不同肥胖表型者中医体质特点分析研究

背景　有研究表明肥胖者和代谢紊乱者的中医体质类型存在一定的相似性，但是不同肥胖者发生代谢紊乱的风险不完全相同，是否中医体质为其内在原因？目前尚不可知。目的　探究不同肥胖表型者中医体质特点。方法　从2012年6月-2014年1月北京同仁医院、安徽中医药大学第一附属医院以及广东省中医院珠海医院治未病中心健康体检人群1 814例数据库中，排除年龄<18岁者、分析变量存在缺失值及体质量过轻和超重者，纳入1 267例体质量正常和肥胖样本进行分析。根据代谢正常/异常及体质量正常/肥胖组合形成4种代谢肥胖表型，即代谢正常体质量正常表型（MHNW）、代谢异常体质量正常表型（MUNW）、代谢正常肥胖表型（MHO）、代谢异常肥胖表型（MUO）。采用中医体质量表评价中医体质，采用最小二乘回归法（控制社会人口学因素及行为习惯因素）计算不同肥胖表型者9种中医体质（平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质）得分。结果　1 267例调查对象中，MHNW 584例（46.1%），MUNW 207例（16.3%），MHO 174例（13.7%），MUO 302例（23.9%）。不同肥胖表型者平和质、阳虚质、痰湿质得分比较，差异均有统计学意义（P<0.05）；其中MUO者平和质得分高于MHNW和MUNW者，阳虚质得分低于MHNW和MUNW者；MHO和MUO者痰湿质得分高于MHNW和MUNW者（P<0.05）。男性不同肥胖表型者平和质、阳虚质、痰湿质得分比较，差异均有统计学意义（P<0.05）；其中MUO者平和质得分高于MHNW和MUNW者，阳虚质得分低于MHNW和MUNW者；MUNW、MHO和MUO者痰湿质得分高于MHNW者（P<0.05）。女性不同肥胖表型者阳虚质、痰湿质得分比较，差异均有统计学意义（P<0.05）；其中MUO者阳虚质得分低于MHNW者，MHO者痰湿质得分高于MHNW和MUNW者，MUO者痰湿质得分高于MUNW者（P<0.05）。结论　代谢状况相近的情况下，肥胖者痰湿质、平和质倾向更高，阳虚质倾向更低；体质量相近的情况下，不同代谢状况者未表现出明显的体质差异。但男性和女性情况有所不同，男性肥胖者和代谢异常者均表现为较高的痰湿质倾向；女性仅有肥胖者表现为较高的痰湿质倾向，而代谢异常者未发现较高的痰湿质倾向。

Traditional Chinese Medicine Constitution Features of Different Obesity Phenotypes

Background Studies have shown that there are certain similarities in the types of TCM constitutions between obese people and those with metabolic disorders,but the risk of metabolically unhealthy in different obese people is not exactly the same.However,it is still unknown whether this difference is essentially related to TCM constitution.Objective To explore the TCM constitution features of different obesity phenotypes.Methods During June 2012 to January 2014,from the database of 1 814 physical examinees recruited from Preventive Treatment Center,Beijing Tongren Hospital,the First Affiliated Hospital of Anhui University of Chinese Medicine,and Zhuhai Branch,Guangdong Provincial Hospital of Traditional Chinese Medicine,1 267 normal-weight and obese cases were included after excluding those who were less than 18 years old,underweight,overweight,and had missing data.According to metabolic and obese phenotypes,they were divided into four groups:metabolically healthy normal weight(MHNW),metabolically unhealthy normal weight(MUNW),metabolically healthy obesity(MHO),and metabolically unhealthy obesity(MUO).The TCM Constitution Questionnaire was used to investigate the TCM constitution.Partial least squares regression was used to calculate the scores of 9 types of TCM constitution for different obesity phenotypes after controlling sociodemographic and behavioral factors,including constitution of gentleness,Qi-deficiency,Yang-deficiency,Yin-deficiency,phlegm-dampness,damp-heat,blood stasis,Qi depression,and allergic.Results The number of cases in groups of MHNW,MUNW,MHO,and MUO was 584(46.1%),207(16.3%),174(13.7%),and 302(23.9%),respectively.The mean scores of constitution of gentleness,Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype(P<0.05).To be specific,MUO group showed higher mean score of gentleness constitution,and lower mean score of Yang-deficiency constitution compared with MHNW and MUNW groups(P<0.05).MHO and MUO groups showed higher mean score of phlegm-dampness constitution compared with other two groups(P<0.05).Sex-based analysis showed that,the mean scores of constitution of gentleness,Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype in males(P<0.05).Specifically,males in MUO group demonstrated higher mean score of gentleness constitution,and lower mean score of Yang-deficiency constitution compared with those in MHNW and MUNW groups(P<0.05).Moreover,males in MHNW group demonstrated lower mean score of phlegm-dampness constitution compared with those in other three groups(P<0.05).The mean scores of constitution of Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype in females(P<0.05).Specifically,females in MUO group demonstrated lower mean score of Yang-deficiency constitution compared with those in MHNW group(P<0.05).And they also showed higher mean score of phlegm-dampness constitution compared with those in MHNW and MUNW groups(P<0.05).Conclusion In the case of similar metabolic status,obese people have a higher tendency to develop phlegm-dampness constitution,and gentleness constitution,but the tendency of developing Yang-deficiency constitution is lower.When people’s body weights are similar,metabolic status is not associated with significant differences in TCM constitution.However,conditions are different in males and females.Males who are obesity and metabolically unhealthy all showed higher tendency to have phlegm-dampness constitution,but in females,only the obese ones tend to show higher tendency of having phlegm-dampness constitution,those with unhealthy metabolism have no the tendency.