摘要
研究背景：
代谢综合征是心脑血管病的重要风险因素,危害极大,发病率高,尤其在老年人群存在更高的发病率,因此老年代谢综合征就更需引起广大医患的关注。中医药在代谢综合征的防治方面发挥了重要作用,然而老年代谢综合征有着怎样的证候学特征、中医药干预老年代谢综合征的疗效现状如何,目前缺乏针对性研究。
研究目的：
补充代谢综合征老年患者中医证候学资料,了解老年代谢综合征中医药干预疗效的现状,掌握影响老年代谢综合征发病的相关危险因素,为老年代谢综合征中西医结合诊治水平的提高提供证据支持。
研究方法：
1文献调研。检索CBM、CNKI、WanFangData、VIP数据库,收集代谢综合征中医证候的临床研究,对纳入研究文献的证型种类、各证型病例数等资料运用Epidate31建立数据库,最后通过SPSS170进行频数统计并得出结论。
2临床调查。对收集病例的临床资料进行整理,运用Logistic回归分析等数理统计方法对中医症状、证候、相关影响因素等资料进行比较分析,总结其中医证候特征及相关危险因素。
3META分析。检索数据库PubMed及CNKI、VIP、WanFangData、CBM,纳入中药或中药联合西药与西药比较的干预老年代谢综合征的随机对照临床试验。采用Cochrane协作网的质量评价标准并采用软件RevMan5.2进行Meta分析。
4前瞻性研究。根据是否接受中药治疗,在接受饮食运动教育的前提下,将符合标准的患者随机分为中药加西药基础治疗组和西药基础治疗组各28例。6周随访一次,共随访2次,观察患者相应中医症状证候变化情况。
5岁运相关性研究。通过病例资料收集患者出生日期,并与身份证或医保卡进行核对。根据患者出生时间,推算其胚胎孕育年份。对181例老年代谢综合征患者与31例老年非代谢综合征人群胎孕期年份的岁运分布采用Logistic回归分析和卡方检验进行统计分析。
研究结果：
1按照入排标准最后得到文献15篇。15篇文献中出现的病例总数为2744例。将类似证型在尊重文献的基础上尽量合并,最后总结出中医证型21个,出现频率前三位的证候分别为气阴两虚、痰瘀阻络、瘀血阻络,其它常见证候还有阴虚热盛、阴阳两虚、痰浊内蕴等,其主要证候类型为虚、痰、瘀、湿,涉及主要脏腑为脾、肾、肝、胃。
2①老年代谢综合征组与对照组相比,经Logistic回归分析,具有相关疾病家族史及累计坐位时间越长为老年代谢综合征发病的正相关因素。老年组和中年代谢综合征组相比,经卡方分析,家族史、吸烟、饮酒、喜甜食、喜辣味5方面在中年组患者中所占比均比例老年代谢综合征组高,差异有统计学意义,P值分别<0.000、<0.000、<0.002、<0.004、<0.005。②观察组血尿酸值、白细胞计数、红细胞计数均较对照组高,而观察组总胆固醇、低密度脂蛋白胆固醇含量均较中年组低,差异均具有统计学意义,P<0.05。③老年代谢综合征组出现频率前6位的症状依次为急躁易怒53.04%、神疲乏力51.93%、口渴多饮44.75%、眠差43.09%、便干41.44%、腰膝酸软40.88%。出现频次前三位的舌脉分别是舌淡74.59%、苔白66.3%、舌紫暗39.78%、脉弦69.06%、脉细56.91%、脉沉32.04%。出现频次前三位的证候类型分别是血瘀56.91%、阴虚38.12%、热邪32.58%,出现频次前三位的脏腑部位分别是心56.91%、肝55.25%、肾54.7%。④经Logistic回归分析,口渴多饮、盗汗、苔白、苔干少津、脉涩为老年人发生代谢综合征的危险因素。经卡方分析,肢体困重、头面烘热、自汗、便稀在中年组中所占比例均较老年组高,差异有统计学意义,P分别<0.05、0.05、0.01、0.000。畏寒肢冷、夜尿多在老年组所占比例均较中年组高,差异有统计学意义,P分别<0.01、0.000。⑤经Logistic回归分析得出,阴虚、气虚、阳虚、血瘀为老年人发生代谢综合征的常见危险因素,脾脏为患亦为老年人群发生代谢综合征的正相关因素。经卡方分析,阳虚、血瘀、肾在老年组所占比例均较中年组高,差异有统计学意义,P分别<0.01、0.01、0.05。⑥经卡方分析得出,在脏腑定位方面,60-69年龄段肝脏部位较70-79年龄段为多,有统计学差异,P<0.05。80岁以上年龄段在脏腑部位脾方面较60-69年龄段出现频次多,差异有统计学意义,P<0.05。⑦经卡方分析得出,在证候分布方面,2-9年病程组、10年以上病程组血瘀证出现的频次均较0-1年病程组多,差异有统计学意义,P<0.05。在脏腑病位脾出现的频次方面,10年以上病程组较0-1年病程组多,差异有统计学意义,P<0.05。⑧经Logistic回归分析得出,心悸、便干在老年糖尿病组较老年代谢综合征组常见。气虚、热邪在老年代谢综合征组较糖尿病组常见,而大肠为糖尿病组较老年代谢综合征组常涉及脏腑。
3①经检索最后得到采用中药与二甲双胍比较的文献1篇,未做Meta分析,但应用Meta分析的方法对所观察指标进行了再次统计分析。中药在改善TG、HDL-C方面疗效优于西药。②经检索最后纳入4篇采用中药联合西药与西药比较的文献。2篇文献报道了对TG的比较研究,结果MD=-0.22[-0.37,-0.06],P=0.006,有显著差异,表明中药联合西药在改善TG方面较西药有优势；有4篇文献报道了对BMI的研究,结果MD=-0.87[-1.04,-0.70],P<0.00001,有显著性差异,表明中药联合西药在改善BMI方面较西药有优势。
4以分组为自变量(中西药组：1,西药组：0),疗效为因变量(症状消失：1,症状尚在：0),症状消失人数为频数变量建立logistic回归方程。经分析,中药联合西药在改善症状便干方面疗效优于单独使用西药；中药联合西药在改善病变部位大肠方面疗效优于单独使用西药。
