通调带脉针刺法治疗代谢综合征腹型肥胖有效性研究
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摘要
代谢综合征(MetS)是指肥胖、糖尿病、高血压和血脂紊乱等心血管疾病危险因子异常聚集存在于同一个体的临床症候群。其临床后果主要表现为冠状动脉粥样硬化性心脏病(ASCVD)、2型糖尿病(T2DM)和中风。据统计,目前全球1/5-1/4的人口患有MetS,MetS及其并发症的研究和防治已成为当今重大的公共卫生问题。
研究发现,腹型肥胖是MetS发病机制的核心。腹型肥胖的危害在于内脏脂质堆积增多和脂肪细胞增大,导致脂肪动员加速,血浆游离脂肪酸升高,引起非脂肪器官的脂肪异位沉积,抑制糖的氧化利用,促进肝糖异生及低密度脂蛋白(LDL)和极低密度脂蛋白合成增加,下调靶细胞膜上的胰岛素受体数目和亲和力,同时脂肪组织释放的脂肪因子、炎性介质增多,加重了机体信号调节紊乱,从而引起糖脂代谢紊乱、胰岛素抵抗(IR)的发生。因此控制腹型肥胖是从源头上防治MetS的发生,可以作为研究MetS诊疗过程的切入点。
既往临床工作和研究表明针刺在治疗MetS及肥胖中存在一定优势,可有效降低体重指数(BMI)和腰围(WC)无不良反应,同时可以改善机体糖脂代谢紊乱,从而防治心脑血管事件的发生,但对于内脏脂肪的影响尚无研究。本研究在中医经络辨证理论的指导下,以彩超检测腹部脂肪堆积情况作为主要结局测量指标,并结合简易体脂参数和血糖、血脂、血压等理化指标,探讨通调带脉针刺法治疗对MetS腹型肥胖患者腹部脂肪堆积的影响,调节机体糖脂代谢紊乱的作用效应,对明确通调带脉针刺法减少脂肪堆积、改善MetS,防治心脑血管事件的疗效具有重要意义。
目的
通过通调带脉针刺法干预MetS腹型肥胖患者的观察和实验研究,探讨该法对MetS腹型肥胖患者治疗的有效性,并进一步探索其远期疗效。
方法
1前期收集在北京中医药大学东方医院针灸科门诊就诊、符合纳入标准的80例MetS腹型肥胖患者的资料,通过通调带脉针刺法干预,初步观察该治法的临床疗效和远期疗效。
2根据前期观察结果,有计划的纳入40例符合纳入标准的受试者作为研究对象,分为针刺组和对照组各20例,比较通调带脉针刺法干预和空白观察的差异,评价通调带脉针刺法对MetS腹型肥胖的临床疗效。
结果
1观察性研究
1.1依从性：80例受试者,进入治疗阶段有79例,最终65例完成研究,依从性比较好(82.28%)。
1.2近期临床疗效：经过两个疗程的治疗,受试者简易体脂参数、腹部脂肪厚度和UVI值、空腹血糖(FBG)、甘油三酯(TG)和血压水平明显降低(P<0.001；P<0.05)；总胆固醇(TC)水平无明显变化(P>0.05),但较前有下降趋势。而高密度脂蛋白(HDL)比治疗前降低(P<0.05)；LDL比治疗前增高,但差异无统计学意义(P>0.05)。
1.3远期疗效：3个月后随访结果,简易体脂参数、UVI值、FBG、TC和血压水平呈持续下降趋势(P<0.05,P<0.001)。腹部皮下脂肪厚度和肝前脂肪(AHF)、肾周脂肪厚度(RPF)总体上降低,但比两疗程结束时有所回升(P>0.05)。TG和LDL变化不明显(P>0.05)；HDL却持续减少(P<0.001)。
2实验性研究
2.1简易体脂参数比较：针刺组经治疗简易体脂参数有所降低(P<0.001)；对照组简易体脂参数却较前增加(P<0.001,P<0.05)。针刺组WC、腰臀比(WHR)、腰围身高比值(WHtR)疗效优于对照组(P<0.05),但体质量、臀围(HC)、BMI、体脂率(PBF)与对照组比较无差异(P>0.05)；两组前后差值比较有统计学差异(P<0.001)。
2.2腹部脂肪厚度和UVI值比较：针刺组经治疗腹部脂肪厚度和UVI值均有所下降(P<0.001,P<0.05)；对照组皮下脂肪厚度、内脏脂肪厚度和UVI值较前无明显变化(P>0.05),AHF和RPF较前增加(P<0.05,P<0.001)。治疗/观察后两组间各指标比较,针刺组优于对照组(P<0.05,P<0.001)。
2.3理化指标比较：针刺组治疗前后结果与观察性研究结果一致；对照组TC、TC、LDL较前增加(P<0.05,P<0.001),HDL水平降低(P<0.05),FBG和血压无变化(P>0.05)。两组治疗、观察后组间比较,针刺组FBG和TG改善作用优于对照组(P<0.05),其余指标无差异(P>0.05)；两组前后差值比较FBG、TC、TG和血压明显差异,针刺组优于对照组(P<0.001,P<0.05),HDL改变两组相当(P>0.05)。
2.4MetS量化指标构成比比较：治疗/观察后针刺组WC、FBG、TG、HDL、舒张压(DBP)达标及改善率总体上优于对照组(P<0.001,P<0.05)；收缩压(SBP)两组变化构成无差别(P>0.05)。
结论
通调带脉针刺法对MetS腹型肥胖患者的WC、WHR、WHtR和腹部脂肪厚度、UVI值,以及FBG、TG水平有明显疗效,同时具有一定远期疗效；并在一定程度上改善患者体质量、HC、PBF和TC、血压水平,缓解MetS加重趋势,增加MetS量化指标的达标率,对MetS和心脑血管疾病的防治有积极意义。
Metabolic syndrome (MetS) is characterized by a cluster of cardiometabolic risk factors including obesity, hyperglycemia, atherogenic dyslipidemia, and hypertension. MetS represents a significant risk factor for the development of atherosclerotic cardiovascular disease (ASCVD), type2diabetes mellitus (T2DM), and stroke. It is estimated that around20%to25%of the world's adult population have the MetS. MetS and its complications have become a relatively new chronic disease and public health problem.
