肥胖合并糖尿病前期的中医病机与中医药干预研究进展

Research Progress on Traditional Chinese Medicine Pathogenesis and Interventions for Obesity with Prediabetes

摘要: 肥胖与糖尿病前期均为2型糖尿病(type 2 diabetes mellitus, T2DM)的重要危险因素，二者常合并存在并互为因果，显著增加T2DM及心血管代谢疾病的发生风险。糖尿病前期属于血糖调节受损阶段，具有一定可逆性，是预防T2DM的关键窗口期。中医学认为，肥胖合并糖尿病前期多归属于“脾瘅”“痰湿”“肥满”等范畴，其核心病机为脾失健运、痰湿膏脂内蕴，兼夹郁热、气阴不足及血瘀，以健脾化痰、祛湿泄浊为基本治法。近年来，中药复方、中成药及针刺、电针、穴位埋线等中医特色疗法在改善该人群体重、糖脂代谢及胰岛素抵抗方面积累了较多临床证据，其作用机制涉及改善胰岛素抵抗、调节脂肪组织炎症及维持糖脂代谢稳态等多条途径。本文系统综述肥胖合并糖尿病前期的中西医认识与中医药干预研究进展，指出现有研究在诊断界定、证候评价及研究设计等方面仍存不足，以期为该人群的中西医结合防治及后续高质量研究提供参考。

Abstract: Obesity and prediabetes are both important risk factors for type 2 diabetes mellitus (T2DM), and their co-occurrence significantly increases the risk of progression to T2DM and cardiometabolic diseases. Prediabetes is a reversible stage of impaired glucose regulation and represents a critical window for diabetes prevention. In traditional Chinese medicine (TCM), obesity complicated with prediabetes is mostly classified under the categories of “pi dan” (spleen-dampness), phlegm-dampness and obesity (fei man). Its core pathogenesis is summarized as deficiency of the spleen in transportation and transformation as the root, with internal accumulation of phlegm-dampness and turbid lipid as the branch, frequently accompanied by stagnant heat, deficiency of qi and yin, and blood stasis; the basic therapeutic principle is invigorating the spleen to resolve phlegm and dispelling dampness to eliminate turbidity. In recent years, accumulating clinical evidence has shown that Chinese herbal formulae, Chinese patent medicines and acupuncture-related therapies, including manual acupuncture, electroacupuncture and acupoint catgut embedding, may improve body weight, glucose and lipid metabolism and insulin resistance in this population. The underlying mechanisms may involve improving insulin resistance, modulating adipose tissue inflammation and maintaining glucose-lipid metabolic homeostasis. This review summarizes the modern medical and TCM understanding of obesity complicated with prediabetes and the research progress of TCM interventions, and points out remaining deficiencies in diagnostic definition, syndrome evaluation and study design, so as to provide a reference for integrative prevention and further high-quality research.