糖调节受损患者中医体质与胰岛素抵抗及糖尿病风险的相关性研究

目的:为了识别糖调节受损(IGR)患者的相关危险因素,以有助于早期发现和预防IGR向糖尿病进展,本研究通过调查分析IGR患者中医体质和胰岛素抵抗的相关性,以及中医体质是否可以独立预测IGR的糖尿病风险。方法 :294例IGR患者采集血液样本,使用体质问卷评估体质类型。酶联免疫吸附法(ELISA)测定血清细胞因子水平。随访3年以上,记录糖尿病发病情况。多因素Logistic回归分析估计不同中医体质的糖尿病比值比(OR)。结果:痰湿、湿热和气虚是IGR患者三种最常见的不平衡体质。痰湿、湿热体质患者血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)和瘦素水平显著升高,血清脂联素水平显著降低(P0.05)。气虚体质者血清瘦素水平升高,血清脂联素、胰高血糖素样肽-1(GLP-1)和抑胃肽(GIP)水平显著降低(P0.05)。痰湿或湿热体质者表现出显著升高的糖尿病风险(P0.05)。结论:IGR患者中医体质、炎症反应与胰岛素抵抗密切相关,确定患者的痰湿或湿热体质可以帮助识别具有较高糖尿病进展风险的IGR群体。

Correlation of Traditional Chinese Medicine Body Constitution Types with Insulin Resistance and Risk of Diabetes in Patients with Impaired Glucose Regulation

Objective:In order to identify relevant risk factors of impared glouse regulation(IGR) patients and detect and prevent IGR progressing to diabetes at an early stage,this study investigated the correlation of traditional Chinese medicine(TCM) body constitution types and insulin resistance,and whether body constitution types could be applied independently to predict diabetes in IGR patients. Method:Two hundred and ninety four patients with IGR received blood tests and their body constitution types were assessed by a body constitution questionnaire(BCQ).Serum levels of cytokines were measured by enzyme-linked immunosorbent assays(ELISA). The patients were followed up for at least three years,and the onset of diabetes were recorded. Multivariate logistic regression was used to determine the odds ratio(OR) of diabetes of different body constitution types. Results:Phlegm damp,damp heat and qi deficiency were the three most common unbalanced constitutions among IGR patients. Patients of phlegm damp and damp heat constitution showed high serum levels of interleukin 6(IL-6),tumor necrosis factor-α(TNF-α) and leptin,and low serum levels of adiponectin(P<0.05). Patients of qi deficiency constitution showed high serum level of leptin,and low serum levels of adiponectin,glucagon-like peptide-1(GLP-1) and gastric inhibitory polypeptide(GIP)(P<0.05). Patients of phlegm damp or damp heat constitution demonstrated a significantly high risk of diabetes(P<0.05). Conclusion:TCM body constitution is closely correlated with inflammatory response and insulin resistance,and could be served as a predictor of diabetes in patients with IGR. IGR subjects of phlegm damp or damp heat are at a high risk of progression to diabetes.