5以相关因素作为自变量：少水(有：1,无：0)、太木(有：1,无：0)、少火(有：1,无：0)、太土(有：1,无：0)、少金(有：1,无：0)、太水(有：1,无：0)、少木(有：1,无：0)、太火(有：1,无：0)、少土(有：1,无：0)、太金(有：1,无：0),以是否患有代谢综合征为因变量(患：1,未患：0),经Logistic回归分析,胎孕期岁运少水为老年人发生代谢综合征的危险因素；经卡方检验,观察组中岁运少水、岁运太金所占比均较观察组高,差异有统计学意义,P值分别为0.031、0.042。
研究结论：
1老年代谢综合征具有其自身的中医证候学特征。老年MS有以血瘀为主、阴虚常见、兼有热邪,脏腑定位涉及心、肝、肾的证候特点；代谢综合征患者在由中年向老年转化的过程中,其中医证候有向阳虚、血瘀发展的趋势；随着老年代谢综合征患者病程的延长,脾虚、血瘀的矛盾将逐渐突出；血瘀贯穿老年代谢综合征的各个年龄段。气虚证和热证可能为老年糖尿病合并MS的危险因素。
2关于中药干预老年代谢综合征的疗效。在改善TG、BMI水平上较单纯使用西药有优势；在缓解大便干燥方面较单纯使用西药效果更佳。
3有代谢综合征或其相关组分家族病史、白天累计坐位时间越长、胎孕期岁运少水的老年人更易患代谢综合征。
Background
Metabolic syndrome is the important risk factor of cardio-cerebrovascular disease, because of it's harmness and high incidence, otherwise higher incidence especially in the elderly population, so the elderly metabolic syndrome is more need to cause the attention of the patients and doctors. Traditional Chinese medicine plays a major role in prevention and control of the metabolic syndrome, but what syndrome characteristics are in the elderly metabolic syndrome and how is the present situation of intervention effect with Chinese medicine in elderly metabolic syndrome, there lack of targeted researchs at present.
Objective
In order to supplement the elderly patients'dates of TCM syndrome, know the present situation of TCM intervention effect in the elderly metabolic syndrome, master the related risk factors of the disease in old people, then to provide evidences to improve the effect of treatment combining Chinese and western medicine for the elderly metabolic syndrome.
Methods
1Literature research.Retrieved the CBM, CNKI, WanFangData and VIP database, collected the literatures of metabolic syndrome TCM syndrome about clinical research, summarized and extract syndromes, then by using Epidate3.1to build a database, finally through the SPSS17.0for frequency statistics and conclusion.
2Clinical investigation.Collected the clinical dates, using logistic regression analysis of mathematical statistics method to compare analysis TCM symptoms, syndromes and the related influence factors, and then summarized the TCM syndrome characteristics and related risk factors of elderly MS.
3The META analysis. Retrieved database of PubMed and CNKI, VIP, WanFangData, CBM about randomized controlled clinical trials using traditional Chinese medicine or Chinese medicine combined with western medicine intervention in elderly metabolic syndrome compared with western medicine. The Cochrane quality evaluation standard and the RevMan5.2software were used.
