摘要
[目的]观察五苓散治疗代谢综合征的临床疗效,并探讨其部分作用机制。
[方法]将纳入符合诊断标准的80例患者,随机分为治疗组40人,对照组40人,对照组采取以健康生活方式为基础的初级干预措施和以控制血糖、血压、血脂为基础的二级干预措施,治疗组在对照组基础上加以五苓散口服,12周为一疗程；观察并比较用药前后所有患者的中医证候、腰围、体重、体重指数、血压、血脂、血糖、胰岛功能、血清炎症指标(超敏C反应蛋白、白介素-6、肿瘤坏死因子-a)、脂肪细胞因子(脂联素、瘦素)、血管内皮功能(一氧化氮、内皮素、肱动脉血流介导的舒张内径)和毒副反应。
[结果]改善中医证候方面,治疗组显效14例,有效20例,无效6例,总有效率85%；对照组显效11例,有效19例,无效10例,总有效率75%；治疗组在显效率、总有效率方面优于优于对照组(P<0.05或P<0.01)。降低腰围、体重、体重指数方面,两组组内比较,差异均有统计学意义(P<0.01或P<0.05)；治疗组腰围、体重、体重指数下降程度分别为(8.65±4.82)cm、(7.46±4.72)kg、(4.39±1.87),与对照组腰围、体重、体重指数下降程度(分别为(7.93±0.81)cm、(6.29±2.88)kg、(3.19±2.48))相比,差异具有统计学意义(P均<0.01)。改善收缩压、舒张压方面,治疗组组内比较,差异有统计学意义(P<0.01),对照组组内比较,治疗前后无显著性差异(P>0.05)。降低血脂方面,两组均能明显降低TC、LDL-C水平,治疗前后比较,差异有统计学意义(P<0.01)；治疗组治疗后HDL-C明显上升(P<0.01),对照组较治疗前未见明显改变(P=0.079),两组治疗后HDL-C水平比较,治疗组优于对照组,差异有统计学意义(P<0.01)。控制血糖方面,两组患者治疗后FBG、PG0.5h、PG1h, PG2h、PG3h, HbA1c的水平均显著降低,较组内治疗前水平比较,差异有统计学意义(P<0.01)；其中治疗组降低FBG和PG0.5h的效果优于对照组(P<0.05)。改善胰岛素分泌水平方面,治疗组治疗后INS0.5h、INS2h水平减低,REISI水平升高,FINS、INS1h、INS3h、 HBCI、MBCI、REISI水平明显下降,与治疗前比较,差异均具有统计学意义(P<0.05、P<0.01)；与治疗前比较,对照组患者INS0.5h、HBCI水平有所减低,/△I30/△G30值有所升高,差异具有统计学意义(P<0.05),FINS、INS1h、INS2h、INS3h、MBCI水平明显下降,差异有统计学意义(P<0.01)；与对照组比较,治疗组在降低FINS、 MBCI水平方面疗效更显著,差异有统计学差异(P<0.05)；同时,治疗组可升高REISI水平,而对照组REISI水平无明显变化,两组治疗后REISI水平比较,P<0.01。改善炎症指标方面,治疗后两组的IL-6、TNF-α和hs-CRP水平均较治疗前下降,三项指标治疗前后比较,差异均具有统计学意义(P<0.05)；与对照组比较,治疗组IL-6、TNF-α和hs-CRP下降水平较更为显著,治疗组优于对照组(P<0.05)。改善脂肪细胞因子方面,两组治疗后LEP较治疗前均有显著降低,差异有统计学意义(P<0.01)；治疗后,治疗组LEP下降水平较对照组LEP下降水平更明显,二者比较有显著性差异,P<0.01；两组治疗后APN均较治疗前显著上升,差异有统计学意义(对照组P<0.05,治疗组P<0.01)；治疗后,治疗组APN升高水平较对照组APN升高水平更明显,二者比较有显著性差异(P<0.01)。改善血管内皮功能方面,治疗后治疗组NO、ET及NO/ET较治疗前均有改善,且优于对照组(P<0.05)；治疗后实验组的FMD值明显增加(P<0.05),对照组FMD值无明显变化(P>0.05),两组差异有统计学意义(P<0.05)。治疗相关不良反应方面,治疗组的不良反应较少,安全性较高。
[结论]五苓散治疗MS不仅可改善临床症状、体征,减少腰围、体重和体重指数,控制血压、血糖、血脂,同时对相关的重要实验室指标包括胰岛素分泌水平、血清炎症标志物(IL-6、TNF-α和hs-CRP)、脂肪细胞因子(LEP、APN)、血管活性物质(ET、NO、NO/ET)等均有良好的干预作用。五苓散通过改善胰岛素分泌,减轻胰岛素抵抗,降低炎症反应,纠正瘦素抵抗,改善低脂联素水平,调节血管活性物质等途径发挥其治疗代谢综合征的功效。该方用药安全,无毒副反应,值得临床推广和进一步研究。
[Objective] Observation of the clinical efficacy of the treatment of metabolic syndrome by the wuling powder and to explore some of its mechanism of action.