MetS's core component is the frequently occurring abdominal obesity. The harm of abdominal obesity is visceral fat accumulated and hyperplasia of adipocytes. It could accelerate lipolysis, increase plasma free fatty acids, cause adipose ectopic deposition in non fat organs, inhibit glucose oxidated, promote gluconeogenesis and synthesis of low density lipoprotein (LDL) and very low density lipoprotein, down-regulate insul in receptors'number and affini ty at the membrane of the target cells, as well as increase adipokines and inflammatory mediators released by adipose tissue. Then the body signals adjustments were disordered, resulting in abnormal glucolipid metabolism and insulin resistance (IR). Hence, controlling abdominal obesity, which can prevent and treat MetS at the original state, is capable for a breakthrought point to studies for MetS.
From past clinical work and studies, acupuncture has the certain advantages in the treatment of MetS and obesity. It reduces body mass index (BMI) and waist circumference (WC) effectively without adverse reaction, and improves the glucolipid metabolism disorders, thereby preventing cardiovascular events. There haven't been studies in acupuncture for the influence of visceral adipose yet. This study within Chinese medicine and theory of pattern differentiation of meridians and collaterals, adpoted ultrasound detection of abdominal fat accumulation as the main outcome measure, accompanied simple anthropometric parameters and blood glucose, blood lipid, blood pressure, to investigate the influencing of acupuncture regulating Dai Meridian to the accumulation of abdominal adipose in abdominal obese patiets with MetS and the effects of regulating glucolipid metabolism disorders. It has important significance for definiting the effect of acupuncture regulating Dai Meridian for decreasing adipose accumulation, improving MetS, and preventing cardio-cerebro-vascular events.
Objective
Prospective studies, including an observational study and an experimental research, were uesd to observe the clinical efficacy of acupuncture for abdominal obesity on patients with MetS under the principle of regulation of Dai Meridian, furthermore to search his long-term effect.