4A prospective study. According to whether to accept Chinese medicine treatment, besides the exclusion criteria, patients were randomly divided into western medicine combined with Chinese traditional medicine and western medicine treatment groups,28cases for each.6weeks for a follow-up, followed up for12weeks, the corresponding symptoms were observed.
5The year circuit study. Collected dates of birth of each case through the ID card or health insurance card, and then to calculated the circuits of year during the prenatal period, finally did the Logistic regression analysis and Chi-square test on the181elderly MS cases and39cases of control group.
Results
115documents were included in this research of TCM syndromes of MS,2744cases were reported and21syndrome types were related to MS, of which the most common types were Qi and Yin deficiency, phlegm and blood stasis and blood stasis.This paper discovered that the main syndromes of Metabolic Syndrome were deficiency, phlegm, stasis, and the mainly involved organs were spleen, kidney, liver.
2①Compared with control group, the related disease family history and the longer the cumulative seat for the elderly metabolic syndrome are positive related factors.Compared with elderly-aged group, family history, drinking, smoking, sweet tooth and spicy tooth were seen more often in middle aged group.②Blood uric acid value, white blood cell count and red blood cell count are higher in the observation group than the control group.Total cholesterol and low-density lipoprotein cholesterol level are lower in observation group than the middle-aged group, P<0.05.③The most common symptoms of elderly metabolic syndrome group are irritability53.04%, fatigue51.93%, thirsty44.75%, poor sleep43.09%, dry stool41.44%, lumbar debility40.88%. The most common tongues and veins are pale tongue74.59%, white fur66.3%, dark purple tongue39.78%and string69.06%, thready56.91%, deep32.04%. The most common syndromes are respectively blood stasis56.91%, Yin deficiency38.12%, heat evil32.58%. The involved organs include heart56.91%, Iiver55.25%, kidney54.7%.④Compared with control group, thirsty, night sweats, white and dry tongue coating and hesitant pulse were seen more often in elderly metabolic syndrome. Compared with middle-aged group, cold chill limbs, nocturia more were seen more often, while heavy limbs, spontaneous sweating and soft stool more often in middl-aged group.⑤Compared with control group, Yin deficiency, Qi deficiency, Yang deficiency, blood stasis were the more common syndromes of elderly metabolic syndrome. Spleen was involved more often too. Compared with middle group, Yang deficiency and blood stasis more common syndromes of elderly metabolic syndrome, and kidney was involved more often too.⑥Compared with70-79group,the liver was involved more often in60-69group, and there is statistically significant difference, P<0.05.Compared with60-69group, spleen more often in80group, the difference was statistically significant, P<0.05.〤ompared with0-1group, blood stasis was more common syndrome in2-9and10group, the difference was statistically significant, P<0.05. Compared with0-1group, spleen was involved more often in10group, the difference was statistically significant, P<0.05.⑧Compared with elderly diabetes group, palpitations and dry stool were seen less often in the elderly metabolic syndrome group. Qi deficiency and heat evil were more common in elderly metabolic syndrome group, while the large intestine was involved more often in diabetes group.
3①urative effect of Traditional Chinese medicine in the improvement of TG, HDL-C s superior to western medicine.②There are four papers using Traditional Chinese medicine combined with western medicine.2articles were reported on the comparative study of TG, the results of the MD [0.37,0.06]=0.22, P=0.006, there are significant differences, which indicates that Traditional Chinese medicine combined western medicine compared with western medicine has advantage in improving the TG.4paper reports the study of BMI, the MD=0.87[1.04,0.70], P<0.00001, there are significant differences, which indicates that Traditional Chinese medicine combined western medicine compared with western medicine has advantage in improving BMI.
4The logistic regression analysis showed that curative effect of Traditional Chinese medicine with western medicine is superior to western medicine alone in improving symptom of dry stool.
5The logistic regression analysis showed that circuit of year during the prenatal period "deficiency of water" is related to the elderly metabolic syndrome. By chi-square test,"deficiency of water" and "sufficient gold" are higher in the observation group.Difference was statistically significant, and P values were0.031,0.042respectively.
Conclusions
1The elderly metabolic syndrome has its own TCM syndrome characteristics, which has more blood stasis, and Yin deficiency is common, while heat evil is also be seen sometimes. The more Yang deficiency and blood stasis syndrome will be seen with the trend of development in the transformation process of middle-aged to elderly patients with metabolic syndrome.With the extension of elderly patients course, the contradiction of spleen deficient and blood stasis will increasingly prominent. Blood stasis runs through all age leves of elderly metabolic syndrome. Qi deficiency and heat syndrome may be a risk factor in elderly diabetic with MS.