[Methods] The80patients corresponding with the diagnostic criteria were randomly divided into treating group of40patients and control group of40patients. The control group take a primary interventions of based on healthy lifestyle and regard controling blood sugar, blood pressure, blood fat as the secondary interventions. The treatment group added the wuling powder based on the interventions of the control group. The course of treatment was tweleve weeks. Compared with the Traditional Chinese Medicine syndrome, waist circumference, weight, body mass index, blood pressure, blood lipids, blood glucose, insulin function, serum inflammatory markers (high sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-a), adipocytokines (adiponectin, leptin), vascular endothelial function (nitric oxide, endothelin, brachial artery flow-mediated dilation diameter) and toxicity before and after treatment of all patients.
[Results] The aspect of improving TCM syndromes, as for the treatment group,14cases were significantly effective,20cases were effectual and6cases were unfruitful with a total effective rate of85%. In40cases of control group,11cases were significantly effective,19cases were effectual, the total effective rate was75%, The rate of excellent and total effective were superior to the control group (P<0.05或P<0.01). The aspect of decreasing the waist circumference, weight, body mass index, the differences were statistically significant comparing with the two groups (P<0.01or P<0.05). As for the treatment group, the fall degree of waist circumference, weight, body mass index were (8.65±4.82) cm,(7.46±4.72) kg,(4.39±1.87). As for the control group, the fall degree were (7.93±0.81) cm、(6.29±2.88) kg、(3.19±2.48), the differences were all statistically significant(P<0.01). There was statistically significant difference before and after treatment of treatment group with respect to improving systolic pressure and diastolic pressure(P <0.01), but there was no statistically significant difference in the control group (P>0.05). The aspect of decreasing blood fat, the two groups could significant decrease the level of TC、LDL-C, they all have statistically significant difference(P<0.01);After treatment, the level of HDL-C significant increased in treatment group (P<0.01), there was no obvious change in control group(P=0.079), the treatment group were superior to the control group (P<0.01). After treatment, there was statistically significant difference of two group with respect to decreasing the level of FBG、PGO.5h、 PGlh、PG2h、PG3h、HbAlc (P<0.01);Comparing with the control group, the treatment group were superior to the control group aspect to decreasing FBG and PGO.5h. After treatment, there was statistically significant difference in treatment group respect to decreasing the level of INS0.5h、INS2h, increasing the level of REISI, decreasing the level of FINS、INSlh、INS3h、 HBCI、MBCI (P<0.05or P<0.01). There was statistically significant difference in control group respect to decreasing the level of INSO.5h、HBCI, increasing the level of△I30/△G30, decreasing the level of FINS、INSlh、INS3h、HBCI、 MBCI (P<0.05or P<0.01). Comparing with the control group, the treatment group were superior to the control group aspect to decreasing FINS、MBCI(P <0.05), there was statistically significant difference aspect to increasing the level of REISI (P<0.01). After treatment, there were statistically significant difference in two groups respect to decreasing the level of IL-6、 TNF-α and hs-CRP (P<0.05). Comparing with the control group, the treatment group were superior to the control group aspect to decreasing the level of IL-6、TNF-α and hs-CRP (P<0.05). After treatment, there were statistically significant difference in two groups respect to decreasing the level of LEP and increasing the level of APN (P<0.05or P<0.01). Comparing with the control group, the treatment group were superior to the control group aspect to decreasing the level of LEP and increasing the level of APN (P<0.01). Comparing with the control group, the treatment group were superior to the control group aspect to imoprving the NO、ET、NO/ET and increasing the level of FMD (P<0.05). The treatment group had less side effects, the safety was higher.
[Conclusion]The wuling powder could not only improve clinical symptoms and signs, decreased waist circumference, weight and body mass index, blood pressure control, blood sugar, blood lipids but also had better intervation of the important laboratory index including the level of insulin secretion, serum inflammatory markers (IL-6, TNF-α and hs-CRP), adipocytokines (LEP, APN), vasoactive substances (ET, NO, NO/ET). Through improving insulin secretion and relieving insulin resistance, decreasing inflammation, correcting leptin resistance, increasing the low-fat adiponectin levels and regulating vasoactive substances, the wuling powder play the effect of its treatment of metabolic syndrome. The wuling powder is worthy of popularization and further research because of the better effects and less side effects.
引文
[1]丁国锋,李志,刘同刚.代谢综合征的中西医结合防治.时珍国医国药,2007,18(1)：240.
[2]熊红萍,李灿东,高碧珍,等.代谢综合征的中医易患因素.中华中医药杂志,2010,25(11)：1858-1859.
[3]谢淑芸,霍艳明.试述代谢综合征的病因病机.中华实用中西医杂志,2007,20(13)：1187.
[4]陈广峰,郭宏敏,代谢综合征整体观治疗初探.陕西中医,2006,27(1)：1398.
[5]吕崇山,李学军,杨叔禹,等.代谢综合征的病因病机探讨[J].光明中医,2008,23(11)：1651-1652.