Methods
1A prospective case series peviously collected80abdominal obesed patients with MetS met the inclusion criteria at the out-patient department of acupuncture and moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, who underwent treatment using the Dai meridian as the prime focus, to tentatively oberserve the clinial effect and long-term effect of this therapy.
2According to the preliminary observation, an experimental research recruited40patients met met the inclusion criteria as the research objects, who were divided into acupuncture group and control group with20cases in each group, then compared the difference between acupuncture regulating Dai Meridian and blank control, to evaluate the clinical efficacy of acupuncture regulating Dai Meridian for abdominal obesity with MetS.
Results
1The observational study
1.1Compliance:Out of80subjects,1of them was excluded due to an abnormal growth found in the abdomen during the ultrasound examination,14of them dropped out due to busy work, taking care of children or other diseases(such as osteoarthritis, fractures, renal calculi, and so on), and65of them completed the entire course. The compliance of this study was82.28%.
1.2Short-term clinical effect:After treatment, the simple anthropometric parameters, thickness of abdominal subcutaneous and visceral adipose (S1, S2, V1, V2), antero-hepat ic fat (AHF) and perirenal fat (PRF), ultrasound viscerofatty index (UVI), fasting blood glucose (FBG), triglycerides (TG) and blood pressure were found to have decreased (P<0.001, P<0.05). Total cholesterol (TO level was lower, yet without statistical significance (P>0.05). High density lipoprotein (HDL) level were lower than pre-treatment (P<0.05). Low density lipoprotein (LDL) were increased after treatment, yet without statistical significance (P>0.05).
1.3Long-term effect:At the3monthes follow-up, the simple anthropometric parameters, UVI, FBG, TG and blood pressure were in a declining trend (P<0.001, P<0.05). The thickness of S1, S2, AHF and RPF were decreased, but have a little rise compared with the end of treatment (P>0.05). TG and LDL levels hadn't significant changed (P>0.05). While HDL decreased continuously (P<0.001).
2The experimental research
2.1Comparisons of simple anthropometric parameters:The simple anthropometric parameters of acupuncture group decreased after treatment (P<0.001), while they increased at control group (P<0.001, P<0.05). The effect of WC, waist-to-hip radio (WHR), and waist-to-height radio (WHtR) were better than control group (P<0.05). There were no differentiation in body mass, hip circumference (HC), BMI, and percentage of body fat (PBF) between two groups (P>0.05). However the differeces, calculated by subtract ing post-treatment value from pre-treatment one, had statistic differentiation between acupuncture group and control group (P<0.001).
2.2Comparisons of thickness of abdominal adipose and UVI:The thickness of abdominal adipose and UVI of acupuncture group decreased after treatment (P<0.001, P<0.05). The S1, S2, V1, V2, and UVI had no difference at control group, while AHF and RPF increased (P<0.05, P<0.001). Comparisons between two groups after treatment, acunpuncture group was more effective than control group (P<0.05, P <0.001).
2.3Comparisons of blood glucose, blood lipid and blood pressure:The results of blood tests at acupuncture group were the same as the observational study between pre-treatment and post-treatment. The TC, TG and LDL were found to have increased at control group (P<0.05, P <0.001), while HDL decreased (P<0.05). The FBG and blood pressure had no difference at control group (P>0.05). Comparisons between two groups after treatment, the improvement of FBG and TG at acunpuncture group was better than them at control group (P<0.05), while other outcomes were no difference (P>0.05). The differeces (pre-treatment minus post-treatment) of FBG, TC, TG and blood pressure had statistic different iat ion between acupuncture group and control group (P<0.001, P<0.05), except HDL (P>0.05).
2.4Comparisons of the constituet ratio in criteria of MetS:The compl iance and improvement rates of WC, FBG, TG, HDL and diastol ic blood pressure (DBP) at acupuncture group were better than them at control group (P<0.001, P<0.05). Then the constituet ratio of systolic blood pressure (SBP) change was indifference (P>0.05).
Conclusion
Acupuncture on regulating Dai meridian has a significant short-term and long term effect on the WC, WHR, WHtR and the thickness of abdominal adipose, UVI, as well as FBG and TG of abdominal obesed patients with MetS. Meanwhile, acupuncture on regulating Dai meridian could improve body mass, HC, PBF, and TC, blood pressure levels in a certain extent, relieve the aggravating trend of MetS, increase the compliance rates of criteria of MetS. That is positive significance for prevention and treatment of MetS and cardio-cerebro-vascular diseases.
