【作者】 吴浩祥；

【导师】 李赛美；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2006， 博士

【摘要】 1 研究目的 探讨代谢综合征中医辨证分型证候规律及伤寒方治疗疑难疾病的作用及其机理。本课题采用临床流行病学调查、频数分析的方法,探讨代谢综合征的病机分型特点,为制定代谢综合征中医诊疗方案提供依据,并与糖尿病中医辨证分型比较,探讨它们的中医辨证差异。在本学科加味桃核承气汤治疗糖尿病及并发症获得显著成绩基础上,进一步观察该方对模型大鼠瘦素水平的影响,探讨本方防治代谢综合征的疗效及其干预机制。 2 研究内容、方法与结果 2.1 理论和文献研究 对代谢综合征的发病情况、病因和病理机制、诊断、治疗以及传统中医理论对代谢综合征的认识、中医药防治代谢综合征的研究概况、中医药对胰岛素抵抗的动物实验研究概况等进行了系统文献复习。研究表明,广大学者对防治代谢综合征做了很多有益的工作,取得了一定的进展,但确也存在不少亟需解决的问题:①诊断标准不统一。因诊断标准不统一导致观察对象不统一,给学术交流和临床研究带来障碍。②辨证分型缺乏统一公认的标准。目前的辨证分型多而零乱,主观随意性大,不利于辨证论治的规范化、客观化。③目前还没有代谢综合征实验动物模型。要尽快研制出具有代谢综合征生物学特征的动物模型,通过大样本动物实验和研究,从而得到对人类代谢综合征研究具有临床指导意义的结论。④如何在目前已有研究成果的基础上,结合当代科技的最新研究成果,充分发挥细胞生物学、分子生物学的技术优势,阐明中医药防治代谢综合征的作用机制,是目前中医药深化代谢综合征研究的又一迫切需要解决的课题。 2.2 临床观察 采用临床流行病学调查、频数分析等方法,对117例代谢综合征和1000例糖尿病患者的临床脉证进行调查,以期揭示代谢综合征的病机分型特点及代谢综合征与糖尿病的中医辨证差异。 结果显示:代谢综合征虚证主要表现为气虚、阴虚、阳虚,以气虚证为主要证型;实证主要表现为胃肠积热、湿热、痰湿、血瘀,以胃肠积热为主要证型。 从合并证型分布频率来看,代谢综合征证型组合中最多见的是气阴两虚证,其它依次为湿热夹瘀证、气虚夹痰湿证、气虚血瘀证、阴阳两虚证,其中气阴两虚证、湿热夹瘀证、气虚夹痰湿证三种合并证型占70%,湿热夹瘀证较气阴两虚证具有更高的体重指数,证型与空腹胰岛素水平无明显相关性。 对于糖尿病中医证候,从舌质分析,舌红与舌淡之比为52.7%∶47.3%,舌暗出更多还原