[6]薛振怀,黄伯梯,代早荣.中西医结合治疗高血压伴代谢综合征的临床观察[J].内蒙古中医药,2008,1：30-31.
[7]李洁儿,孙景波.浅谈以健脾渗湿法为主论治代谢综合征[J].新中医,2008,40(2)：104-105.
[8]王健,陈元园.复方淫羊藿冲剂对老年代谢综合征糖耐量低减相关指标的影响[J].中国中医药科技,2005,5(12)：186-187.
[9]杨丽华.从痰湿论治代谢综合征[J].实用中医内科杂志,2005,(3)：223.
[10]黄耀先.从痰湿瘀论治代谢综合征40例[J].新中医,2007,39(12)：68.
[11]卢立广,叶子.滋阴清心汤治疗代谢综合征63例观察[J].浙江中医杂志,2005,(4)：2001.
[12]李存鲁.活血化瘀、舒肝利胆治疗代谢综合征42例[J].菏泽医专学报,2004,(2)：63.
[13]罗艳.健脾利湿法治疗代谢综合征[J].辽宁中医杂志,2002,(4)：2-7.
[14]王建勤,梁海峰.脑心通治疗代谢综合征的临床观察[J].中西医结合心脑血管杂志,2003,(9)：546-547.
[15]仝小林,柳红芳,朴信映,等.开郁清胃颗粒治疗2型糖尿病胰岛素抵抗的临床研究[J].实用中医内科杂志,2001,15(2)：10.
[16]刘荣东,黄如萍,张玉辉,等.加味半夏白术天麻汤对痰湿壅盛型代谢综合征的影响[J].中华中医药学刊,2008,26(10)：2242-2245.
[17]刘向红,姚干,陈明岭.中药复方减肥胶囊对营养性肥胖大鼠减肥作用及机理的实验研究[J].成都中医药大学学报,2002,25(1)：39.
[18]常柏,甄仲,李修洋,等.长期单独应用开郁清热法治疗肥胖2型糖尿病降糖疗效观察[J].中华中医药杂志,2009,24(2)：132-134.
[19]陈洁.化痰祛瘀法治疗代谢综合征32例[J].辽宁中医杂志,2006,33(1)：61.
[20]何春燕,王文健,李玢,等.益气散聚方治疗代谢综合征肥胖高危人群的临床研究[J].中西医结合学报,2007,5(3)：263-267.
[21]张奇,张志民,时俊伟,等.化湿解毒法治疗代谢综合征100例临床观察[J].中医药临床杂志,2008,20(2)：145-147.
[22]梁兴伦.胰岛素抵抗综合征中医药治疗研究进展[J].安徽中医学院学报,2000,19(5)：60-62.
[23]张京春,陈可翼.代谢综合征与中西医结合综合干预[J].中国中西医结合杂志,2004,24(11)：1029-1032.
[24]司福全.中医对代谢综合征的认识与防治[J].辽宁中医杂志,2006,33(9)：1107-1108.
[25]汤小虎,邓中甲,唐辉.代谢综合征的中医认识及治疗[J].中医研究,2007,20(5)：5-7.
[26]夏晓莉,陈伯钧,陈浩生,等.代谢综合征的中医辨证分型研究进展.中国中医急症,2009,18(4)：609-611.
[27]胥改珍.从痰瘀论治代谢综合征[J].山西中医,2003,(8)：61-62.
[28]刘志龙,李锡杰.浅谈代谢综合征的辨证论治[J].新中医,2007,39(3)：88-89.
[29]张剑.从三焦与“毒”探讨代谢综合征[J].中医杂志,2007,48(6)：487-489.
[30]葛伟,欧阳钢,徐小梅.代谢综合征中医证型研究概况.河北中医,2011,33(7)：1096-1099.
[31]胡章华.代谢综合征的中医药防治思路与方法[C].第八次全国中医糖尿病学术大会论文汇编,2005：282-285.
[32]黎波,张荣华.浅析代谢综合征的中医病机[C].第九次全国中西医结合虚证与老年病学术会议论文集,2007：213-214.
[33]仝小林,段军.代谢综合征的中医认识和治疗[J].中日友好医院学报,2002,16(5-6)：347-350.
[34]吕仁和,肖永华,刘滔波.脾瘅期(糖尿病前期)的防治[J].药品评价,2008,5(4)：175-177.
[35]王琦,李英帅.中医对代谢综合征的认识及辨治探讨(下)[J].浙江中医杂志,2006,41(11)：623-625.
[36]赵进喜.糖尿病前期的中医干预措施[J].糖尿病之友,2008,(9)：50-51.
[37]翟耀.针刺治疗糖尿病及心血管并发症的临床研究[J].中国针灸,1996,16(8)：11-13.
[38]李静茁,王晓燕,王巍.针刺减肥210例[J].陕西中医,2003,24：67-68.
[39]李新明.参苓白术散结合针刺疗法治疗代谢综合征30例[J].光明中医,2009,24(3)：496-497.