研究发现,腹型肥胖是MetS发病机制的核心。腹型肥胖的危害在于内脏脂质堆积增多和脂肪细胞增大,导致脂肪动员加速,血浆游离脂肪酸升高,引起非脂肪器官的脂肪异位沉积,抑制糖的氧化利用,促进肝糖异生及低密度脂蛋白(LDL)和极低密度脂蛋白合成增加,下调靶细胞膜上的胰岛素受体数目和亲和力,同时脂肪组织释放的脂肪因子、炎性介质增多,加重了机体信号调节紊乱,从而引起糖脂代谢紊乱、胰岛素抵抗(IR)的发生。因此控制腹型肥胖是从源头上防治MetS的发生,可以作为研究MetS诊疗过程的切入点。
既往临床工作和研究表明针刺在治疗MetS及肥胖中存在一定优势,可有效降低体重指数(BMI)和腰围(WC)无不良反应,同时可以改善机体糖脂代谢紊乱,从而防治心脑血管事件的发生,但对于内脏脂肪的影响尚无研究。本研究在中医经络辨证理论的指导下,以彩超检测腹部脂肪堆积情况作为主要结局测量指标,并结合简易体脂参数和血糖、血脂、血压等理化指标,探讨通调带脉针刺法治疗对MetS腹型肥胖患者腹部脂肪堆积的影响,调节机体糖脂代谢紊乱的作用效应,对明确通调带脉针刺法减少脂肪堆积、改善MetS,防治心脑血管事件的疗效具有重要意义。
目的
通过通调带脉针刺法干预MetS腹型肥胖患者的观察和实验研究,探讨该法对MetS腹型肥胖患者治疗的有效性,并进一步探索其远期疗效。
方法
1前期收集在北京中医药大学东方医院针灸科门诊就诊、符合纳入标准的80例MetS腹型肥胖患者的资料,通过通调带脉针刺法干预,初步观察该治法的临床疗效和远期疗效。
2根据前期观察结果,有计划的纳入40例符合纳入标准的受试者作为研究对象,分为针刺组和对照组各20例,比较通调带脉针刺法干预和空白观察的差异,评价通调带脉针刺法对MetS腹型肥胖的临床疗效。
结果
1观察性研究
1.1依从性：80例受试者,进入治疗阶段有79例,最终65例完成研究,依从性比较好(82.28%)。
1.2近期临床疗效：经过两个疗程的治疗,受试者简易体脂参数、腹部脂肪厚度和UVI值、空腹血糖(FBG)、甘油三酯(TG)和血压水平明显降低(P<0.001；P<0.05)；总胆固醇(TC)水平无明显变化(P>0.05),但较前有下降趋势。而高密度脂蛋白(HDL)比治疗前降低(P<0.05)；LDL比治疗前增高,但差异无统计学意义(P>0.05)。
1.3远期疗效：3个月后随访结果,简易体脂参数、UVI值、FBG、TC和血压水平呈持续下降趋势(P<0.05,P<0.001)。腹部皮下脂肪厚度和肝前脂肪(AHF)、肾周脂肪厚度(RPF)总体上降低,但比两疗程结束时有所回升(P>0.05)。TG和LDL变化不明显(P>0.05)；HDL却持续减少(P<0.001)。
2实验性研究
2.1简易体脂参数比较：针刺组经治疗简易体脂参数有所降低(P<0.001)；对照组简易体脂参数却较前增加(P<0.001,P<0.05)。针刺组WC、腰臀比(WHR)、腰围身高比值(WHtR)疗效优于对照组(P<0.05),但体质量、臀围(HC)、BMI、体脂率(PBF)与对照组比较无差异(P>0.05)；两组前后差值比较有统计学差异(P<0.001)。
2.2腹部脂肪厚度和UVI值比较：针刺组经治疗腹部脂肪厚度和UVI值均有所下降(P<0.001,P<0.05)；对照组皮下脂肪厚度、内脏脂肪厚度和UVI值较前无明显变化(P>0.05),AHF和RPF较前增加(P<0.05,P<0.001)。治疗/观察后两组间各指标比较,针刺组优于对照组(P<0.05,P<0.001)。
2.3理化指标比较：针刺组治疗前后结果与观察性研究结果一致；对照组TC、TC、LDL较前增加(P<0.05,P<0.001),HDL水平降低(P<0.05),FBG和血压无变化(P>0.05)。两组治疗、观察后组间比较,针刺组FBG和TG改善作用优于对照组(P<0.05),其余指标无差异(P>0.05)；两组前后差值比较FBG、TC、TG和血压明显差异,针刺组优于对照组(P<0.001,P<0.05),HDL改变两组相当(P>0.05)。
2.4MetS量化指标构成比比较：治疗/观察后针刺组WC、FBG、TG、HDL、舒张压(DBP)达标及改善率总体上优于对照组(P<0.001,P<0.05)；收缩压(SBP)两组变化构成无差别(P>0.05)。
结论
通调带脉针刺法对MetS腹型肥胖患者的WC、WHR、WHtR和腹部脂肪厚度、UVI值,以及FBG、TG水平有明显疗效,同时具有一定远期疗效；并在一定程度上改善患者体质量、HC、PBF和TC、血压水平,缓解MetS加重趋势,增加MetS量化指标的达标率,对MetS和心脑血管疾病的防治有积极意义。
Metabolic syndrome (MetS) is characterized by a cluster of cardiometabolic risk factors including obesity, hyperglycemia, atherogenic dyslipidemia, and hypertension. MetS represents a significant risk factor for the development of atherosclerotic cardiovascular disease (ASCVD), type2diabetes mellitus (T2DM), and stroke. It is estimated that around20%to25%of the world's adult population have the MetS. MetS and its complications have become a relatively new chronic disease and public health problem.
