【作者】 毛睿睿；

【导师】 冯维斌；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2005， 硕士

【摘要】 胰岛素抵抗综合征即代谢综合征(MS)包括了一组导致动脉粥样硬化的症候群:中心性肥胖、糖耐量低减或2型糖尿病、高胰岛素血症或胰岛素抵抗、血脂紊乱、高血压病、高尿酸血症、高粘状态、高凝状态、脂肪肝、骨质疏松以及过早动脉硬化和(或)冠心病、内皮细胞功能障碍等。1999年WHO对MS的定义提出建议,即糖耐量低减(IGT)或2型糖尿病(DM)和(或)胰岛素抵抗(IR),并伴有2种以上下列表现:高血压、高甘油三酯血症、中心性肥胖、微量白蛋白尿。可以看出,这个定义是以IGT、IR、2型糖尿病为核心。现代医学真正认识MS是从1988年Reaven提出“x综合征”这一常见的临床症候群开始。 中医古代文献中无胰岛素抵抗综合征的病名,从中医学的角度,则认为过食、酗酒损伤肝脾,肝脾功能失调,不能运化摄入的过多饮食,则形成痰郁、痰湿、湿浊等,日久积热化燥。如长期酗酒更易致湿热内蕴;如活动过少,气血运行缓慢,湿热郁阻脉络,甚而瘀血内生,脉道不利,变证百生,久而形成了以湿热内困为核心的病机。湿热中阻则脾运胃纳失健,精微不得运化以滋养机体脏腑,出现脘腹胀闷、口渴喜饮或不多饮或饮入渴不解、多食或食少纳呆、便溏不爽、肢体困重等症状。故临床因湿热内阻而致者亦不少见。其所见症状还会随湿热内阻程度的轻重而有所不同。此类患者若用滋阴清热法多不奏效,反因用药之寒凉滋润而助湿阻碍气机,或因苦寒化燥、湿郁化热,湿热互结不去,其病难愈。由此可见,湿热内阻与胰岛素抵抗综合征在临床上密切相关。 目的:探讨2型糖尿病湿热证与胰岛素抵抗综合征之间的关系。 方法:根据1997年7月美国糖尿病协会在Diabetes Care公布的2型糖尿病诊断标准及《中药新药临床研究指导原则》(中国医药科技出版社.2002,5.第一版)公布的湿热证诊断标准,纳入50例2型糖尿病湿热证患者,并按湿热内阻的症候积分标准分为轻度组、中度组和重度组三组,分别检测其空腹血糖、餐后2小时血糖、空腹胰岛素、餐后2小时胰岛素、甘油三酯、高密度脂蛋白、尿微量白蛋白排泄率、体重指数,并计算胰岛素敏感性指数,将其与胰岛素抵抗综合征(1998年7月WHO专家咨询报公布)的标准进行对比。 结果: 1.50例2型糖尿病湿热证患者的空腹血糖、餐后2小时血糖、空腹胰岛素、餐后2小时胰岛素、甘油三酯、高密度脂蛋白、尿微量白蛋白排泄率、体重指数均符合胰岛素抵抗综合征标准。 2.湿热内阻轻度组与中度组的甘油三酯、体重指数的比较无显著性差异(P>0.05)。 3.随着湿热内阻程度的加重,湿热内阻重度组的空腹血糖、餐后2小时血糖、空腹胰更多还原

【Abstract】 Insulin Resistance Syndrome which is called Metabolic Syndrome(MS) include abdominal obesity, lmpai red Glucose Tolerance (IGT) or type 2 diabetes, hyperinsulinism or insulin resistance, serum lipid disorder, hypertensive disease, hyperuricemia, high blood viscosity state, hypercoagulabi 1 i ty state, fatty liver, osteoporosis, early atherosclerosis or coronary heart disease and endothelial cell dysfunction, etc that can lead to atherosclerosis. In 1999, WHO gave a definition to MS that is IGT or type 2 diabetes and (or) IR accompanied with two of the followingS: hypertension, high triglvceride, abdominal obesity, microalbuminuria. From it, we can see the core of this definition are IGT, IR, type 2 diabetes.There was no name of lnsulin Resistance Syndrome in ancient Chinese medicine literature. From Chinese medicine point of view, it has been believed that eating too much, alcohol abuse can damage liver and spleen which leads to its dysfunct ion. Spleen can not transport excess food which has been intaken. So sputum and dampness are formed. Alcoholism can produce dampness and heat. Too less activity make gas and blood run slowly, meridian block that can lead to the core of the disease mechanism — dampness and heat. Inner dampness block, so substance can not be transported which leads to symptoms such as abdominal distent ion, thirsty but drinking fewer water, bad appetite, diarrhea and tenesmus, flabbiness. We can see many patients like this. These symptoms can be different with the extent of inner dampness and heat block. So the intended effect can not be received without the right treatment. From the above, it is clear that damp-heat inner block and lnsul in Resistance Syndrome are closely correlated.Aim: To study the Relationship between Damp-heat Syndrome of type 2 Diabetes Mellitus and Insulin Resistance SyndromeMethod: According to Diabetes Diagnosis Criteria published by ADA on Diabetes Care 1997, 7and Damp-heat Syndrome Diagnosis Criteria published on更多还原