[40]周嘉澄.复方芪麻胶囊治疗气虚痰浊型代谢综合征30例[J].陕西中医,2009,30(4)：415.
[41]赵志英.自拟温阳消浊饮加二甲双胍治疗脾肾阳虚型代谢综合征临床观察[J].北京中医药,2008,27(8)：620-622.
[42]华伟.中西医结合治疗代谢综合征30例[J].四川中医,2008,26(5)：62.
[43]郎宁,刘贵阳.代谢综合征证治探讨[J].中医药学刊,2005,23(7)：1289-1290.
[44]童丽,吴萍,魏全嘉,等.复方芎芪胶囊治疗代谢综合征的临床观察[J].青海医学院学报,2006,27(1)：24-26.
[45]孟妮佳,陈德明.影响运动治疗代谢综合征运动学因素的研究进展[J].哈尔滨体育学院学报,2010,28(5)：110-114.
[46]潘文松,梁桂珍,赵天骄,等.饮食治疗代谢综合征的效果观察[J].第四军医大学学报,2006,27(2)：160.
[47]张京春,陈可冀.代谢综合征与中西医结合综合干预[J].中国中西医结合杂志,2004,24(11)：1029-1032.
[48]曹立杰,孙清源,杜娇娇.超重和肥胖学龄儿童中代谢综合征的临床特征[J].哈尔滨医药,201030(1).21-22.
[49]徐天舒,钱雷,万茜,等.针刺治疗代谢综合征21例临床观察[J].江苏中医药,2007,39(11)：55-56.
[50]骆斌,黄山.肥胖人痰湿体质与人类白细胞抗原关联研究[J].北京中医学院学报,1993,16(5)：9.
[51]宋剑男.从生物化学角度看痰及痰瘀相关[J].中国中医基础医学杂志,2000,6(3)：40-43.
[52]梁兴伦.胰岛素抵抗模型大鼠的中医证候研究[J].中国中西医结合杂志,2001,21(7)：528-530.
[53]李旋珠,熊洪艳,林青.强胰降糖胶囊对糖尿病模型大鼠的影响[J].中国中西医结合杂志,2005,25(12)：1109-1111.
[54]武晓宇,王燕,马伯艳,等.温胆汤对实验性大鼠血脂代谢紊乱的调节及机理研究[J].中国实验方剂学杂志,2007,13(7)：44-46.
[55]冯瑞儿,郑琳颖,吕俊华.白芍总苷对代谢综合征2高血压大鼠改善胰岛素敏感性、降压和抗氧化作用.中国临床药理学与治疗学,2010,15(2)：154-159.
[56]吴林根,陈敏,黄连素对高尿酸血症的影响[J].中国中西医结合杂志,2010,30(6)：659-662.
[57]黄雪萍.绞股蓝总苷与辛伐他汀治疗原发性高脂血症的疗效比较[J].临床医药,2006,15(6)：46.
[58]江焱.黄连素对代谢综合征胰岛素敏感性的影响[J].浙江中医药大学学报,2009,33(3)：390-391.
[59]傅晓东.雷氏丹参片治疗代谢综合征的临床疗效观察[J].中成药,2005,27(10)：1173-1175.
[60]刘少波.溪黄草对代谢综合征患者血栓前状态及前炎性状态标志物的作用[J].解剖学研究,2009,31(3)：176-177
[61]Yamamoto Masahiro. Effects of ginsenosides and saikosaponin on experimental hyperlip idemia, especially on plasma lipoproteins and prostanoids[Jj. CA,1995,122:306261.
[62]贺玉琢.五苓散预防脑中风的效果(2)：白术抑制体重增加与降低血中甘油三酯的作用[J].国外医学：中医中药分册,1996,18(1)：41.
[63]终丽,吴波.植物多糖对S180、K562细胞增殖和唾液酸、磷脂、胆固醇含量的影响[J].中国中西医结合杂志,1994,14(8)：482.
[64]Sato M, Tai T, Nunoura Y, et al. Dehydrotrametenolic acid induces preadipocyte differentiation And sensitizes animalmodels of noninsulindependent diabetesmellitus to insulin[J].BiolPharm Bull,2002,25(1):81.
[65]郝志奇,杭秉茜,王英.山药水煎剂对实验性小鼠的降血糖作用[J].中国药科大学学报,1990,25(1)：36.
[66]王本祥.现代中药药理学[M].天津：天津科学技术出版社,1997：529,537.
[67]杨新波,黄正明,曹文斌,等.泽泻水提物对正常及高血糖小鼠血糖的影响[J].中药药理与临床,1998,14(6)：29.
[68]李延福.用现代药理学方法研究中草药作用[J].中草药,1987,18(11)：38.
[69]涂淑珍,杨静薇,郑汉巧,等.当归抗家兔主动脉粥样硬化形成的作用[J].中国动脉硬化杂志,2000,8(1)：46.
[70]孟富敏,李新芳,崔志刚.甘草次酸钠的调血脂及急性毒性作用[J].兰州医学院学报,1994,20(4)：225.