MetS's core component is the frequently occurring abdominal obesity. The harm of abdominal obesity is visceral fat accumulated and hyperplasia of adipocytes. It could accelerate lipolysis, increase plasma free fatty acids, cause adipose ectopic deposition in non fat organs, inhibit glucose oxidated, promote gluconeogenesis and synthesis of low density lipoprotein (LDL) and very low density lipoprotein, down-regulate insul in receptors'number and affini ty at the membrane of the target cells, as well as increase adipokines and inflammatory mediators released by adipose tissue. Then the body signals adjustments were disordered, resulting in abnormal glucolipid metabolism and insulin resistance (IR). Hence, controlling abdominal obesity, which can prevent and treat MetS at the original state, is capable for a breakthrought point to studies for MetS.
From past clinical work and studies, acupuncture has the certain advantages in the treatment of MetS and obesity. It reduces body mass index (BMI) and waist circumference (WC) effectively without adverse reaction, and improves the glucolipid metabolism disorders, thereby preventing cardiovascular events. There haven't been studies in acupuncture for the influence of visceral adipose yet. This study within Chinese medicine and theory of pattern differentiation of meridians and collaterals, adpoted ultrasound detection of abdominal fat accumulation as the main outcome measure, accompanied simple anthropometric parameters and blood glucose, blood lipid, blood pressure, to investigate the influencing of acupuncture regulating Dai Meridian to the accumulation of abdominal adipose in abdominal obese patiets with MetS and the effects of regulating glucolipid metabolism disorders. It has important significance for definiting the effect of acupuncture regulating Dai Meridian for decreasing adipose accumulation, improving MetS, and preventing cardio-cerebro-vascular events.
Objective
Prospective studies, including an observational study and an experimental research, were uesd to observe the clinical efficacy of acupuncture for abdominal obesity on patients with MetS under the principle of regulation of Dai Meridian, furthermore to search his long-term effect.
Methods
1A prospective case series peviously collected80abdominal obesed patients with MetS met the inclusion criteria at the out-patient department of acupuncture and moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, who underwent treatment using the Dai meridian as the prime focus, to tentatively oberserve the clinial effect and long-term effect of this therapy.