【Abstract】 1.Objective:To Approach on TCM law of syndrome about metabolic syndrome as well as the function and mechanism of classical prescription in typhoid theory. In order to provide evidence on metabolic syndrome which is treated by TCM diagnosis proposal. This article uses the method of clinical epidemiology investigating and frequency-analyzing to study the pathogenesis grouping characteristics of metabolic syndrome. At the same time ,we compare the differentiation of symptoms and signs for classification of syndrome between metabolic syndrome and diabetes, approach the difference between them. On the basis of clinical and laboratorial researches on Jia Wei Tao He Cheng Qi Tang, we observe the influence of Jia Wei Tao He Cheng Qi Tang on the leptin of Model rat and thus discuss the efficacy and intervention mechanism to prevent and treat metabolic syndrome.2.Content, Method and Result2.1 Research on the theory and literatureThrough the review of the documents, we do a further research on the occurence, pathogeny, pathological mechanism, diagnosis and treatment of metabolic syndrome on the basis of metabolic syndrome in TCM, the general research situation of TCM to prevent and treat metabolic syndrome and its fuctions in insulin-resistant animal experiments.According to the documents we’ve got so far, many scholars have done a great deal for the prevention and treatment of metabolic syndrome and really have made some progress.however there are stll many problems to be solved:(1) ununified diagnostic criteria: As diagnosis standard is not the same, that leads to the observed objectives different which brings obstacles for academic exchange and clinical research. (2) Lack of unified received standard for syndrome differentiation.Now there are many sorts of syndrome differentiation with a lot of subjective opinions but in great disorder which is not good for standardization and objective.(3) No animal model with metabolic syndrome so far. We should prepare the animal model with metabolic syndrome as soon as possible, and draw conclusion of clinical guidance which benefits human metabolic syndrome research through the experiment and research on animals of large samples. (4) On the basis of achieved research achievements, how to indicate the function mechanism of TCM to metabolic syndrome combining the latest research results oftechnology and exerting the technology advantages of cell biology and molecular biology, is a problem requiring urgent settlement in the process of deepening the research of metabolic syndrome in TCM. 2.2 Clinical researchThis research accepts the method of clinical epidemiology investigating and frequency-analyzing etc. We make an investigation on the clinical pulse condition of 117 cases of metabolic syndrome patients to reveal the features of differentiating syndrome by pathogenesis of metabolic syndrome and the difference about the differentiation of syndrome between metabolic syndrome and diabetes.The results shows: The deficient syndromes mainly include qi deficiency , yin deficiency and yang deficiency , among which qi deficiency is the most common. The sthenia syndromes mainly include accumulated heat of gastrointestine, damp-heat, phlegm dampness and blood stasis, among which the accumulated heat of gastrointestine is the most common.From the viewpoint of the combined syndromes frequency distribution, we can tell that the deficiency syndrome of both qi and yin is the most common, and in turn, the damp-heat syndrome with blood stasis, qi-deficiency syndrome with phlegm, qi-deficiency syndrome with blood stasis, deficiency syndrome of both yin and yang, among which the combined syndromes of deficiency syndrome of both qi and yin, damp-heat syndrome with blood stasis and qi-deficiency syndrome with phlegm occupies 70%, and the damp-heat syndrome with blood stasis has a higher body weight index than that of deficiency syndrome of both qi and yin. Syndrome type is not obviously relevant to the insulin level in empty stomach.The features about the diabetes TCM symptoms are that analyzing from body of the tongue the ad rat. between red tongue and pale tongue is 52.7%:47.3%, the rat of dark tongue is 33%;analyzing from coat of the tongue, yellow and yellowish greasy tongue occupy 52.2%, greasy tongue(yellowish greasy and whitish greasy tongue) occupy 24.5%, display that the pathogenetic condition is coldheat complex, blood stasis, dampness and heat are the main causative agents and patho-productions;Analyzing from the pulse tracings, the frequent pulse and the excessive pulse almost have the same frequency, display the pathogenetic condition is excess and deficiency complex.Analyzing from the TCM differentiation of symptoms and signs, the deficiency syndrome of both qi and yin occupies 99.9%, it is still the main syndrome in the diabetes longer course;deficiency both yin and yang is only less than it;the syndrome both deficiency yin and dryness-heat is little in the patients in hospital, this type is often appear the early stage of diabetes, the course is short, the patients condition is light, so it is not the main syndrome in the patients in hospital.Comparison of the difference between metabolic syndrome and diabetes display that their TCM differentiation of symptoms and signs is nearly the same. In the single syndromes, the frequency occurrence of blood stasis and deficiency yin is higher indiabetes patients than metabolic syndrome patients. But the frequency occurrence of damp-heat and phlegmatic hygrosis is on the contrary. In the type of combined syndrome, deficiency both qi and yin is their mutual main syndrome, but the frequency occurrence is more higher in diabetes than in metabolic syndrome.Accord to this research result, we find that the metabolic syndrome is based on deficiency qi, and the damp-heat, phlegmatic hygrosis and blood stasis are superficially. Its character is asthenia in origin and asthenia in superficiality. The deficiency both qi and yin is the main syndrome in its progress course and the key point of the pathogenesis transition. The syndrome of deficiency both qi and yin is controlled, the syndrome can transfer to the deficiency qi or deficiency yin, the disease condition will be better, on the contrary, it well be worse.This research shows that in all kinds of combined syndomes, the deficiency syndrome of qi and yin, damp-heat syndrome with blood stasis and qi-deficiency syndrome with phlegm are the most common. In the author’s opinion, those three syndromes can act as standard syndrome in syndrome differentiation of metabolic syndrome and offer an referrence for making the solution furtherly of diagnosis and treatment of metabolic syndrome. 2.3 Experiment researchOn the basis of clinical and laboratory research on Jia Wei Tao He Cheng Qi Tang, we select Jia Wei Tao He Cheng Qi Tang as the main prescription with the function of supplementing qi and nourishing yin and purging heat and expelling stasis, the leptin is relevant to the pathological process of metabolic syndrome as the observing index, injecting streptozotocin into abdominal cavity and feeding fat and sweet food (with high calories)sucessively as the method to foster the animal model, to observe the influence of Jia Wei Tao He Cheng Qi Tang on the leptin level of model rat and approach the efficacy and intervention mechanism of it.It shows that Compared with the normal rat group, the leptin level of model rat group rises up obviously(P<0.01) which indicates that the leptin level of rat can rise up after fostering the model. The leptin levels of high dosage group and low dosage groups decline obviously(P<0.01) comparing to the model group which indicates the priscription can lower down the leptin level in rat serum.The mechanism of Jia Wei Tao He Cheng Qi Tang to reduce the leptin level of rat isn’t clear yet. Maybe it’s relevant to the improvement of resistance to leptin. As to the function place or segment of this prescription to improve resistance to leptin, we need to make a further research in future. 3. Prospectation3.1 In order to reveal the features of differentiating syndorme by pathogenesis of metabolic syndrome and the basis for standardization as well as the treatment, it’s necessary to apply the method of Evidence Based Medicine to do the prospective and polycentric research on large samples and conduct the systematic research from segments of syndrome feature,standard of syndrome differentiation, application of medicine and priscription and function mechanism etc, to exert the advantage of sleeting treatment by differentiating syndromes in TCM and open an new era of preventing and treating metabolic syndrome.3.2 To strengthen the research of metabolic syndrome in TCM. The Syndrome is the high generalization of pathogeny, pathogenesis and lesion location and it has inversion and evolution tendency in the process of disease, which determines the complexity and versatility of syndrome. Meanwhile, as metabolic syndrome involvesMany metabolic diseases with complicated clinical syndromes and variable indexes, we should strengthen the observation of the index of metabolic syndrome and externalization research of syndrome in TCM.3.3 To conduct the research on the resistance of Jia Wei Tao He Cheng Qi Tang to leptin step by step.As leptin is involved in the pathological process of obesity, diabetesll, hyperlipemia, hypertension, atherosclerosis and coronary heart disease and closely related with metabolic syndrome, the research on the resistance of leptin will be more and more important. In furture, we should conduct further research on the influence of Ji Wei Tao He Cheng Qi Tang on leptin acceptor and the situation after that and try to discuss the function mechanism of Jia Wei Tao He Cheng Qi Tang to intervene metabolic syndrome furtherly.更多还原