2About the curative effect of Chinese medicine intervention of elderly metabolic syndrome, Chinese medicine is more effective than western medicine in the improvement of TG, BMI level, and is better in terms of relieving dry stool.3There are some related risks of developing metabolic syndrome in the elderly, which are Circuit of year during the prenatal period "deficiency of water", the metabolic syndrome and its related components family history, longer cumulative seat during the day.
引文
[1]Gupta R. Metabolic syndrome as a marker of risk in type 2 diabetes. Indian J Med Res, 2009,129(5):481-484.
[2]Kassi E et al. Metabolic syndrome:definitions and controversies. BMC Med,2011,9:48.
[3]Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes,2010,2:180-193.
[4]Ervin RB. Prevalence of metabolic syndrome among adults 20 years of age and over,by sex,age,race and ethnicity,and body mass index:United States,2003-2006.Natl Health Stat Report 2009,13:1-7.
[5]Grundy SM. Metabolic Syndrome Pandemic. Arterioscler Thromb Vasc Biol,2008,28(4): 629-636.
[6]Daniels SR, Arnett DK, Eckel RH, etal. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation,2005,111 (15): 1999-2012.
[7]Gu D,Reynolds K,Wu X,et al. Prevalence of the Metabolic Syndrome and Overweight Among Adults in China.Lancet,2005,365(9468):1398-1405.
[8]贾卫平.老年代谢综合征流行趋势及发病特点.中华保健医学杂志,2010,12(6)：415-416.
[9]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率.中华糖尿病杂志,2005,13(3)：181-186.
[10]Abhimanyu Garg MD. Acquired and Inherited Lipodystrophies.N Engl J Med,2004, 350:1220-1234.
[11]罗樱樱,纪立农.代谢综合征与遗传.医学与哲学,2009,30(1)：18-20.
[12]杨丽兰,华琦.代谢综合征的基因多态性研究进展.医学研究生学报,2008,21(5)：553-556.
[13]Gale CR, Martyn CN, Kellingray S, et al. Intrauterine programming of adult body composition. J Clin Eedocrinol Metab,2001,86(l):267-272.
[14]Bruce K D, Byrne C D. The metabolic syndrome:common origins of a multifactorial disorder.Postgrad Med J,2009,85(1009):614-621.
[15]Prasad H, Ryan DA. Celzo MF,et al. Metabolic Syndrome:Definition and Therapeutic Implications.Postgrad Med,2012,124(1):21-30.
[16]左惠娟,姚崇华,胡以松,等.中国18-45岁男性人群行为习惯与代谢综合征的关系.中华流行病学杂志,2011,32(3)：235-238.
[17]Lamberti JS, Olson D, Crilly JF, et al. Prevalence of the metavolic syndrome among patients receiving clozapine. Am J Psychiatry,2006,163(7):1273-1276.
[18]Ceriello A, Assaloni R, Ros RD, et al. Effect of atorvastatin and irbesartan, alone and in combination, on post-prandial endothelial dysfunction, oxidative stress, and inflammation in type 2 diabetic patient. Circulation,2005,111:2518-2524.
[19]Bansal S, Buring J, Rifai N, et al. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA,2007,298:309-316.
[20]Stefan N, Kantartzis K, Machann J, et al. Identicication and characterization of metabolically benign obesity in humans. Arch Intern Med,2008,168:1609-1616.
[21]Matsuzawa Y. The role of fat topology in the risk of disease. Int J Obes,2008, 32(Supp17):S83-S92
[22]Matsuzawa Y.Adiponectin:a key player in obesity related disorders. Curr Pharm Des, 2010,16:1896-1901.
[23]Kahn SE, Prigeon RL, Schwartz RS, et al. Obesity, body fat distribution, insulin sensitivity and islet beta-cell function as explanations for metabolic diversity. J Nutr,2001,131:354S-360S.
[24]Wang CC,Goalstone ML,Draznin B. Molecular mechanisms of insulin resistance that impact cardiovascular biology. Diabetes,2004,53(11):2735-2740.
[25]杨文英.加强胰岛素细胞胰岛素抵抗的研究.中华医学杂志,2006,86(36)：2521-2523.
[26]Haffner SM.The metabolic syndrome:inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol,2006,97(2A):3A-11 A.
[27]Onat A,Hergenc G, Can G,et al. Complement C3:a determinant of cardiometabolic risk, assitive to metabolic syndrome, in middle-aged population.Metabolism.2010,59:628-634.
[28]Onat A,Ozhan H, Erbilen E, et al. Independent prediction of metabolic syndrome by plasma fibrinofen in men, and predictors of elevated levels.Int J Cardiol.2009,135:211-217.
[29]Onat A,Can QHergenc G,et al.Serum apolipoprotein B predicts dyslipidemia, metabolic syndrome and, in women, hypertension, diabetes, independent of markers of central obesity and inflammation. Int J Obes (Lond),2007,31:1119-1125.