[71]李怡,闫小光.中医药对胰岛素抵抗的研究现状[J].中草药,2005,36(5)：793-795.
[72]何勇,周鑫,陈晓雯。复方健胰颗粒对代谢综合征大鼠超敏C反应蛋白和主动脉组织形态学的影响.中国中医药信息杂志,2010,17(11)：36-38.
[73]张倩,梁晓春.中医论治代谢综合征的研究进展[J].环球中医药,2011,4(2)：157-160.
[74]王吉耀.内科学[M].北京：人民卫生出版社,2008：1006.
[75]王海燕,李肃清,等.代谢综合征的研究进展与防治[M].职业与健康,2009,25(23)：2615-2617.
[76]Ford ES, Giles WH.Dietz WH. Prevalence of the metabolic syndrome among US adults:findings from the third National Health and Nutrition Examination Survey. JAMA, 2002,287:356.
[77]Ozsahin AK, Gokeel A, Sezgin N, et al. Prevalence of the metabolic syndrome in a Turkish adult population.Diabetes Nutr Metab,2004,17:230.
[78]脑卒中、冠心病发病危险因素进一步研究协作组.11省市队列人群代谢综合征的流行病研究[J].中华预防医学杂志,2002,36(5)：：298-301.
[79]徐成斌.代谢综合征[J].国外医学：内分泌分册,2005,25(1)：3-6.
[80]金雪梅,陈灏珠.代谢综合征与心血管疾病关系概述[J].中国实用内科杂志,2006,26(1)：54-56.
[81]Adams RJ, App reton S, Wilson DH, et al. Population comparison of two clinical approaches to the metabolic syndrome implication of the new International Diabetes Federation consensus definition[J]. Diabetes Care,2005,28(11):2777-2779.
[82]Grundy SM. The metabolic syndrome:inflammation, diabetes mellitus,and cardio-vascular disease[J]. Am J Cardio,2006,97(1):3A-11A.
[83]Chen J, Muntner P, Hamm LL, et al.The metabolic syndrome and chronic kidney disease in U. S. dults[J].Ann Intern Med,2004,140(3):167-174.
[84]边琪,袁伟杰,鲁维维,等.代谢综合征及其代谢因子与慢性肾损害相关性的临床研究[J].中华肾病杂志,2007,7(1)：389-393.
[85]Lsomaa B, Almgren P, Tuomi T, et al. Cardiovascularmorbidity and mortality associated with the metabolic syndrome. Diabetes Care,2001,24:683-689.
[86]肖伟忠.汪锡华.韩东华.脑梗死合并代谢综合征的临床分析.脑与神经疾病杂志,2011,19(1)： 46-48.
[87]Ni Y X, Zhu ZM, Yu J, et al.Increased postprandial blood pressure and pulse pressure cause target organ damages in metabolic syndrome [J].Am J Hypertens,2004,17(5):S63.
[88]张刚,祝之明.不同代谢综合征诊断与靶器官损害的关系[J].中华老年心脑血管病杂志,2005,7(3)：145-149.
[89]Borugian MJ,Sheps SB, Kim-Sing C, et al. Waist-to-hip ratio and breast cancer mortality[J]. Am J Epidemiol,2003,158(10):963-968.
[90]Otake S, Takeda H, Suzuki Y, et al. Association of visceral fat accumulation and plasma adiponectin with colorectal adenoma:evidence for participation of insulin resistance[J].Clin Cancer Res,2005,11(10):3642-3646.
[91]Cowey S, Hardy R W. The metabolic syndrome:A high—risk state for cancer[J]? Am J Pathol,2006,169:1505-1522.
[92]Bosch F X, Ribes J, Diaz M, Cleries R. Primary liver cancer:worldwide incidence and trends [J]. Gastroenterology,2004,127(5 suppll):S5-S16.
[93]Marrero J A, Fontana R J, Su G L, Conjeevaram H S, Emick D M, Lok A S. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States [J]. Hepatology,2002,36:1349-1354.
[94]Lafontan M, Girard J. Impact of visceral adipose tissue on liver metabolism. Part I:heterogeneity of adipose tissue and functional properties of visceral adipose tissue[J]. Diabetes Metab,2008,34:317-327.
[95]Pousada JM, Brit to MM, Cruz T, et al. The metabolic syndrome in Spanish migrants to B razilunexpected results[J]. Diabetes Res Clin Pract,2006,72(1):75-28.
[96]王吉耀.内科学[M].北京：人民卫生出版社,2010：1071.
[97]MollerDE, Kaufman KD. Metabolic syndrome:A clinical and molecular perspect-ive[J]. Annu RevMed,2005,56(1):45-62.
[98]徐乐超,任西珍,郑诚东.成人代谢综合征及相关因素的调查研究[J].中华名医论坛,2005,12(2)：55-56.
[99]贾伟平.代谢综合征与胰岛素抵抗[J].中华妇产科杂志,2004,39(9)：643-645.
[100]Trayhurn P, Wood IS. Adipokines:inflammation and the pleiotropic role of white adipose tissue[J].Br J Nutr,2004,92(3):347-355.
