2型糖尿病脂代谢紊乱患者中医证型与血清同型半胱氨酸和胱抑素C关系

目的 探究2型糖尿病脂代谢紊乱的中医证型特点及其与冠心病预测因子血清同型半胱氨酸（homocysteine,Hcy）、胱抑素C（cystatinC,CysC）的关系。方法 共纳入300例2型糖尿病脂代谢紊乱患者，调查其中医证型，检测并比较各证型患者血清Hcy、CysC、空腹胰岛素（fastinginsulin,FINS）、空腹血糖（fastingplasmaglucose,FPG）和糖化血红蛋白A1c（glycosylatedhemoglobinA1c,HbA1c）及胰岛素抵抗指数（homeostasismodelassessmentofinsulinresistance,HOMA-IR）水平。结果 300例患者中，痰湿阻遏型、气阴两虚型、肝肾阴虚型、血瘀脉络型和脾肾阳虚型和其他证型的病例数分别105、84、34、39、12、16。各证型患者HbA1c和FPG比较，差异无统计学意义（P>0.05）；以血瘀脉络型患者Hcy、CysC和HOMA-IR水平为最高（P＜0.05，或P＜0.01）。结论 2型糖尿病脂代谢紊乱患者以痰湿阻遏型和气阴两虚证型最为常见，血瘀脉络型患者冠心病预测因子异常与胰岛素抵抗有关。

Relationship between Traditional Chinese Medicine Syndrome Types and Serum Homocysteine and Cystatin C Levels in Type 2 Diabetes Patients with Dyslipidemia

Objective To investigate the traditional Chinese medicine (TCM) syndrome types and their relationship with the predictive factors for coronary heart disease, serum homocysteine (Hcy) and cystatin C (Cys C), in type 2 diabetes patients with dyslipidemia. Methods A total of 300 type 2 diabetes patients with dyslipidemia were included in the study. Their TCM syndrome types were investigated, and serum Hcy and Cys C levels, as well as fasting insulin (FINS), fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), and homeostasis model assessment of insulin resistance homeostasis (HOMA IR), were measured and compared between patients with different TCM syndrome types. Results Of the 300 patients, 105 had syndrome of phlegm dampness obstruction, 84 had syndrome of deficiency of both qi and yin, 34 had syndrome of liver kidney yin deficiency, 39 had syndrome of blood stasis in collaterals, 12 had syndrome of spleen kidney yang deficiency, and 16 had other TCM syndromes. There were no significant differences in HbA1c and FPG levels between patients with different TCM syndromes (P >0.05). Among all patients, those with syndrome of blood stasis in collaterals had the highest Hcy and Cys C levels and HOMA IR ( P <0.05 or P <0.01). Conclusion Phlegm dampness obstruction and deficiency of both qi and yin are the most common TCM syndromes in type 2 diabetes patients with dyslipidemia. Abnormal levels of predictive factors for coronary heart disease are associated with insulin resistance in patients with syndrome of blood stasis in collaterals.