Analysis Of Clinical Characteristics And TCM Syndrome Types Of Obesity Patients

PurposeThe purpose of this study was to analyze whether there were differences in clinical physicochemical indexes and insulin resistance among obese patients with different BMI groups.To further explore the risk factors related to insulin resistance in obese patients;Through cross-sectional study,we investigated the distribution characteristics of TCM syndromes in obesity patients and the differences of body composition among different TCM syndromes.MethodA total of 122 patients with obesity who were admitted to the obesity Department of Optics Valley Hospital of Hubei Hospital of Traditional Chinese Medicine from January 2018 to January 2021 were enrolled.General information and clinical data of the patients were collected.Including gender,age,height,comorbidities,body composition,thyroid function,biochemical indicators,erythrocyte related indicators,75g OGTT blood glucose and insulin at each time point,TCM syndrome type diagnosis and TCM symptom information,etc.,homeostasis model was used to calculate insulin resistance（homa-ir）andβcell secretion function（HOMA-β）.According to the calculation results of Body Mass Index（BMI）,47 patients were divided into mild obesity group（28kg/㎡≤BMI<32.5kg/㎡）,moderate obesity group（32.5kg/㎡≤BMI<37.5kg/㎡）,Twenty-eight patients with severe obesity（BMI≥37.5kg/㎡）were studied to explore the differences of physical and chemical indexes and risk factors of insulin resistance（IR）in patients with different levels of obesity.According to the syndrome types diagnosed by TCM,it can be divided into five types:spleen deficiency and dampness syndrome,phlegm dampness and dampness syndrome,qi stagnation and blood stasis syndrome,stomach heat stagnation syndrome and spleen and kidney Yang deficiency syndrome.Through cross-sectional study,the distribution characteristics of TCM syndrome types in obesity patients and their correlation with human body components were investigated.The ancient and modern motion cloud platform V2.3.5 was used to conduct standardization,frequency statistics and TCM syndrome elements analysis of TCM syndrome types and symptoms.Duncan multiple comparison analysis was used for multiple comparison between groups of differences in body components between TCM syndrome types of obesity patients,and significance was expressed by letter marking method.The general data and physical and chemical indexes of different obese patients were analyzed by Chi-square test or analysis of variance,and multiple comparisons between groups were analyzed by non-parametric test,LSD or Kruskal-Wallis test.Pearson correlation analysis was used to study the correlation between HOMA-IR and various variables,and multiple linear stepstep regression was used to analyze the risk factors of IR in obese patients.SPSS 26.0 statistical analysis software was used for statistical analysis,and Origin 2021 software was used for visualization of plasma insulin and blood glucose levels in OGTT test between different BMI groups.Results1.Among the included patients with obesity,the most frequent comorbidities were non-alcoholic fatty liver disease,hyperuricemia,hyperlipidemia,hyperinsulinemia,hypertension,impaired glucose tolerance,and type 2diabetes mellitus,among which the prevalence of non-alcoholic fatty liver disease was the highest at 94%.The prevalence of hyperuricemia was 80%,but there was no significant difference among the three groups（P>0.05）.2.Thyroid function analysis among obese patients with different BMI groupsAmong the patients with obesity,the group with high degree of obesity had higher FT₃,FT₃/FT₄ and lower FT4 than the group with low degree of obesity.TSH showed non-linear change among obese patients.However,there was no statistical significance in obesity patients with different BMI groups（P>0.05）.3.Biochemical indexes of obese patients with different BMI groups were analyzedIn patients with obesity,there were no significant differences in biochemical indexes AST,GGT,ALP,TP,ALB,GLOB,TBIL,DBIL,IBIL,CHOL,HDL-C,LDL-C,APO-A1,APO-B,UREA and CREA among different BMI groups（P>0.05）.Only ALT,TG and UA were significantly increased with the increase of BMI（P<0.05）.4.Analysis of corpus-related indicators among obese patients with different BMI groupsIn patients with obesity,there was no significant difference in RBC,HGB,HCT,MCV,MCH,MCHC,RDWSD and RDW among different BMI groups（P>0.05）.5.Analysis of plasma insulin results at 75g OGTT at each time point in obese patients with different BMI groupsPlasma insulin levels increased with the increase of BMI at all time points after fasting and oral administration of 75g anhydrous glucose.There were significant