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| 2型糖尿病合并内脏脂肪型肥胖患者的临床特征及中医证素研究 |
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王悦1, 尚唱2, 王泽厚1, 张正姗1, 王娅辉3, 孙鲁英1,4
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1.北京中医药大学附属东直门医院肾病内分泌一区, 北京 100700;2.北京中医药大学东方医院康复医学科, 北京 100078;3.北京中医药大学附属房山医院科教科, 北京 102488;4.北京中医药大学附属房山医院中西医结合代谢性疾病研究中心, 北京 102488
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| 摘要: |
| [目的] 探讨2型糖尿病（T2DM）合并内脏脂肪型肥胖（VO）患者的临床特征及中医证素分布规律，为其中西医结合防治提供依据。[方法] 收集2023年2月—2025年2月北京中医药大学房山医院451例T2DM患者，依据内脏脂肪面积（VFA）分为非VO组与VO组，收集临床资料及中医四诊信息，比较组间差异，并运用多因素Logistic回归、证素聚类及相关性分析探讨VO与糖尿病肾脏病（DKD）及中医证素的关系。[结果] VO组占60.9%，其中59.6%的患者身体质量指数（BMI）未达到肥胖标准。VO组男性比例、肥胖比例、胰岛素使用率、收缩压（SBP）、舒张压（DBP）、BMI、臂踝脉搏波传导速度（baPWV）、空腹血糖（FPG）、空腹胰岛素（FINS）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、三酰甘油（TG）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、肌酐（Cr）、尿酸（UA）、尿白蛋白肌酐比（UACR）、游离三碘甲状腺原氨酸（FT3）等指标水平增高，高密度脂蛋白胆固醇（HDL-C）降低，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示VO是DKD的影响因素[OR=1.717，95% CI（1.100，2.687），P=0.018]。中医证素分析显示，VO组湿、痰、血瘀证素及脾、心病位证素频次显著高于非VO组（P<0.05）。基于证素进行聚类分析得出T2DM合并VO患者常见证型为痰湿困脾证、胃热津伤证、气滞血瘀证、阴阳两虚证。VFA与多项代谢指标呈正相关（P<0.05），且合并湿、痰、血瘀证素的患者VFA均显著高于未合并者（P<0.05）。[结论] T2DM合并VO患者临床以男性居多，内脏脂肪增多与代谢紊乱及DKD风险密切相关。VO患者中医证素以脾、心为关键病位，湿、痰、血瘀为重要病机，为应用健脾化湿、化痰逐瘀治法进行中西医结合改善内脏肥胖及代谢异常提供了辨治思路。 |
| 关键词: 2型糖尿病 内脏脂肪型肥胖 中医证素 临床特征 糖尿病肾脏病 |
| DOI：10.11656/j.issn.1672-1519.2026.09.03 |
| 分类号:R587.1 |
| 基金项目:中国中医药科技发展中心中西医协同慢病管理研究项目（CXZH2024097）。 |
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| Clinical characteristics and traditional Chinese medicine syndrome elements in patients with type 2 diabetes mellitus with visceral obesity |
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WANG Yue1, SHANG Chang2, WANG Zehou1, ZHANG Zhengshan1, WANG Yahui3, SUN Luying1,4
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1.First Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China;2.Department of Rehabilitation Medicine, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China;3.Department of Science and Education, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing 102488, China;4.Center for Integrated Traditional and Western Medicine in Metabolic Diseases, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing 102488, China
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| Abstract: |
| [Objective] To explore the clinical characteristics and traditional chinese medicine（TCM）symptom distribution patterns of type 2 diabetes mellitus（T2DM）patients with visceral obesity（VO），and provide evidence for integrated traditional and Western medicine intervention. [Methods] A total of 451 T2DM patients from Beijing University of Chinese Medicine Fangshan Hospital between February 2023 and February 2025 were enrolled and divided into non-VO and VO groups based on visceral fat area（VFA）. Clinical data and TCM data were collected. Differences between groups were compared，with multivariate Logistic regression，syndrome element clustering，and correlation analysis used to investigate the association of VO with diabetic kidney disease（DKD）and TCM syndrome elements. [Results] The VO group accounted for 60.9%，among whom 59.6% did not meet the body mass index（BMI） criteria for obesity. Compared with the non-VO group，the VO group had higher levels of male proportion，obesity proportion，insulin usage rate，systolic blood pressure（SBP），diastolic blood pressure（DBP），body mass index（BMI），brachial ankle pulse wave velocity （baPWV），fasting plasma glucose（FPG），fasting insulin（FINS），fasting C- peptide（FCP），insulin resistance index（HOMA-IR）， triglycerides（TG），alanine aminotransferase（ALT），aspartate aminotransferase（AST），creatinine（Cr），uric acid（UA），urine albumin- creatinine ratio（UACR），and free triiodothyronine（FT3），while high- density lipoprotein cholesterol（HDL-C）was decreased，with statistically significant differences（P<0.05）. Multivariate Logistic regression analysis indicated that VO was an influencing factor for DKD[OR=1.717，95%CI（1.100，2.687），P=0.018]. TCM syndrome elements analysis revealed that the frequencies of dampness， phlegm，blood stasis，and spleen and heart were significantly higher in the VO group than in the non- VO group（P<0.05）. Cluster analysis based on syndrome elements identified the common TCM syndrome patterns in T2DM patients with VO as：phlegm-dampness encumbering spleen pattern，stomach heat injuring fluid pattern，qi stagnation and blood stasis pattern，and yin-yang deficiency pattern. VFA was positively correlated with multiple metabolic indicators（P<0.05），and VFA levels in patients with dampness，phlegm，or blood stasis syndrome elements were significantly higher than those in patients without these elements（P<0.05）. [Conclusion] T2DM patients with VO are predominantly male. Increased visceral fat is closely associated with metabolic disorders and the risk of DKD. The key TCM disease locations in VO patients are the spleen and heart，with dampness，phlegm，and blood stasis being important pathogenesis. This provides a diagnostic and treatment rationale for applying integrated TCM and Western medicine approaches，such as strengthening the spleen and resolving dampness，resolving phlegm and dispelling stasis，to improve visceral obesity and metabolic abnormalities. |
| Key words: type 2 diabetes mellitus visceral obesity traditional chinese medicine syndrome element clinical characteristic diabetic kidney disease |