[101]Dandona P, Aljada A,ChaudhuriA, et al.Metabolic syndrome:a comprehensive pe-rspective based on interactions between obesity, diabetes and inflammation[J]. Ci-rculation,2005,111(11):1448-1454.
[102]卢毅,杨金奎.代谢综合征病理生理学机制研究进展[J].中国医药导刊,2009,11(5)：740-741.
[103]王中燕.嘉应学院教师代谢综合症的调查和健康教育[J].中国伤残医学,2006,14(4)：56-58.
[104]潘文松.饮食治疗代谢综合症的效果观察[J].第四军医大学学报,2006,27(2)：160-162.
[105]王丽.代谢综合征的认识及综合干预措施[J].实用心脑肺血管病,2007,15(8)：641-642.
[106]李健斋.北京市职业人群代谢综合症患病率调查[J].基础医学与临床,2004,24(2)：217-221.
[107]金义胜,潘长玉.2型糖尿病的一级预防[J].中华内科杂志,2002,41(81)：571-572.
[108]刘军,姚庆姑,许火根,等.代谢紊乱患者脂联素水平和颈动脉粥样硬化的研究[J].临床内科杂志,2004,21(10)：684-686.
[109]李卉,姜一农.代谢综合征患者的血清瘦素[J].高血压杂志,2006,14(1)：28-32.
[110]李焱,甘小玲,刘珊英,等.代谢综合征的临床特征及其危险因素分析[J].中国糖尿病杂志,2007,15(2)：76-78.
[111]Han TS, Williams K, Sattar N, et al. Analysis of obesity and hyperinsulineraia in the development of metabolic syndrome:sanAnt onio Heart Study[J]. Obesity Res,2002,10(9): 923-931.
[112]Haffner SM. The metabolic syndrome:inflammation diabetesmellitus, and cardio-vascular disease[J]. Am J Cardiol,2006,97 (2A):3A-11A.
[113]陈晓燕,李瑞杰,李涛,等.不同血尿酸水平对代谢综合征患者血管内皮功能的影响[J].临床荟萃,2008,23(11)：766-768.
[114]邵继红,沈霞,李东野,等.高尿酸血症与代谢综合征组分关系的研究[J].中华流行病学杂志,2007,28(2)：180.
[115]余玲岭,周乃珍,陈治卿,等.老年高尿酸血症与胰岛素抵抗的关系[J].中国糖尿病杂志,200715(8)：466-467.
[116]Feig D1, Nakagawa T, Karumanchi SA, et al. Hypothesis:Uric acid, nephron number, and the pathogenesis of essential hypertension [J]. Kidney Int,2004,66(1):281-282.
[117]王素平,邓新.老年人高尿酸血症与高血压相关性研究[J].山东医药,2008,48(9)：65-66.
[118]陈汝杰,吴文琴,罗标.中、老年人高尿酸血症与高血压关系的探讨[J].医学理论与实践,200720(3)：295-296.
[119]蒋升,李素华.老年高尿酸血症与糖尿病前期及胰岛素抵抗的关系[J].中国全科医学,2009,12(1)：20-21.
[120]Yoo TW, Sung KC, Shin HS, et al. Relationship between serum acid concent ration and insulin resistance and metabolic syndrome[J]. Circ J,2005,69(8):928-933.
[121]Bock G, Dalla C, Campioni M, et al. Pathogenesis of pre-Diabetes, mechanisms of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance[J]. Diabetes,2006,55(11):3536-3538.
[22]庞建华,周亚茹,王战建.2型糖尿病与胰岛素抵抗[J].河北医药,2004,26(4)：292.
[123]Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome[J]. Psychoneuroendocrinology,2005,30(1):1-10.
[124]吴南楠,李强.代谢综合征的发病机制研究进展.哈尔滨医科大学学报,2010,44(1)：95-98.
[125]孔维佳.耳鼻咽喉科学[M].北京：人民卫生出版社,2002：146-147、457-459.
[126]廖二元,莫朝晖.内分泌学[M].2版.北京：人民卫生出版社,2007：1420-1422.
[127]杨丽兰,华琦.代谢综合征的基因多态性研究进展[J].医学研究生学报,2008,21(5)：553-556.
[128]罗樱樱,纪立农.代谢综合征与遗传[J].医学与哲学,2009,30(1)：18-20.
[129]李秀均.代谢综合征[M].第2版.北京：人民卫生出版社,2007：10-30.
[130]Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome:An American Heart Association/National Heart, Lung and Blood Institute Scientific Statement[J]. Circulation,2005,112:2735.
[131]Hypertension in the metabolic syndrome:summary of the new position statement of the European Society of Hypertension. Po 1 Arch MedWewn,2009,119(4):255-260.
[132]徐峰.二十年之大庆糖尿病预防研究[J].药品研究,2008,5(8)：376.
[133]Di Bonito P, De Natale C, Salvatore T, et al. Management of type 2 diabetic patients attending diabetic outpatient clinics compared with those cared for by the general practitioners:an experience of integrated diabetes management[J]. Ann Ist Super Sanita,2009,45 (2):162-167.
