Study On The Correlation Between TCM Syndrome, Heath - Carter 's Body Type And Insulin Resistance In Metabolic Syndrome

ObjectTo explore the inter-relation of TCM prime characteristics and distribution of body fat and muscle and insulin resistance factors of the metabolic syndrome via literature research, clinical and experimental studies three aspectsMethod1. Literature study①After searching the reports on the distribution of TCM syndromes of MS, we analyze their integrality from 3 parts including 17 items which are briefly designed according to the principles of clinical epidemiology. Then analyze the relationship between the integrality and 3 basic attributes of these reports.② Database including Wanfang DATA, CNKI, VIP Database prior to December 2014.Searches were limited to Chinese/English-language observational studies. Three independent reviewers assesse researches by using the JBI-PACES and extract the data from retrieved articles then analyzed them by Review Manager 5 (RevMan 5) Meta-analysis software in systematic review.2. Clinical StudyVia cross-sectional study, researcher collected the four diagnostic methods information in patients with metabolic syndrome through the questionnaire. Then distinguish the TCM syndrome element and rank thenm by expertise. Calculate the correlation coefficient assigned to each syndrome elements. While the use of Heath-Carter somatotype classification system estimates the Endomorphy,Mesomorphy and Ectomorphy of patients, therefore patients can be classified. The patient’s insulin resistance index and other related factors were detected. The Irisin level of 78 patients detectd by ELISA method..3. Experimental StudyBuild high-fat diet MS rat model on SD rat, while normal diet SD rats as controls. MS rats were randomly divided into three groups, berberine group received 150mg/kg of berberine, Rhizoma coptidis decoction group were given 1807mg/kg Rhizoma coptidis decoction, and model control group were given an equal volume of distilled water rats for 4 weeks. After anesthesia drawn, measuring epididymis fat mass, glucose, lipids, insulin, irisin. and other indicators.Results1. Literature study①Collecting 49 reports published in theses, core journals, non-core journals as well as in academic conferences within 12 years. Every item of the integrality is differently reported. Meanwhile no obvious relation was found between their integrality and basic attributes of these reports.②8 researches are eligible. The quality index of these researches is between 9 to 13. All of 8 researches reported the relation in BMI,3 were in WC, only 1 in WHR. By meta-analysis, the phlegm with blood stasis group is higher than deficiency of both qi and yin group in BMI(relative risk 2.24;95% confidence interval[CI] 1.6,2.89)and in WC (relative risk 4.15;95% confidence interval[CI] 2.55,5.75).2. Clinical Study①General conditions,205 cases were collected including 117men and 88women. The age range is 59.00 (52.00,57.00).Most of them showed merged abdominal obesity, abnormal glucose metabolism and abnormal lipid. The female showed higher HDL, TC, F-Ins than men, lower FPG, UA than men.②Distribution character of TCM syndrome elemets.The distribution of TCM syndrome elements of MS patients involves multiple organs, and intermingled deficiency and excess. The importance of TCM location showed a decreasing law from liver to spleen&stomach to heart&kidney to lung. Also among TCM syndromes, a decreasing law of their importance from the heat to Qi&Yin to wet to stasis, qi stagnation and sputum to blood deficiency was told. The male showed lower level of TCM syndromes in liver, heart, Yin deficiency, Qi deficiency than that of women, but higher level of TCM syndrome stomach than women. The elders show higher TCM syndrome liver, lung, kidney, phlegm, qi deficiency. Analyzed by linear regression model validation,the corelationship of heart&fever, liver&heat, stomach&heat, spleen&wet liver&qi-stagnation, lung&qi stagnation and spleen&sputum, pulmonary & sputum, heart&yin, liver&yin, pulmonary&sputum, spleen&qi-deficiency and kidney&qi-deficiency was revealed.Meanwhile the linear regression model showed positive relation between heart and sour, stomach and sour, phlegm and Salty, kidney and Salty, stomach and meat, heat and greasiness, qi-stagnation and greasiness, and negatively correlation between qi-deficiency and greasiness.