| ObjectiveThis research takes the indexes of Fasting Blood glucose(FBG),Total Cholesterol(TC),Triacylglycerol(TG),High-Density Lipoprotein Cholesterol(HDL-C),Low-Density Lipoprotein Cholesterol(LDL-C),Systolic Blood Pressure(Sub-Bottom Pressure,SBP),Diastolic Blood Pressure(Diastolic Blood Pressure,DBP),Body Mass Index(BMI)and Uric Acid(UA)as the study point.By mining correlations between glycolipid metabolism parameters and syndrome elements and exploring the distribution of syndrome elements in glycolipid metabolism diseases(GLMD),it is expected to given the traditional Chinese medicine(TCM)syndrome differentiation meaning to these indexes from the perspective of the theory,literature and clinic,which hopes to prvide reference for the prevention and treatment of chronic metabolic diseases by TCM.Methods1.Theoretical study on "paste and lipid"By applying the methods of analysis,comparison and induction,the connotation,physiological properties and functions,sorting and summarizing the connotation,physiological characteristics and functions,metabolic regulation,pathological evolution rules as well as holistic outcome and prognosis of "paste and lipid" were sorted out.Furthermore,to explore the correlation between "paste and lipid" theory and Glycolipid Metabolic Disease(GLMD),it also had a mutual reference with GLMD in modern medicine.2.Correlation study between glycolipid metabolism indexes and TCM syndrome factorsLiterature study:based on China National Knowledge Infrastructure,Chinese Journal Database and China Academic Journal Database as searching source,take glycolipid metabolism indexes and TCM pattern as the key words in paper between 2015-2020.Normalizing the TCM pattern and name of the disease in western medicine to screened the literature from the inclusion and exclusion criteria,then extract the syndrome elements with syndrome elements classification method and Python language program.Finally,through frequency analysis,common syndromes and diseases in western medicine which related to glycolipid metabolism physicochemical indexes were counted.Clinical study:with the cross-sectional study of clinical epidemiological investigation method,patients with criteria compliant to GLMD were gathered in accordance to the diagnostic,inclusion and exclusion standard.Among them,general information of age,gender,weight,height,waist circumference,weight and body mass index and TCM four diagnostic information as well as physicochemical indexes which relative glycolipid metabolism diseases were collected.Then importing the patients four diagnostic information to the state identification system and based on correlation analysis,exploring the relevant relationship between glycolipid metabolism indexes and syndrome elements.Finally,exploring the TCM syndrome differentiation meaning in the glycolipid metabolism indexes with the analyzing results from literature study and literature study.3.Study on the distribution of syndrome elements in GLMD different stagesWith the cross-sectional study of clinical epidemiological investigation method,patients with criteria compliant to GLMD were gathered in accordance to the diagnostic,inclusion and exclusion standard.Among them,general information of age,gender,weight,height,waist circumference,weight and body mass index and TCM four diagnostic information as well as physicochemical indexes which relative glycolipid metabolism diseases were collected.Then importing the patients four diagnostic information to the state identification system.By the factor analysis method,giving the dimensionality reduction to TCM four diagnostic variate in GLMD I,II and III stages,extracting the main syndrome elements of location and character in metabolism diseases with professional knowledge and compares the syndrome elements in different stages.Results1.Theoretical study on "paste and lipid"As the essential substances in the body,"paste and lipid" is an important pathological factor to obesity in TCM.In modern medicine,it also includes essential substances of sugar,lipid,protein and other substances in the blood which organized by the fluid,worked by qi,flowed in meridian,circulated by nutrient qi and spread to the body from the defensive qi.By virtue of the moist and nourish characters,this watery substance has the functions to warm the body,moist the skin,protect the zang-fu organs,full the bone marrows and digest the food,maintaining the physical and energy metabolism functions of "generation,growth,transformation,contraction and storage".In addition,the metabolism of the "paste and lipid" are related to the spleen、stomach、liver and kidney.It originated from the spleen and stomach,transported by the liver and stored by the kidney,which implies the water and food metabolism process in the body.Affected by improper diet,imbalance of work and rest,congenital difference,emotional disorder and supplement abuse,"paste and lipid" could have the two-sides pathological changes of insufficient