[134]苏言辉,陈秋.代谢综合征研究进展[J].陕西医学杂志,2010,3(39)：359-361.
[135]王颖.有氧锻炼对2型糖尿病的疗效观察及其机制探讨[J].河南大学学报,2002,21(4)：64-65.
[136]郑大东.军队干部代谢综合征现状与防治策略[J].东南国防医学,2008,10(4)：283-284.
[137]俞银燕,田慧.代谢综合征的综合控制[J].中华保健医学杂志,2010,6(12)：229-232.
[138]陈楠,陶秀娟,侯文刚.代谢综合征患者生存质量评价及其社会支持的调查研究.中国老年保健医学杂志,2010,8(6)：13-15.
[139]司天梅,刘艳.精神分裂症患者的代谢综合征风险,精神医学杂志,2009,22(1)：66-69.
[140]岳松,田凤石.代谢综合征的诊断标准和防治研究进展.天津医药,2011,39(8)：770-773.
[141]Kilpelainen TO, Lakka TA, Laaksonen DE,et al. Interaction of single nucleotide polymorphisms in ADRB2, ADRB3, TNF, IL6, IGF1R, LIPC, IEPR, and GHRL with physical activity on the risk of type 2 diabetes mellitus and changes in characteristics of the metabolic syndrome:The Finnish Diabetes Prevention Study[J]. Metabolism,2008,57 (3):428-436.
[142]PyrlK, Ballantyne CM, Gumbiner B, et al. Reduction of cardiovascular events by simvastatin in nondiabetic coronary heart disease patients with and without the metabolic syndrome:subgroup analyses of the Scandinavian Simvastatin Survival Study(4S)[J]. Diabetes,2004,27(7):1735-1740.
[143]Flier JS, Scherer PE. Adipose tissue:from lipid storage compartment to endocrine organ[J].Diabetes,2006,55(6):1537-1545.
[144]Chobanian AV, Bakris G L, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure[J]. Hypertension,2003,42(6):1206-1252.
[145]Grundy SM, Brewer HB Jr, Cleeman JI, et al. Definition of Metabslic Syndrome Report of the National, Heart, Lung and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition[J]. Arterioscler Thromb Vasc Biol,2004, 24(2):13-18.
[146]金汝真,余仁欢.五苓散的临床应用体会.北京中医药,2011,30(5)：366-367.
[147]杨殿兴,罗良娟,邓宜恩,等.四川名家经方实验录[M].北京：化学工业出版社,医学图书出版中心,2006：121,253.
[148]宋新安,张兆航,郭太山.从脂肥论治代谢综合征.光明中医,2011,26(4)：801-803.
[149]彭贤,黄舒,郦皆秀,等.泽泻属植物化学成分与药理活性[J].国外医药植物药分册,2000,15(6)：245-247.
[150]曹莉,茅彩萍,顾振纶.三种中药对糖尿病小鼠胰岛素抵抗的影响[J].中国血流流变学杂志,2005,15(1)：42-44.
[151]梅全喜,等.现代中药药理手册[M].北京：中国中医药出版社1998,348.
[152]刘青云主编.中药药理学[M].北京：人民卫生出版社,2002.
[153]付玲,于淼.茯苓研究的新进展[J].新疆中医药,2005,23(3)：79-83.
[154]冯启荣,康白.猪苓对大鼠肾脏水通道蛋白22基因表达的影响[J].中国医药,2007,3(2)：174-175.
[155]Kim W, KhilLY, Clark R, et al. Naphthaleneme thylester derivative of dihydro-xyhydrocinnamic acid, a component of cinnamon, increases glucose disposal by enhancingtransbcation of glucose transported[J]. Diabetologia,2006,49(10): 2437-2448.
[156]麦熙,邓暖繁.五苓散加减治疗脾虚痰湿型单纯性肥胖症30例.河南中医,2009,29(12)：1159-1161.
[157]申屠瑾.800例单纯性肥胖患者与中医分型的关系[J].中国医药学报,1990,5(6)：22.
[158]赵鸣芳.五苓散的应用思路及机理分析[J].江苏中医药,2005,26(7)：36-38.
[159]李春娟,徐太生,冯占荣,等.仲景五芩散法对实验性代谢综合征大鼠高血压的影响[J].吉林中医药,2007,27(5)：561.
[160]吕会民.五苓散加减治疗高血压病50例临床观察[J].现代中西医结合杂志,2000,9(1)：51.
[161]钱荣江.五苓散治疗流行性出血热1例[J].中西医结合实用临床急救,1998,5(4)：16.
[162]苏庆民,王琦.肥胖人痰湿型体质血脂、血糖、胰岛素及红细胞Na+—K+—ATP酶活性的检测与特征[J].中国中医基础医学杂志,1995,1(2)：39-41.
[163]罗千古.中药对高脂血症的作用机制[J].中国医药导报,2010,7(1)：85-86.
