儿童肥胖症不同临床分型与中医辨证的相关性

目的研究不同病因引起儿童肥胖症(obesity)的中医辨证分型,为使用中医药治疗各种儿童肥胖症提供辩证诊断依据。方法对89例肥胖儿童通过口服糖耐量试验(Oralglucosetolerancetest,OGTT),测定空腹、服糖后2h血糖和胰岛素水平,以及肝脏B超、血脂、皮质醇检测,对合并性早熟或青春早发育者的骨龄、性激素及性腺进行测评,并根据结果进行肥胖症临床分型。分别记录其舌质、舌苔、脉象,结合临床症状进行中医辨证。随机抽取22例属脾虚湿困血瘀型患者,检测其血液流变性。结果89例儿童肥胖症检出单纯性肥胖不伴有并发症32例,肥胖伴并发症28例,症状性肥胖29例。单纯性肥胖患者中湿热中阻型25例,脾虚湿困伴血瘀型4例,脾虚湿困型1例,其他2例。肥胖伴有并发症患者中湿热中阻型8例,脾虚湿困伴血瘀型17例,其他3例。症状性肥胖患者中湿热中阻型2例,脾虚湿困伴血瘀型23例,脾虚湿困型2例,其他2例。全血粘度、血浆粘度及纤维蛋白原均明显高于正常对照(P<0.05,P<0.01,P<0.001)。结论不同临床分型的肥胖症与中医辨证分型具有一定的相关性。肥胖儿童湿邪阻滞型多发,单纯性肥胖患者中湿热中阻常见,在肥胖伴有并发症及症状性肥胖患者中脾虚湿困伴血瘀型易见。伴有血瘀证表现患者血液存在高凝状态。

Study of Correlation between TCM Syndrome Differentiation and Clinical Classification of Western Medicine in Childhood Obesity

Objective To study the correlation of TCM syndrome differentiation with clinical classification in childhood obesity, and to provide reasonable arguments for using Chinese Medicine to treat different childhood obesity. Method Detection of blood glucose level at time 0, 2 hours of oral glucose tolerance test, insulin, lipid, cortisone and liver condition was performed on a total of 89 children with obesity. Of patients with neonaty, bone age, sex hormone and gland were also examined. The patients are classified according to the above presentation. The texture tongue, tongue fur, pulse condition and other clinic manifestations were used to syndrome differentiation in TCM. The blood dynamic condition were detected in 22 patients of splenasthenic hygrosis accompanying blood stasis randomly. Results Among 89 children with obesity, 32 of them were simple obesity without complications, 28 were simple obesity with complications, 29 were secondary obesity. Of 32 simple obesity cases without complications, 25 were damp heat blockage of middle energizer, 4 were splenasthenic hygrosis accompanying blood stasis, 1 were splenasthenic hygrosis, the rest 2 were other types. Of 28 simple obesity cases with complications, 8 were damp heat blockage of middle energizer, 17 were splenasthenic hygrosis accompanying blood stasis, the rest 3 were other types. Of 29 secondary obesity cases, 2 were damp heat blockage of middle energizer, 23 were splenasthenic hygrosis accompanying blood stasis, 2 were splenasthenic hygrosis, the rest 2 were other types. The blood viscosity, plasma viscosity and fibrinogen were much higher than that of normal control (P <0.05, P <0.01, P <0.001). Conclusions Clinical classification of childhood obesity was related to TCM syndrome differentiation. Damp heat blockage is common in childhood obesity. Damp heat blockage of middle energizer were common in patients with simple obesity without complications. Splenasthenic hygrosis accompanying blood stasis were common in patients with simple obesity with complications and secondary obesity. Patients with blood stasis present high blood viscosity.