and redundancy.Once the "paste and lipid" become redundant,it could gathered together and changed into dampness,phlegm,turbidity,heat and stasis,which leads to the new pathological products as the second pathogenesis,leading the pathological changes of obesity,diabetes,spleen dan and attack paralysis with the disease-causing characteristics of widespread,prolonged,intractable and internal damage.In the combination of the prevalent occurrence background of chronic metabolic diseases in modern time,it could be discovered that the pathological evolution of "paste and lipid" are highly correlated to the occurrence and development of GLMD.2.Correlation study between glycolipid metabolism indexes and TCM syndrome factorsLiterature study:there were 2534 literatures met the target research criteria with 36 syndrome elements and 360 diseases in western medical connotation were involved,and the association rules of microscopic indexes and syndrome elements were established.Among them,syndrome elements which associated with glycolipid metabolism indexes in disease locations are focused on the spleen,kidney and liver,and disease characters are phlegm,dampness,heat,blood stasis,qi deficiency,yin deficiency and qi stagnation.It was found that the top 10 FBGrelated syndrome elements were qi deficiency,blood stasis,yin deficiency,phlegm,spleen,dampness,heat,kidney,qi stagnation and liver;the top 10 UA-related syndrome elements were dampness,heat,blood stasis;qi deficiency,phlegm,spleen,kidney,yin deficiency,yang deficiency and tendon;the top 10 TC-related syndrome elements were blood stasis,phlegm,qi deficiency,spleen,dampness,yin deficiency,kidney,heat,qi stagnation and liver;the top 10 TG-related syndrome elements were blood stasis,phlegm,qi deficiency,dampness,spleen,yin deficiency,kidney,heat,qi stagnation and liver;the top 10 HDL-C-related syndrome elements were blood stasis,phlegm,qi deficiency,dampness,yin deficiency,spleen,kidney,heat,qi stagnation and liver;the top 10 LDL-C-related syndrome elements were blood stasis,phlegm,qi deficiency,yin deficiency,dampness,spleen,heat,kidney,qi stagnation and liver;the top 10 SBP-related syndrome elements were hyperactivity of yang,phlegm,liver,yin deficiency,blood stasis,qi deficiency,dampness,heat,kidney and spleen;the top 10 DBPrelated syndrome elements were hyperactivity of yang,liver,phlegm,yin deficiency,blood stasis,qi deficiency,dampness,heat,kidney and spleen;the top 10 BMI-related syndrome elements were phlegm,dampness,qi deficiency,spleen,blood stasis,heat,kidney,qi stagnation,yin deficiency and liver.The diseases of the physicochemical indexes related to glycolipid metabolism focused on Type 2 diabetes,hypertension,hyperlipidemia,fatty liver,obesity,coronary heart disease,diabetic nephropathy,stroke,metabolic syndrome and polycystic ovary syndrome.Clinical study:after the correlation analysis to the syndrome elements and glycolipid metabolism related physicochemical indexes in 437 GLMD patients from the Spearman method,it was found that FBG was positively correlated with syndrome elements including liver,heart spirit,half-exterior half-interior,kidney,large intestine,stomach,dampness,heat,summerheat,qi deficiency,fluid inadequacy,blood deficiency,yin deficiency and hyperactivity of yang,and the correlation coefficients were 0.108(P<0.05)、0.116(P<0.05)、0.125(P<0.01)、0.149(P<0.01)、0.200(P<0.01)、0.108(P<0.05)、0.295(P<0.01)、0.187(P<0.01)、0.137(P<0.01)、0.225(P<0.01)、0.110(P<0.05)、0.200(P<0.01)、0.365(P<0.01)、0.191(P<0.01);UA was positively correlated with liver,qi stagnation,blood deficiency and yang deficiency syndrome elements,which the correlation coefficient were-0.1(P<0.05),-0.094(P<0.05),0.135(P<0.05),-0.102(P<0.05),and negatively correlated with fluid-retention,which the correlation coefficient was 0.108(P<0.05);TC was positively correlated with syndrome elements including stomach,uterus,heat and qi collapse,which the correlation coefficients were 0.096(P<0.05)、0.117(P<0.05)、0.123(P<0.05)、0.098(P<0.05),and negatively correlated with lung and fluid-retention,which the correlation coefficients were-0.105(P<0.05)、-0.109(P<0.05);TG was positively correlated with syndrome elements including spleen,gallbladder,stomach,dampness,heat,fluid inadequacy,yin deficiency,hyperactivity of yang,phlegm,unconsolidated qi,which the correlation coefficients were 0.101(P<0.05)、0.133(P<0.01)、0.138(P<0.01)、0.199(P<0.01)、0.229(P<0.01)、0.120(P<0.05)、0.097(P<0.05)、0.128(P<0.01)、0.148(P<0.01)、0.139(P<0.01)、0.105(P<0.05);HDL-C was positively correlated with syndrome elements including tendon,cold,blood deficiency,essence deficiency,which the correlation coefficients were 0.101、0.116、0.119、0.103(with all P<0.05),and negatively correlated with heat,which the correlation coefficients was-0.139(P<0.05);LDL-C was positively correlated with syndrome elements of uterus,which the correlation coefficients was 0.095(P<0.05);SBP was positively correlated with syndrome elements including