[30]Onat A, Hergenc QAyhan E, et al. Serum apolipoprotein E concentrations among Turks: Additive information to genotype relative to dyslipidemia and metabolic syndrome. Arch Turk Soc Cardiol,2007,35:449-157.
[31]Festa A,D'Agostino R Jr,Howard G, et al. Chronic subclinical inflammation as part of the nsulin resistance syndrome:the Insulin Resistance Atherosclerosis Study(IRAS).Circulation,2000,102:42-47.
[32]Chrousos GP, Kino T. Glucocorticoid signaling in the cell. Ann N Y Acad Sci,2009,1179: 153-166
[33]Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome:a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention.Circulation,2009,120(16):1640-1645.
[34]Ford ES, Li C, Sattar N,.Metabolic syndrome and incident diabetes:current state of the evidence.Diabetes Care,2008,31:1899-1904.
[35]Hanley AJ, Karter AJ, Willians K,et al. Prediction of type 2 diabetes mellitus with alternative definitions of the metabolic syndrome:the Insulin Resistance Atherosclerosis Study.Circulation,2005,112:3713-3721.
[36]Reaven GM. Insulin resistance and its consequence.In Diabetes Mellitus:A Fundamental and Clinical Text. LeRoith D, Taylor S, Olefasky JM. Philadelphia,Lippincott,Williams and Wilkins,2004,899-915.
[37]迟家敏.实用糖尿病学.人民卫生出版社,北京,2009.
[38]Semplicini A, Ceolotto G, Massimino M, et al. Interactions between insulin and sodium homeostasis in essential hypertension. Am J Med Sci,1994,307 (Suppl 1):S43-46.
[39]ter Maaten JC, Voordouw JJ, Bakker SJ, et al. Salt sensitivity correlates positively with insulin sensitivity in healthy volunteers. Eur J Clin Invest,1999,29 (3):189-195.
[40]Lastra-Lastra G, Sowers JR, Restrepo-Erazo K, etal. Role of aldosterone and angiotensin II in insulin resistance:an update. Clin Endocrinol(Oxf),2009,71(1):1-6.
[41]Fujita T.Mineralocorticoid receptors, salt-sensitive hypertension, and metabolic syndrome. Hypertension,2010,55(4):813-818.
[42]Geum Joon Cho, Jung-Ho Shin, Kyong Wook Yi, et al. Serum calcium level is associated with metabolic syndrome in elderly women. Maturitas,2011,68:382-386.
[43]Browning JD, Szczepaniak LS, Dobbins R, et al. Prevalence of hepatic steatosis in an urban population in the United States:impact of ethnicity. Hepatology,2004,40:1387-1395.
[44]Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease:a feature of the metabolic syndrome.Diabetes,2001,50:1844-1850.
[45]Kotronen A, Yki-Jarvinen H. Fatty liver:a novel component of the metabolic syndrome. Arterioscler Thromb Vase Biol,2008,28:27-38.
[46]Targher G, Marra F, Marchesini G. Increased risk of cardiovascular disease in nonalcoholic fatty liver disease:causl effect or epiphenomenon? Diabetologia,2008,51: 1947-1953.
[47]Franks S. Polycystic ovary syndrome. N Engl J Med,1995,333:853-861.
[48]Cascella T, Palomba S,Dc Sio I, et al. Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum Reprod,2008,23:153-159.
[49]Cussons AJ, Stuckey BG, Watts GF. Metabolic syndrome and cardiometabolic risk in PCOS. Curr Diab Rep,2007,7:66-73.
[50]Apridonidze T, Essah PA, Iuorno MJ,et al. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab,2005,90:1929-1935.
[51]Gruber A, Horwood F, Sithole J, et al. Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Deabetol,2006,5:22.
[52]Barcelo A, Pierola J, de la Pena M, et al. Free fatty acids and the metabolic syndrome in patients with obstructive sleep apnoea. Eur Respir J,2011,37:1418-1423.
[53]Baguet JP, Barone-Rochette G, Levy P, et al. Left ventricular diastolic dysfunction is linked to severity of obstructive sleep apnoea. Eur Respir J,2010,36:1323-1329.
[54]Akahoshi T, Uematsu A, Akashiba T, et al. Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome. Respirology,2010,15:1122-1126.
[55]Li Z, Woollar JR, Wang S, et al. Increased glomerular filtration rate in early metabolic syndrome is associated with renal adiposity and microvascular proliferation. Am J Physiol Renal Physiol,2011,301 (5):1078-1087.
