社区干部代谢综合征与中医体质的相关性研究

Study on the Correlation between Metabolic Syndrome and Traditional Chinese Medicine Constitution in Community Officials

摘要: 背景：社区干部为代谢综合征(Metabolic Syndrome, MS)高危人群。中医体质辨识在慢病防控中价值显著，但针对该人群的中西医结合研究较少，本研究基于中医体质视角探讨二者的相关性。目的：探讨社区干部人群中代谢综合征与中医体质及早期靶器官损伤指标的关系，为职业人群慢病防控提供依据。方法：选取2024年4月在克拉玛依市中西医结合医院(克拉玛依市人民医院)体检的克拉玛依区所辖社区干部178人，按《中国糖尿病防治指南(2024版)》制定的代谢综合征诊断标准诊断MS，并采用《中医体质分类与判定》(ZYYXH/T157-2009)标准分为痰湿质与平和质等9种体质。比较不同性别、不同体质及MS与非MS组间的人体测量、血压、血糖、血脂、肝肾功能、血常规、胰岛素抵抗指数、胰岛素早相分泌指数、胰岛素曲线下面积等指标，进行Logistic回归分析。结果：男性BMI、腰围、收缩压、舒张压、内脏脂肪、感觉阈值、胰岛素抵抗指数、GLU (空腹、0.5小时)、ALT、AST、UA、TG、WBC、RBC、HGB、HCT、Crea均高于女性(P < 0.05)，HDL-C显著低于女性(P < 0.01)。克拉玛依社区干部MS患病率较高，为29.78%。MS组BMI、体质评分、INS120、胰岛素曲线下面积(AUC)、ALT、AST、UA、WBC、RBC、HGB、HCT、Crea显著高于非MS组(P < 0.05)。痰湿质组MS患病率37.10%显著高于平和质组MS患病率24% (P < 0.05)。男性以痰湿质占比最高(45.07%)，其次为气虚质(16.90%)和湿热质(9.86%)；女性以气虚质(24.30%)、平和质(19.63%)和阳虚质(18.69%)为主。男性痰湿质构成比高于女性(P < 0.05)，而气虚质、平和质、阳虚质构成比低于女性(P > 0.05)。MS组以痰湿质为主(56.60%)，高于非MS组(25.60%)；而非MS组平和质(21.60%)和气虚质(26.40%)构成比高于MS组(5.66%, 9.43%) (P < 0.05)。两组阳虚质、湿热质、阴虚质构成比差异无统计学意义(P > 0.05)。痰湿质组BMI、腰围、感觉阈值、胰岛素抵抗指数(IRI)、TG、PLT显著升高，HDL-C显著降低(P < 0.05)。Logistic回归分析显示，痰湿质(OR = 2.981, 95% CI: 1.362~6.520, P < 0.05)、男性(OR = 5.952, 95% CI: 2.588~13.691, P < 0.05)是MS的独立危险因素，年龄与MS无显著关联(P = 0.815)。结论：社区干部人群中，痰湿质和男性是MS的重要危险因素，MS患者存在多系统代谢及炎症指标异常。中医体质辨识与常规体检相结合，有助于职业人群MS的早期预警和精准干预。

Abstract: Background: Community officials are the high risk population suffering from metabolic syndrome (MS). There is significant value for the TCMC identification in the prevention and control of chronic diseases. But less research has been conducted aiming at the integrated research of traditional Chinese and western medicine for the group. This research is to explore the correlation between the two groups based on the perspective of Traditional Chinese Medicine Constitution (TCMC). Objective: To discuss the correlations among MS, TCMC and early target organ damage indicators, providing evidence for the prevention and control of chronic diseases in the occupational population. Methods: Selecting 178 community officials medically examined in Karamay Integrated Traditional Chinese and Western Medicine Hospital (Karamay People’s Hospital) in April, 2024, diagnosing MS according to The Guideline for the Prevention and treatment of Metabolic Syndrome in Chinese Adults (version 2024), adopting the standard from Classification and Determination of constitution of Traditional Chinese Medicine (ZYYXH/T157-2009), dividing TCMC into 9 constitutions including Tanshizhi (Phlegm-Dampness Constitution) and Pinghezhi (Balanced Constitution). Comparing the indicators of anthropometric measure, blood pressure, blood glucose, blood lipid, liver and kidney function, blood routine, insulin resistance index, early-phase insulin secretion index, area under the insulin curve etc. among the groups of different sexes, different constitutions, MS and non-MS, Logistic regression analysis is also performed. Results: Male participants exhibited significantly higher values for BMI, waist circumference, systolic blood pressure, diastolic blood pressure, visceral fat, sensory thresholds, insulin resistance index, GLU (fasting and 0.5-hour), ALT, AST, UA, TG, WBC, RBC, HGB, HCT, and creatinine (Crea) compared to females (P < 0.05), while HDL-C levels were markedly lower in males (P < 0.01). The prevalence of MS among community officials in Karamay was notably high at 29.78%. In the MS group, BMI, physical constitution score, INS120, area under the insulin curve (AUC), ALT, AST, UA, WBC, RBC, HGB, HCT, and Crea were significantly higher than those in the non-MS group (P < 0.05). The MS prevalence in the phlegm-dampness constitution group (37.10%) was significantly higher than that in the balanced constitution group (24%) (P < 0.05). Among males, the most prevalent constitution was phlegm-dampness (45.07%), followed by qi deficiency (16.90%) and damp-heat (9.86%). Among females, the predominant constitutions were qi deficiency (24.30%), balanced harmony (19.63%), and yang deficiency (18.69%). The proportion of phlegm-dampness constitution was significantly higher in males than in females (P < 0.05), whereas the proportions of qi deficiency, balanced harmony, and yang deficiency were significantly lower (P > 0.05). In the MS group, phlegm-dampness constituted the majority (56.60%), exceeding that in the non-MS group (25.60%). Conversely, the proportions of balanced harmony (21.60%) and qi deficiency (26.40%) in the non-MS group were significantly higher than those in the MS group (5.66% and 9.43%, respectively) (P < 0.05). No statistically significant differences were observed in the proportions of yang deficiency, damp-heat, or yin deficiency between the two groups (P > 0.05). The phlegm-dampness group showed significantly elevated BMI, waist circumference, sensory threshold, insulin resistance index (IRI), triglycerides (TG), and platelet count (PLT), as well as significantly reduced high-density lipoprotein cholesterol (HDL-C) levels (P < 0.05). Logistic regression analysis identified phlegm-dampness constitution (OR = 2.981, 95% CI: 1.362~6.520, P < 0.05) and male (OR = 5.952, 95% CI: 2.588~13.691, P < 0.05) as independent risk factors for MS, whereas age showed no significant association with MS (P = 0.815). Conclusion: Among community officials, Tanshizhi and male are the major risk factors of MS, with MS patients having anomaly values in multisystem metabolism and inflammation index. Combining TCMC identification and routine medical examination, it is favourable for occupational groups to conduct early warning and intervention of MS.