[164]景华,刘华.五苓散加味对原发性高脂血症之脂质调节的影响[J].中成药,2005,27(1)：56-59.
[165]张银卿,王宁生,刘启德,等.五苓散的毒性评价.中国现代药物应用,2008,2(12)：16-18.
[166]ZOU T, WANG J, YANG TL. Relationship of fasting serum resistin and insulin resistance in patients with metabolic syndrome [J]. China Journal of Modern Medicine,2008,18(18): 2712-2715. Chinese.
[167]李娜,李显文,李思成,等.患糖尿病的代谢综合征患者血清抵抗素水平的研究[J].中国现代医学杂志,2009,19(8)：1249-1252.
[168]祝之明,徐成斌.应加强代谢综合征的研究和防治[J].中华心血管杂志,2005,33(2)：105-106.
[169]陈娜,姚兵.11β-羟类固醇脱氧酶与2型糖尿病发病机制的重要因素.中华内分泌杂志,2003,19(3)：245-247.
[170]孙刚,李晓玲.痰浊证型患者糖、脂等代谢指标检测及其临床意义[J].贵阳中医学院学报,1997,19(3)：59-60.
[171]李乐愚,梁振钟,等.代谢综合征胰岛素抵抗与中医证候辨证分型关系研究[J].实用心脑肺血管病杂志,2008,16(11)：13-14.
[172]高雁鸿,刘素筠.亚临床炎症、胰岛素抵抗与2型糖尿病大血管病变相关性分析[J].中国药物与临床,2005,5(1)：46-47.
[173]朱禧星.炎症标志物可预测2型糖尿病的发生[J].国外医学内分泌分册,2003,23(3)：164-165.
[174]何积源.慢性炎症与代谢综合征.内科.2010,5(1)：67-69.
[175]魏爱生,叶建红,蒋开平,等.茵陈五苓散对代谢综合征患者血清炎症指标的影响.山东中医药杂志,2007,26(1)：16-18.
[176]Arita Y, Kihara S, Ouchi N, et al. Paradoxical decrease of an adipose-specific protein, adipose-specific protein, adiponectin, in obesity[J]. Biochem Biopbys Res Commun,1999, 257:79-83.
[177]Yataai T, Nagasaka S.Taniguchi A, et al. Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus[J]. Metabolism,2003,52:1274-1278.
[178]Abbasi F, Chu Jff, Lamendola C, et al. Discrimination between obesity and insulin resistance in the relationship with adiponectin [J]. Diabetes,2004,53:585.
[179]Ryo M, Nakamura T, Kihara S, et al. Adiponectin as a biomarker of the metablic syndrome [J].Circ J,2004,68:975-981.
[180]Matsushita K, Yatsuya H, Tamakoshi K, et al. Comparison of circulating Adiponectin and proinflamatory markers regarding their association with metabolic syndrome in Japanese men[J]. Arterioscler Thromb Vasc Biol,2006,26:871-876.
[181]Matstuda M, Shimomura I, Sata M, et al. Role of adiponectin in preventing vascular stenosis. The missing link of adpo-vascular axis[J].Biol Chem,2002,277(40):37487.
[182]Kazumi T, Kawaguchi A, Sakai K, et al.Young men with high blood pressure have lower serum adiponectin, smaller LDL size, and higher elevated heart rate than those with optimal blood pressure. [J].Diabetes Care,2002,25:971.
[183]贾兆通,田凯华.1型糖尿病并发代谢综合征的患病特点及其原因分析[J].中国现代医学杂志,2007,17(22)：2770-2776.
[184]曾道炳,雷正明,甘西伦,等.瘦素胆囊收缩素质代谢与胆固醇结石的关系探讨[J].中国现代医学杂志,2008,18(3)：354-357.
[185]Shigemura N, Ohta R, Kusakabe Y, et al. Leptin modulates behavioral responses to sweet substances by influencing peripheral taste structures[J]. Endocrinology,2004,145 839-847.
[186]Rhamouni K, Correia MLG, Haynes WC, et al. Obesity-associated hypertension. [J]Hypertension,2005,45:9.
[187]吴智春,王浩,王志宏,等.泽泻汤对代谢综合征大鼠血清瘦素素、血浆神经肽Y影响的研究。时珍国医国药,2010,21(12)：3128-3129
[188]Dzurik R, Spustova V, Gajdos M. Nit ric oxide modulation of metabolic and haemodynamic balance[J].Bratisl Lek Listy,2005,106(8/9):252-256.
[189]Anderson A D, Uehata A, Gerhard M D, et al. Close relation-ship of endothelial function in the human coronary and peripheral circulations[J]. J Am Coll Cardiol,1995,26(5): 1235-1241.
[190]高展翔,黄海,王红妹,等.加味五苓散对高尿酸血症大鼠血管内皮功能的影响.成都中医药大学学报,2010,33(2)：68-70.
[191]王东生,唐发清,肖长江,等1茵陈五苓散抗大鼠动脉粥样硬化作用机理探讨[J].中医杂志,2008,49(1)：67.