[56]Ferraro PM, Lupo A, Yabarek T, et al. Metabolic Syndrome, Cardiovacular Disease, and Risk for Chronic Kidney Disease in an Italian Cohort:Analysis of the INCIPE study. Metab Syndr Relat Disord,2011,9:381-388.
[57]Changgui Li, Ming-Chia Hsieh, Shun-Jen Chang. Metabolic syndrome, diabetes and hyperuricemia. Curr Opin Rheumatol,2013,25(2):210-6.
[58]Esposito K, Chiodini P, Capuano A,et al.Metabolic Syndrome and Risk of Cancer:A systematic review and meta-analysis. Diabetes Care,2012,35-.2402-2411.
[59]虚一新,顾萍,王坚.代谢综合征与肿瘤关系的研究进展.中国全科医学,2012,15(11)：3685-3687.
[60]Stattin P, Lukanova A, Biessy C, et al. Obesity and colon cancer:does leptin provide a link?. IntJ Cancer,2004,109(1):149-152.
[61]Kang JH, Yu BY, Youn DS. Relationship of serum adiponectin and resistin levels with breast cancer risk. J Korean Med Sci,2007,22(1):117-121.
[62]Jackson L, Wahli W, Michalik L, et al. Potential role for peroxisome proliferator activated receptor (PPAR) in preventing colon cancer. Gut,2003 52(9):1317-1322.
[63]Sarwar N, Sandhu MS, Ricketts SL, et al. Triglyceride Coronary Disease Genetics Consortium and Emerging Risk Factors Collaboration. Triglyceride-mediated pathways and
coronary disease:collaborative analysis of 101 studies. Lancet,2010,375:1634-1639.
[64]Jenkins D, Kendall C, Faulkner D, et al. Long-term effects of a plant-based dietary portfolio of cholesterol-lowering foods on blood pressure. Eur J Clin Nutr,2007,62:781-788.
[65]Lichtenstein A, Appel L, Brands M, et al. Diet and lifestyle recommendations revision 2006:a scientific statement from the American Heart Associantion Nutrition Committee.Circulation,2006,114:82-96.
[66]Arora S, MacFarlane S. The case for low carbohydrate diets in diabetes management. Nutr Metab,2005,2:16-24.
[67]Fontana L, Klein S, Aging, adiposity, and calorie restriction.JAMA,2007,297:986-994.
[68]Ohkawara K, Tanaka S, Miyachi M, et al. A does-response relation between aerobic exercise and visceral fat reduction:systematic review of clinical trials. Int J Obes, 2007,31(2):1786-1797.
[69]Kelley GA, Kelley KS, Vu TZ. Aerobic exercise, lipids and lipoproteins in overweight and obese adults:a meta analysis of randomized controlled trials. Int J Obes,2005,29(2):881-893.
[70]Whelton SP, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure:a meta-analysis of randomized controlled trials. Ann Intern Med,2002,136(7):493-503.
[71]Haskell WL, Lee IM, Pate RR, etal. Physical activity and publichealth:updated recommendation for adults from the American Collegeof Sports Medicine and the American Heart Association.Circulation,2007,116(9):1081-1093.
[72]Cena H, Fonte ML, Turconi G. Relationship between smoking and metabolic syndrome. Nutr Rev.2011,69(12):745-753.
[73]Di Castelnuovo A,Costanzo S, Bagnardi V,et al.Alcohol dosing and total mortality in men and women:an up-dated meta-analysis of34 prospective studies.Arch Intern Med, 2006; 166:2437-45.
[74]Gaziano JM, Buring JE, Breslow JL, et al. Moderate alcohol intake increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med,1993,329:1829-34.
[75]中国2型糖尿病防治指2010版.北京：北京大学医学出版社,2011,57-59.
[76]Torgerson JS,Hauptman J,Boldrin MN,et al.XENical in the prevention of diabetes in obese subjects(XENDOS)study:a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care.2004,27(l): 155-161.
[77]Gerstein HC,Yusuf S,Bosch J,et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose:a randomized controlled trial.Lancet.2006,368(9541):1096-1105.
[78]Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus:the STOP-NIDDM randomised trial.Lancet.2002,359(9323):2072-2077.
[79]Barnett AH, Bain SC, Bouter P, etal. Angiotensin-receptor blockade versus conveiling-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med.2004. 351(19):1952-1961.
[80]Third Report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel Ⅲ)final report.Circulation.2002,106(25):3143-3421.
[81]Leaf DA, Connor WE, Illingworth DR, etal. The hypolipidemic effects of gemfibrozil in type V hyperlipidemia. A double-blind, crossover study. JAMA.1989,262(22):3154-3160.
[82]董静,王琦,王东坡,等.从痰湿体质角度论析代谢综合征.北京中医药大学学报,2006,29(12)：802-803.
