摘要

Objective: Analyze the corresponding relationship of insulin resistance, injury of islet β-cell function and evolution of Traditional Chinese Medicine (TCM) syndromes in patients with type 2 diabetes mellitus (T2DM). Methods: We studied 98 cases of Endocrinology inpatients from the Suzhou Hospital of TCM for the diagnosis and treatment of diabetes, divided into Yin deifciency and heat syndrome, syndrome of phlegm-damp invading the spleen, Qi and Yin deifciency syndrome, and Yang and Yin deifciency syndrome. Analyzed the corresponding relationship of insulin resistance, injury of islet β-cell function and evolution of TCM syndromes in patients with T2DM.Results: Four types of syndrome and Fins, CPS have no significance (P>0.05). Fins with syndrome of phlegm-damp invading the spleen was highest, and then Qi and Yin deficiency syndrome, Yang and Yin deifciency syndrome was lowest. CPS with Qi and Yin deifciency syndrome was highest, and then Yin deifciency and heat syndrome, Yang and Yin deficiency syndrome was lowest. Four types of syndrome and HOMA-IR, ISI, HMOA-β have no significance (P>0.05). HOMA-IR with syndrome of phlegm-damp invading the spleen was highest, and according to Qi and Yin deifciency syndrome, Yin deifciency and heat syndrome, Yang and Yin deifciency syndrome gradually increased. According to Yin deifciency and heat syndrome, syndrome of phlegm-damp invading the spleen, Qi and Yin deifciency syndrome, and Yang and Yin deifciency syndrome, ISI gradually decreased. HOMA-β with syndrome of phlegm-damp invading the spleen was highest, and according to Yin deficiency and heat syndrome, Qi and Yin deficiency syndrome, Yang and Yin deficiency syndrome gradually decreased. Four types of syndrome and HbA1c, FPG, 2hPG have no signiifcance (P>0.05).Conclusion: 1) Yin deficiency and heat syndrome, syndrome of phlegm-damp invading the spleen were mainly to IR. Qi and Yin deficiency syndrome, Yang and Yin deficiency syndrome were mainly to function of βcells reduced. 2) TCM syndromes were mainly to syndrome of phlegm-damp invading the spleen throughout the disease always. Point out: Damp Retention may be more important diabetes pathogenesis in Suzhou.%目的：观察中医证型与2型糖尿病患者胰岛素抵抗、B细胞功能的关系。方法：选取2012年至2014年7月苏州市中医医院内分泌科确诊的2型糖尿病住院病人98例，分析其胰岛素抵抗、B细胞功能和中医证型：阴虚热盛证、痰湿困脾证、气阴两虚证、阴阳两虚证的关系。结果：四种证型的空腹胰岛素、空腹C肽在各组间无统计学差异(P>0.05)。但空腹胰岛素值以痰湿困脾证最高，气阴两虚证次之，阴阳两虚证最低；空腹C肽以气阴两虚证最高，阴虚热盛证次之，阴阳两虚证最低。四种证型的HOMA-IR、ISI、HOMA-β在各组间无统计学差异(P>0.05)。但HOMA-IR在痰湿困脾证最大，其余按阴虚热盛证→气阴两虚证→阴阳两虚证的顺序逐渐增大；按阴虚热盛证→痰湿困脾证→气阴两虚证→阴阳两虚证顺序的ISI依次减低；HOMA-β值在痰湿困脾证最大，其余按阴虚热盛证→气阴两虚证→阴阳两虚证排序逐渐减小。结论：2型糖尿病患者的中医证型及病机与胰岛素抵抗、胰岛β细胞分泌功能的损害程度相关。阴虚热盛证、痰湿困脾证以胰岛素抵抗为主；气阴两虚证、阴阳两虚证以胰岛β细胞功能降低为主。苏州地区2型糖尿病患者的中医证型以痰湿困脾证为主，并贯穿病程始终。提示：痰湿困脾可能是苏州地区糖尿病的重要病因病机。