新诊断2型糖尿病常见中医证型与非酒精性脂肪肝及其相关危险因素分析

目的探讨新诊断2型糖尿病(T2DM)常见中医证型与非酒精性脂肪肝(NAFLD)及其相关危险因素的相关性,为中西医结合治疗提供临床指导。方法选择沧州中西医结合医院门诊和病房收治的300例新诊断T2DM患者作为研究对象,根据其是否合并NAFLD分为合并NAFLD组,单纯T2DM组。记录2组一般资料,依照《糖尿病中医防治指南》对所有患者进行辨证分型,记录2组腰围、身高、体质量、体质量指数(BMI)、肝功指标丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)]、血脂指标(TG、TC、HDL-C、LDL-C)及血尿酸(SUA)、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C-肽(FC-P)、胰岛素抵抗指数(HOMA-IR),分析各中医证型与客观化指标的关系。结果合并NAFLD组124例,单纯T2DM组176例,2组性别、年龄比较差异无统计学意义(P均>0.05);合并NAFLD组的痰湿郁阻证占比明显高于T2DM组(P<0.05),其余分型占比组间比较差异无统计学意义(P均>0.05);合并NAFLD组的腰围、BMI、TG、TC、FC-P、HOMA-IR均显著高于T2DM组(P均<0.05),其余指标2组比较差异无统计学意义(P均>0.05);非条件Logistic回归分析显示,NAFLD的独立危险因素为BMI、TG、HOMA-IR。结论痰湿郁阻证是T2DM合并NAFLD患者的最常见证型,肥胖、胰岛素抵抗、脂质代谢紊乱是T2DM合并NAFLD患者的独立危险因素。

Analysis of common TCM syndromes,nonalcoholic fatty liver and related risk factors in newly diagnosed type 2 diabetes

Objective It is to explore the correlation of common TCM syndrome types of newly diagnosed type 2 diabetes mellitus(T2DM)with non-alcoholic fatty liver disease(NAFLD)and related risk factors,and to provide clinical guidance for the treatment of integrated Chinese and western medicine.Methods A retrospective study was performed.300 newly diagnosed T2DM patients admitted to the outpatient department(or ward)of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected as the research subjects.They were divided into two groups based on whether they had NAFLD:124 cases with NAFLD were considered as group A,and 176 patients with T2DM alone were considered as group B.According to the"Traditional Chinese Medicine Prevention and Treatment Guidelines for Diabetes",all patients were classified according to their syndrome types,and waist circumference,height,and weight were measured simultaneously,body mass index(BMI)was calculated,and liver function indicatorsalanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),alanine aminotransferase(ALP)]and blood lipid indicators(TG,TC,HDL-C,LDL-C)and serum uric acid(SUA),fasting blood glucose(FBG),fasting insulin(FINS),fasting C-peptide(FC-P)were determined,the insulin resistance index(HOMA-IR)was calculated;statistical analysis of all data was performed to understand the clinical characteristics and distribution of each syndrome type,and the relationship between each TCM syndrome type and objective indicators was explored.Results The proportion of syndrome of phlegm-dampness stagnation in group A was higher than that in group B(P<0.05),and there was no significant difference in the other syndrome types between the two groups(P>0.05).The waist circumference,BMI,TG,TC,FC-P,and HOMA-IR in group A were significantly higher than those in group B(P<0.05),and there was no significant difference in the other indicators between the two groups(P>0.05);unconditional logistic regression analysis showed that the independent risk factors of NAFLD were BMI,TG,and HOMA-IR.Conclusion The syndrome of phlegm-dampness stagnation is the most common syndrome type of T2DM patients with NAFLD.Obesity,insulin resistance,and lipid metabolism disorders are independent risk factors for T2DM patients with NAFLD.