[83]李锡杰,刘志龙.论从脾论治代谢综合征.中医药导报,2006,12(4)：9-10.
[84]乔琳琳,李怡.浅议代谢综合征的中医病机及辨证论治,第三次全国中西医结合内 分泌代谢病学术大会暨糖尿病论坛论文集,2010,39-42.
[85]王坤玲,王建清.从肝脾肾浅析代谢综合征的中医病机.新疆中医药,201 1,29(5)：1-2.
[86]张剑.从三焦与“毒”探讨代谢综合征.中医杂志,2007,48(6)：487-489.
[87]李晔,朱玲,张铁梅,李怡.对1231人代谢综合征相关指标的中医证候初步分析.中华中医药杂志,2009,24(12)：1578-1580.
[88]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.
[89]陈广峰.老年代谢综合征中医分型与胰岛素抵抗相关性临床研究.南京：南京中医药大学,2007.
[90]徐远.中医治疗代谢综合征的思路与方法.中医杂志,2003,44(4)：301-302.
[91]仝小林,段军.代谢综合征的中医认识与治疗.中日友好医院学报,2003,16(5-6)：347-348.
[92]张静,郭宏敏.从阴虚血瘀论治老年代谢综合征.吉林中医药,2011,31(1)：8-9.
[93]王兵.老年代谢综合征的中医辨治特点.中华中医药学刊,2011,29(4)：839-840.
[94]江焱.黄连素对代谢综合征胰岛素敏感性的影响.浙江中医药大学学报,2009,33(3)：390-393.
[95]叶建红,黎锋,李芳萍,等.水飞蓟宾对代谢综合征患者葡萄糖代谢率与脂肪因子的影响.中国老年学杂志,2011,31(3)：374-376.
[96]彭丹洋,王琳,朱德增.山楂精纯提取片治疗代谢综合征的临床研究.长春中医药大学学报,2011,27(5)：723-724.
[97]褚松龄,富宏,杨金霞,等.普洱茶提取物调节代谢综合征的随即双盲安慰剂对照研究.内分泌代谢病中西医结合研究——临床与基础,2010,99-101.
[98]向芳.葛根素注射液治疗代谢综合征64例临床观察.中医药导报,2010,16(11)：48-49.
[99]冯瑞芳.舒血宁治疗代谢综合征疗效观察.山西医药杂志,2011,40(8)：823-824.
[100]王红梅,关晓辉,王自兴.荷丹片对伴高脂血症的代谢综合征患者糖脂代谢及胰岛素抵抗的影响.河北中医,2009,31(4)：603-604.
[101]杭胤.复方丹参滴丸治疗代谢综合征临床观察.山东医药,2009,49(25)：82-83.
[102]孙素芹,周丽梅.补阳还五汤治疗代谢综合征53例疗效观察.山东中医药大学学报,2010,34(6)：515-516.
[103]范玉网.五苓散治疗代谢综合征的理论与临床研究.广州：广州中医药大学,2012.
[104]潘玲,冯全生.八味丸方药对代谢综合征患者治疗效应的临床观察.四川生理科学杂志,2005,27(2)：78-81.
[105]李岩,赵桂君,陈英华,等.针刺治疗代谢综合征50例临床观察.中国中医药科技,2010,17(4)：359-360.
[106]李青,李莲,王少锦,等.电针对代谢综合征患者脂代谢的影响.中国针灸,2010,30(9)：713-716.
[107]Yamada S. Pleiotropic effects of ARB in metabolic syndrome. Curr Vasc Pharmacol, 2011,9(2):158-61.
[108]牟新,周迪夷,周旦阳,等.采用前瞻性队列研究在观察中医证候演变规律中的方法学探讨.中华中医药杂志,2014,29(2)：514-517.
[1]迟家敏.实用糖尿病学第3版.北京：人民卫生出版社,2009：50.
[2]张鹏,赵慧辉,陈婵,等.慢性心力衰竭常见证候和证候要素的现代文献研究.中华中医药杂,2011,26(6)：2378-2381.
[3]国家技术监督局.中华人民共和国国家标准：中医临床诊疗术语证候部分.1997,GB/T16751.2-1997.
[4]崔博乐,李怡,张军,等.论肥胖与代谢综合征的中医学认识.北京中医药,2009,28(1)：32-34.
[5]卢艳慧,陆菊明,王淑玉,等.国际糖尿病联盟与中国糖尿病学会关于代谢综合征诊断标准的比较研究分析.中华医学杂志,2006,86(6)：386-389.
[6]陈世波,倪青.伴2型糖尿病的代谢综合征中医证候规律研究思路.中国中医基础医学杂志,2006,12(7)：511-512.