2According to the preliminary observation, an experimental research recruited40patients met met the inclusion criteria as the research objects, who were divided into acupuncture group and control group with20cases in each group, then compared the difference between acupuncture regulating Dai Meridian and blank control, to evaluate the clinical efficacy of acupuncture regulating Dai Meridian for abdominal obesity with MetS.
Results
1The observational study
1.1Compliance:Out of80subjects,1of them was excluded due to an abnormal growth found in the abdomen during the ultrasound examination,14of them dropped out due to busy work, taking care of children or other diseases(such as osteoarthritis, fractures, renal calculi, and so on), and65of them completed the entire course. The compliance of this study was82.28%.
1.2Short-term clinical effect:After treatment, the simple anthropometric parameters, thickness of abdominal subcutaneous and visceral adipose (S1, S2, V1, V2), antero-hepat ic fat (AHF) and perirenal fat (PRF), ultrasound viscerofatty index (UVI), fasting blood glucose (FBG), triglycerides (TG) and blood pressure were found to have decreased (P<0.001, P<0.05). Total cholesterol (TO level was lower, yet without statistical significance (P>0.05). High density lipoprotein (HDL) level were lower than pre-treatment (P<0.05). Low density lipoprotein (LDL) were increased after treatment, yet without statistical significance (P>0.05).
1.3Long-term effect:At the3monthes follow-up, the simple anthropometric parameters, UVI, FBG, TG and blood pressure were in a declining trend (P<0.001, P<0.05). The thickness of S1, S2, AHF and RPF were decreased, but have a little rise compared with the end of treatment (P>0.05). TG and LDL levels hadn't significant changed (P>0.05). While HDL decreased continuously (P<0.001).
2The experimental research
2.1Comparisons of simple anthropometric parameters:The simple anthropometric parameters of acupuncture group decreased after treatment (P<0.001), while they increased at control group (P<0.001, P<0.05). The effect of WC, waist-to-hip radio (WHR), and waist-to-height radio (WHtR) were better than control group (P<0.05). There were no differentiation in body mass, hip circumference (HC), BMI, and percentage of body fat (PBF) between two groups (P>0.05). However the differeces, calculated by subtract ing post-treatment value from pre-treatment one, had statistic differentiation between acupuncture group and control group (P<0.001).
2.2Comparisons of thickness of abdominal adipose and UVI:The thickness of abdominal adipose and UVI of acupuncture group decreased after treatment (P<0.001, P<0.05). The S1, S2, V1, V2, and UVI had no difference at control group, while AHF and RPF increased (P<0.05, P<0.001). Comparisons between two groups after treatment, acunpuncture group was more effective than control group (P<0.05, P <0.001).
2.3Comparisons of blood glucose, blood lipid and blood pressure:The results of blood tests at acupuncture group were the same as the observational study between pre-treatment and post-treatment. The TC, TG and LDL were found to have increased at control group (P<0.05, P <0.001), while HDL decreased (P<0.05). The FBG and blood pressure had no difference at control group (P>0.05). Comparisons between two groups after treatment, the improvement of FBG and TG at acunpuncture group was better than them at control group (P<0.05), while other outcomes were no difference (P>0.05). The differeces (pre-treatment minus post-treatment) of FBG, TC, TG and blood pressure had statistic different iat ion between acupuncture group and control group (P<0.001, P<0.05), except HDL (P>0.05).
2.4Comparisons of the constituet ratio in criteria of MetS:The compl iance and improvement rates of WC, FBG, TG, HDL and diastol ic blood pressure (DBP) at acupuncture group were better than them at control group (P<0.001, P<0.05). Then the constituet ratio of systolic blood pressure (SBP) change was indifference (P>0.05).
Conclusion
Acupuncture on regulating Dai meridian has a significant short-term and long term effect on the WC, WHR, WHtR and the thickness of abdominal adipose, UVI, as well as FBG and TG of abdominal obesed patients with MetS. Meanwhile, acupuncture on regulating Dai meridian could improve body mass, HC, PBF, and TC, blood pressure levels in a certain extent, relieve the aggravating trend of MetS, increase the compliance rates of criteria of MetS. That is positive significance for prevention and treatment of MetS and cardio-cerebro-vascular diseases.
引文
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