③The somatotype of patients in heath-carter system and its relationship with insulin resistance related factors. MS patient’s Heath-Carter somatotypes concentrated on the Endomorphic or Mesomorphic style. The Female showed higher endomorphy factor levels than men, but lower BMI. The elderly pateints has higher waistline than other patients. A linear regression equation prompted BMI and waistline were positively correlated with levels of endomorphy factor; BMI positively correlated with levels of mesomorphy factor; negatively correlated with levels of ectomorphy factors after adjusted sex and exercise. Bivariate correlation showed endomorphy factor and mesomorphy factor are positively correlated with the F-Ins and HOMA-IR; mesomorphy factor also positively correlated with uric acid, blood triglyceride,but negatively correlated with HDL. The ectomorphy factor positively correlated with HDL-C, negatively correlated with TG, HOMA-IR, F-Ins, UA. The multiple linear regression equation corrected with the use of drugs and exercise habits found mesomorphy factor positively correlated the level of F-Ins, HOMA-IR independently and ectomorphy factor positively correlated with HDL-C. But mesomorphy factor can be replaced by BMI to correlate with HOMA-IR. ④Relation between somatotype and TCM syndrome elements. Qi-deficiency was prominent among Mesomorph-endomorph style and biased endomorph style than biased Mesomorph style. Stepwise linear regression equation adjusted sex, exercise showed endomorphy factor positively correlate to TCM syndrome kidney, qi-deficiency and dampness. And Mesomorphy factor positively correlate to TCM syndrome dampness and lung. And waistline positively correlated to TCM syndrome spleen, lung, dampness and phlegm. Otherwise a significant positive correlation between BMI and dampness also revealed.⑤The relation between insulin resistance and TCM syndrome elements.Stepwise linear regression equation adjusted sex, exercise and using of drugs, showed TCM syndrome lung positively correlated to HOMA-IR and F-Ins, meanwhile TCM syndrome stomach and heat positively correlated to Uric acid. Among MS patients, Irisin level negatively correlated to HOMA-IR and BMI, but has not established a clear correlation with the TCM syndrome elements.3. Experimental Study①Both berberine and Rhizoma Coptidis apozem can improve blood sugar of MS rats modle, HOMA-IR. Rhizoma Coptidis apozem can improve epididymis fat, body weight, triglycerides either.②Rhizoma Coptidis apozem can significantly increased irisin relative to the control group, while model group and berberine hydrochloride group did not increase Irisin levels significantly compared with the control group.③After stepwise linear regression equation corrected for intervention and feed, found no factors associated with irisin.Conclusions1. Literature study①Most of reports are focused on the introductions of sketchy design and results, neglecting on the details of the studies, results and the meaning of results. So the integrality of reports need to be improved, and the guidelines should also be developed.②The phlegm with blood stasis group is worse than deficiency of both qi and yin in the somatotype index of metabolic syndrome in limited evidences.2. Clinical Study①Among observed patients basic TCM syndromes are liver heat, stomach heat and spleen dampness, with the development of qi-deficiency of lung, spleen, kidney, yin-deficiency of liver and heart, then phlegm, blood-stasis, qi-stagnation well appear. Wherein the TCM syndrome heat, liver, spleen, stomach hormone is particularly important, and does not exactly change with obesity, insulin resistance. Prompt that TCM syndrome can not be replaced by statistic simply. ②In the Heath-Cartet somatotype system, the Mesomorphy which reflects skeletal muscle show better relation to insulin resistance among MS patients.③ The fat content relate to TCM syndrome elements kidney, dampness, Qi-deficiency, and the muscle content relate to TCM syndrome element lung and dampness closer.④TCM Syndrome elements partly relate to insulin resistance and the concentration of circulating Irisin remain unclear relationship, regard to the complicated background and their mechanism and intrinsic characteristics related.3. Experimental Study①berberine and Rhizoma Coptidis apozem can improve the insulin resistance in high fat induced MS rats;②Rhizoma Coptidis apozem improve liquid metabolism more than berberine; ③berberine may elevate plasma concentration of irisin, concrete mechanism is unknown.