[7]顾小琼,袁叶,邵亚鹏,等.代谢综合征中高血压患者的中医分型研究.内蒙古中医药,2008,27(3)：5-7.
[8]李惠林,李增英,张志玲,等.脂联素、血脂、SOD与代谢综合征痰湿内蕴辨证关系研究.世界中医药,2011,6(1)：73-7.
[1]Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes,2010,2:180-193.
[2]范德花,管慧丽.中医为主、多学科防治代谢综合征临床观察[J].光明中医,2013,28(1)：71-73.
[3]周芬,郝玉芳,陈岩,等.中药治疗羊水过多系统评价与Meta分析[J].北京中医药,2013,32(1)：18-22.
[4]魏治鹏.补肾活血法对老年代谢综合征血压及纤维蛋白原影响的临床研究[D].南京：南京中医药大学,2007.
[5]李鑫.化浊行血、健脾益气法干预老年代谢综合征临床疗效研究[D].济南：山东中医药大学,2009.
[6]王东建,洪庆祥,杨曼昕,等.保龄汤对老年代谢综合征胰岛素抵抗的影响[J].河北中医,2012,34(12)：1779-1781.
[7]葛登奎,赵敏.益气活血降浊方治疗老年代谢综合征临床观察[J].中医临床研究,2013,5(6)：9-10.
[8]高文澜.益肾活血方治疗老年代谢综合征的临床观察[J].辽宁中医杂志,2013,40(4)：730-731.
[9]王志国.基于症状变化的中医疗效评价方法探讨[J].中华中医药学刊,2009,27(1)：33-35.
[1]王颖辉,赵进喜,王世东,等.糖尿病肾病不同分期证候演变研究.中华中医药杂志,2012,27(10)：2687-2690.
[2]李晔,朱玲,张铁梅,等.对1231人代谢综合征相关指标的中医证候初步分析.中华中医药杂志,2009,24(12)：1578-1580.
[3]吴政.老年代谢综合征患者外周白细胞计数的研究.中国老年学杂志,2008,28(14)：1405-1406.
[4]郑虹,薛慎伍,张兆岩.老年代谢综合征患者血小板参数的变化及临床意义.中华保健医学杂志,2010,12(4)：319-322.
[5]程薇莉.老年高血压、冠心病和糖尿病患者红细胞参数的临床分析.第七届全国老年老年医学学术会议论文汇编,2004：230-231.
[6]韩全水,孙岩,廖淑萍.老年代谢综合征血尿酸与血压、甘油三脂的相关性分析.华西医学,2009,24(7)：1717-1719.
[7]闫玉光,张华,张明香,等.慢性乙型肝炎及肝炎后肝硬化与中医症状间相关性回顾性分析.中国中医基础医学杂志,2012,18(11)：1227-1229.
[8]孟庆芳.加减黄连温胆汤对代谢综合征患者临床疗效及MAU的影响.哈尔滨：黑龙江中医药大学,2012.
[9]张剑,闫小光, 刘勇,等.214例2型糖尿病辨证分型与代谢综合征关系的探析.中华中医药杂志,2006,21(4)：201-202.
[10]赵展荣,闫小光,黄飞,等.254例2型糖尿病患者代谢综合征的证候分析.北京中医药大学学报,2006,29(12)：856-857.
[1]董霞.五运六气禀赋与原发性高血压形成的相关性研究.北京：北京中医药大学,2012.
[2]汪德云.小儿疾病与胚胎期发育期之间内在规律的探讨一匕京中医学院学报,1984,4：12-13.
[3]田合禄,田蔚.中医运气学解密[M].太原：山西科学技术出版社,2007： 212.
[4]叶正华,柳红芳,刘变玲.糖尿病肾病患者胎孕期岁运特点以及相关危险因素的临床研究.北京中医药大学学报,2012,19(6)：10-12.
[5]Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes,2010,2:180-193.
[6]王坤玲,王建清.从肝脾肾浅析代谢综合征的中医病机.新疆中医药,2011,29(5)：1-2.
[1]顾雯霞,翟乐乐.老年代谢综合征患者便秘原因分析及对策.中国中医基础医学杂志,2008,14(7)：559-560.
[2]常婧舒,李晔.老年糖尿病症状、证型特点及相关性分析.河北中医,2010,32(8)：1142-1144.
[3]戴霞,邹艳军,部帅,等.老年高血压病证候分别规律的临床回顾性研究.中国中医药信息杂志,2010,17(2)：24-25.
[4]张娜,章怡祎,刘萍.从痰瘀论治高脂血症.中华中医药学刊,2011,29(6)：1263-1264.
[5]韩丽蓓,杨惠民,崔春燕,等.老年前期及老年人血脂代谢紊乱与中医证候的相关性研究.北京中医药大学学报,2005,28(4)：77-79.