exterior,liver,kidney,meridian,lung,cold,qi deficiency,blood deficiency,phlegm and stirring wind,which the correlation coefficients were 0.110(P<0.05)、0.148(P<0.01)、0.095(P<0.05)、0.169(P<0.01)、0.110(P<0.05)、0.110(P<0.05)、0.096(P<0.05)、0.120(P<0.05)、0.121(P<0.05)、0.193(P<0.01);DBP was negatively correlated with syndrome elements including exterior,liver,heart spirit,kidney,large intestine,tendon,qi stagnation,blood deficiency,yin deficiency,yang deficiency,hyperactivity of yang and essence deficiency,which the correlation coefficients were-0.136(P<0.01)、-0.138(P<0.01)、-0.098(P<0.05)、0.146(P<0.01)、-0.094(P<0.05)、-0.101(P<0.05)、-0.107(P<0.05)、-0.152(P<0.01)、-0.159(P<0.01)、-0.228(P<0.01)、-0.204(P<0.01)、-0.182(P<0.01)、-0.101(P<0.05)、-0.153(P<0.01);BMI was positively correlated with syndrome elements of dampness and phlegm,,which the correlation coefficients were 0.143、0.166(with all P<0.01)and negatively correlated with liver,kidney,blood deficiency,yin deficiency,yang deficiency,hyperactivity of yang,which the correlation coefficients were-0.131(P<0.01)、-0.094(P<0.05)、-0.187(P<0.01)、-0.168(P<0.01)、-0.132(P<0.01).The correlation coefficient between each index and syndrome element was rs=[-0.228,0.365].The canonical correlation analysis was used to explore the correlation between glucose and lipid metabolism indexes and TCM syndrome factors from the whole,and it showed that there was a significant positive correlation between the two types of variables,which the canonical correlation coefficient was 0.562(P=0.00<0.01).Furthermore,it indicated that FBG had a significant positive correlation with heat and yin deficiency.3.Study on the distribution of syndrome elements in GLMD different stagesIn 343 cases of GLMD patients,applying the factor analysis to there TCM four diagnostic information and extracting more than 20%syndrome information in them.Finally,10 common factors and 15 syndrome elements were extracted.It includes 9 characteristic elements of phlegm,dampness,heat,yin deficiency,qi deficiency,qi depression,blood stasis,blood deficiency and yang deficiency and 6 location elements of lung,kidney,liver,heart,spleen and tendon.By the factor equation,the highest 3 frequency of character elements in GLMD(stage Ⅰ)were phlegm,dampness and yin deficiency,and the location elements were liver,lung and spleen.The highest 3 frequency of character elements in GLMD(stage Ⅱ)were phlegm,yin deficiency and blood stasis,and the location elements were liver,spleen and lung;The highest 3 frequency of character elements in GLMD(stage Ⅲ)were blood stasis,phlegm and yin deficiency,and the location elements were liver,kidney and heart.Therefore,it can be concluded that the syndrome elements of liver and phlegm are the common factors in different stages of GLMD,while the pathological factor of blood stasis is increasingly prominent.In the course of disease development,disease characters were changed from excessive to deficiency and disease location were gradually spread to five-zang organs from liver,spleen and kidney.Conclusions1.Glycolipid metabolism indexes and TCM syndrome elements have relativity.Relationship.TCM syndrome differentiation of FBG is mainly based on damp,heat,qi deficiency,yin deficiency and kidney syndrome elements;TCM syndrome differentiation of UA is mainly based on liver,qi stagnation and yang deficiency syndrome elements;TCM syndrome differentiation of TC is mainly based on blood stasis,phlegm,qi deficiency,spleen and dampness syndrome elements;TCM syndrome differentiation of TG is mainly based on spleen,phlegm,dampness,heat and yin deficiency syndrome elements;TCM syndrome differentiation of HDL-C is mainly based on heat syndrome element;TCM syndrome differentiation of LDL-C is mainly based on blood stasis,phlegm,qi deficiency,yin deficiency,dampness,spleen and uterus syndrome elements;TCM syndrome differentiation of SBP is mainly based on liver,kidney,qi deficiency and phlegm syndrome elements;TCM syndrome differentiation of DBP is mainly based on liver,kidney,hyperactivity of yang,yang deficiency,yin deficiency and qi deficiency syndrome elements;TCM syndrome differentiation of BMI is mainly based on phlegm,dampness,heat,liver,kidney and yin deficiency syndrome elements.2.The location elements of GLMD are related to the five viscera,with liver as the primary.Different stages of this disease is associated with phlegm,dampness,heat,blood stasis,qi stagnation,yin deficiency,qi deficiency,blood deficiency.Among them,phlegm is the important,while blood stasis blood is increasingly prominent as a pathological factor.The inherent law and etiology and pathogenesis of "paste and lipid" provide guidance for the prevention and treatment of GLMD.In clinical practice,attention should be paid to the application of the methods of regulating lipid and lowering turbidity,promoting blood circulation and nourishing blood,and soothing liver and resolving phlegm. |
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