differences in plasma insulin levels at 75g OGTT 0h,0.5h,1h and 3h（P<0.001,P=0.011,P=0.005 and P=0.012,respectively）.There was no significant difference in plasma insulin level between the three groups at 2h time point（P=0.385）.6.75g OGTT analysis of plasma glucose levels at different time points in obese patients with different BMI groupsAnalysis of plasma glucose levels measured at each time point after fasting and 75g oral administration of anhydrous glucose showed that there was no statistical significance in blood glucose levels at each time point among the three groups（P>0.05）.7.Homa-ir and HOMA-βanalysis of obese patients with different BMI groupsIn obese patients,HOMA-IR increased gradually with the increase of BMI,and the difference between groups was statistically significant（P<0.001）.HOMA-βalso increased with the increase of BMI,but there was no significant difference between groups（P=0.079）.8.Correlation analysis of HOMA-IR with body composition and physical and chemical indexes in obese patientsIn obesity patients,gender and age had no significant correlation with HOMA-IR（P>0.05）.BMI,FMI,BFM,BFM of trunk,BFM of limbs,FFM,VFA,PBF and WHR of trunk were positively correlated with HOMA-IR（P<0.05）.BMI（r=0.30,P=0.002）,BFM（r=0.40,P<0.001）and VFA（r=0.37,P=0.036）were moderately correlated with HOMA-IR（r>0.3）,while others were weakly correlated（r<0.3）.Body weight,TBW,protein,minerals,FFM,SMM and FFM of limbs had no significant correlation with HOMA-IR（P>0.05）.The physical and chemical indexes of FT₃,FT₃/FT₄,TSH,ALT,AST,TG,UA were positively correlated with HOMA-IR（P<0.05）.ALT（r=0.47,P<0.001）,AST（r=0.48,P<0.001）,TG（r=0.32,P=0.001）were moderately correlated with HOMA-IR（r>0.3）,while other indexes were weakly correlated with HOMA-IR（r<0.3）.HOMA IR and HDL-C,the MCV showed a negative correlation（P<0.05）,are all weak correlation（|r|<0.3）.9.Risk factors analysis of IR in obese patientsLn（HOMA-IR）was used as the dependent variable to construct a regression model,and the results showed that ALT and VFA were risk factors for Ln（HOMA-IR）（ALT:standardizedβ:0.393,95%CI:0.002-0.006,P<0.001,VIF:1.023;VFA:standardizedβ:0.343,95%CI:0.002-0.008,VIF:1.023）,ALT and VFA in this model can explain 29.6%of the change of the dependent variable Ln（HOMA-IR）（P<0.001）,and the regression equation constructed on this basis is:Ln（HOMA-IR）=0.271+0.004*ALT+0.005*VFA,and this model is relatively stable.10.The distribution of TCM syndromes in obesity patients was most common with the syndrome of phlegm-dampness in the body,followed by the syndrome of spleen deficiency dampness,qi stagnation and blood stasis,the syndrome of stomach heat stagnation,and the syndrome of spleen and kidney Yang deficiency.11.The clinical symptoms of obesity patients are not typical,such as fatigue,heavy sleepiness in head and body,loose stools,poor sleep,nose and snore,dry mouth,dizziness,liver discomfort,headache or pain,bitter mouth,polydipsia,etc.12.The syndromes of patients with obesity involve the viscera,mainly the spleen,liver,kidney and the stomach.The syndromes of disease are mainly dampness,phlegm,deficiency,qi stagnation,blood stasis,heat,Yang deficiency and so on.13.Analysis of TCM syndrome types and body components in patients with obesityThe obese patients with spleen and kidney Yang deficiency syndrome were more obese and had higher fat and muscle contents.BMI,FMI,TBW,protein,minerals,FFM,SMM,BFM and VFA were higher than those of the other four syndrome types（P<0.05）.The protein,mineral,TBW,FFM,SMM,BFM of muscle and fat related indexes,and BMI of obesity index in obese patients with qi stagnation and blood stasis syndrome were significantly lower than those in patients with spleen and kidney Yang deficiency syndrome,phlegm-dampness syndrome and spleen-deficiency dampness syndrome（P<0.05）.However,there was no significant difference between the two groups（P>0.05）.There were no significant differences in body composition indexes of obesity patients with spleen deficiency and dampness syndrome,phlegm-dampness syndrome and stomach heat depression syndrome（P>0.05）.ConclusionThe results of this cross-sectional study showed that the most common TCM syndrome type of obesity patients was phlegm-dampness syndrome;The degree of obesity in patients with spleen and kidney Yang deficiency syndrome is more serious,while the degree of obesity in patients with qi stagnation and blood stasis syndrome is less.The related indexes of human body composition detection can provide the thinking of"body differentiation-syndrome differentiation"in TCM.In obese patients,ALT,TG,UA and IR increased significantly with the increase of obesity degree.VFA and ALT can be important predictors of IR in obese patients.