| ObjectiveThis paper systematically evaluates the research on physical types of type 2 diabetes in Chinese and foreign databases,and analyzes the distribution law of physical types of type 2 diabetes.To sort out the clinical trial acupuncture prescriptions of acupuncture for insulin resistance in type 2 diabetes mellitus in Chinese and foreign databases,and analyze the acupoint selection law of acupuncture for insulin resistance in type 2 diabetes mellitus based on data mining.Based on the literature research results,combined with the clinical acupuncture prescription of "regulating belt and resolving phlegm",this paper observed the therapeutic effect of acupuncture prescription of "regulating belt and resolving phlegm" on insulin resistance in Zucker diabetic obesity(ZDF)rats,and explored the possible mechanism of "regulating belt and resolving phlegm" to improve insulin resistance by using metabonomics technology,with a view to guiding clinic.MethodsThe literatures retrieved from CNKI,Wanfang,VIP,CBM,PubMud,The Cochrane Library and Web of Scinece were systematically sorted out,and the literatures were screened according to the ranking standard,and the extracted TCM physique type Meta of type 2 diabetes were analyzed by using Review Manager 5.4 software.The clinical trial prescriptions of acupuncture for insulin resistance in type 2 diabetes mellitus in CNKI,Wanfang,VIP,CBM and PubMud were systematically sorted out,and the acupoints were analyzed by descriptive analysis and cluster analysis,and the association rules were analyzed by SPSS Modeler 18.0,so as to explore the law of acupuncture selection for insulin resistance in type 2 diabetes mellitus.Based on the idea of "regulating band and resolving phlegm" formed by literature research,20 ZDF rats were randomly divided into model group and electroacupuncture group,with 10 rats in each group.Ten homologous non-diabetic Zucker lean(ZL)rats were selected as the normal control group.In the electroacupuncture group,electroacupuncture intervention was performed at points with bilateral veins,Fenglong,Zusanli,Gongsun,Neiguan,Lieque and Zhongwan once every other day for 8 weeks.The model group was fixed synchronously and intervened by sham acupuncture;The normal control group was fixed synchronously without any intervention.The changes of body mass,fasting blood glucose(FBG)and random blood glucose(RBG)were observed every week,and OGTT experiment was performed after the last acupuncture.After all the experiments,all rats stayed overnight without water for 12 hours.After anesthesia,samples were taken,and serum was taken to detect ALT,AST,TC,TG,HDL and LDL.Some liver tissues were taken to observe the pathological changes of liver tissues,and the rest were detected by metabonomics.Results1.Meta-analysis screened 1264 articles,and finally included 11 articles,including 4893 patients with type 2 diabetes.And the results showed that the ratio of TCM Con stitution Types in Type 2 diabetes mellitus were gentleness constitution accounting for 27.9%[95CI(16%-36%),RD=0.26],phlegm-dampness constitution accounting for 18.15%[95CI(11%-24%),RD=0.17],Yin-deficiency constitution accounting for 14.12%[95CI(11%-20%),RD=0.15],Qi-deficiency constitution accounting for 12.65%[95CI(8%-16%),RD=0.12],Yang-deficiency constitution accounting for 11.22%[95CI(7%-16%),RD=0.12],damp-heat constitution accounting for 6.17%[95CI(5%-8%),RD=0.07],blood-stagnation constitution a ccounting for 4.88%[95CI(3%-6%),RD=0.05],Qi-stagnation constitution accounting for 3.35%[95CI(2%-4%),RD=0.03],and special-constitutio accounting for 1.51%[95CI(1%-2%),RD=0.01].2.Based on data mining,this paper discusses the law of acupoint selection in acupuncture treatment of insulin resistance in type 2 diabetes mellitus.A total of 1465 literatures were retrieved,screened according to the standard of admission and carefully read and re-screened.Finally,55 literatures were included,including 93 acupuncture prescriptions,involving 83 acupoints with a total frequency of 896 times.The analysis shows that Zusanli,Pishu,Yishu,Sanyinjiao and Shenshu are the top five acupoints with the highest frequency of use.Meridian tropism is concentrated in bladder meridian of Foot Taiyang,stomach meridian of Foot Yangming,Ren meridian,spleen meridian of Foot Taiyin,exotic points and experience points.The most frequently distributed acupoints are waist and back,lower limbs and chest and abdomen.The most commonly used specific points are Beishu,Wushu and Intersection.The top three acupoints in association rule analysis support are Pishu-Yishu,Zusanli-Sanyinjiao and Pishu-Shenshu.Five effective cluster groups were obtained by cluster analysis,which were cluster 1:Quchi,Hegu,Neiting,Yinlingquan and Fenglong;Cluster 2:Tian Shu,Daheng,Zhongwan and Qihai;Cluster 3:Guanyuan;Cluster 4:Yishu,Shenshu,Pishu,Feishu,Weishu,Sanyinjiao and Zusanli;Cluster 5:Taichong,Ganshu and Taixi.1.The effect of acupuncture Tiaodai Huatan recipe on insulin resistance in ZDF rats showed that compared with the normal group,the body weight,FBG,RBG,OGTT,AUC and serum AST,ALT,TG,TC,LDL and HDL in the model group were significantly increased(P<0.05).Compared with the model group,the body weight of the electroacupuncture group did not change significantly(P>0.05),but the contents of blood sugar,AUC,TG and TC in serum decreased at each time point(P<0.05),while HDL increased and LDL decreased,but the difference was not significant(P>0.05).HE staining showed that the structure of hepatic lobules in the model group was blurred,the nuclei of hepatocytes were condensed,the arrangement of hepatic cords was disordered,there were a lot of fat vacuoles,some hepatocytes were edema and steatosis,and some inflammatory cells infiltrated.In the electroacupuncture group,the structure of hepatic lobule was cleared,the arrangement of hepatocytes was relatively neat,and no obvious steatosis was found.Under glycogen staining,glycogen in liver cells of model group decreased and the area decreased.In electroacupuncture group,glycogen in hepatocytes increased and the area became larger.By screening metabolites and metabolic pathways,metabonomics further identified that the mechanism of acupuncture improving insulin resistance was mainly tricarboxylic acid cycle.Conclusion1.Phlegm-dampness constitution is the main type of biased constitution in type 2 diabetes patients,and phlegm-dampness affects the occurrence and progression of type 2 diabetes.2.The overall treatment of acupuncture for IR of type 2 diabetes is to regulate the spleen and stomach and give consideration to the liver and kidney,which provides clinical guidance from the overall multiple viscera and meridians.3.According to the literature research and clinical treatment ideas,the acupuncture"Tiaodaihuatan Formula " can effectively reduce the blood glucose level of ZDF rats,effectively correct the lipid metabolism disorder in ZDF rats,improve the cell morphology structure of liver tissue,increase the generation of liver glycogen,and significantly regulate the liver cell function.Based on the perspective of metabolomics,the insulin resistance of ZDF rats may be improved by regulating the mitochondrial tricA acid cycle. |
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