| Metabolic Syndrome(MetS)is a group of metabolic disorders that include high blood pressure,central obesity,insulin resistance and dyslipidemia,increasing the risk of diabetes mellitus,atherosclerotic cardiovascular disease.It was first proposed by American scholar Gerald Reaven in the 1980s and formally named metabolic syndrome by the World Health Organization in 1999.According to research,one in three American adults has been diagnosed with metabolic syndrome,compared with 24.3 percent in Europe.The conventional treatment of metabolic syndrome includes comprehensive treatment such as lifestyle intervention,dietary structure adjustment,regular exercise,etc.In addition,reasonable and accurate drug control is required according to different clinical manifestations,also including various surgical treatments in recent years.Abdominal vibrating tuina therapy is a visceral disease massage founded in the 1990s by Professor ZangFuKe in Dongzhimen hospital,Beijing university of Chinese medicine.After many years of clinical study and practice,Abdominal vibrating tuina therapy has developed into one of the representative of the viscera massage genre which has extensive influence in the field of massage and has certain improvement and treatment effect for internal medicine,gynecology,pediatric,orthopedics and so on the many kinds of diseases.This paper summarizes the literature of metabolic syndrome and abdominal vibrating tuina therapy in recent years,and carries out clinical and mechanism studies with the purpose of:(1)to evaluate the efficacy and safety of randomized controlled trial of metabolic syndrome by tuina,and understand the present situation of the metabolic syndrome by tuina,exploring the advantages of tuina therapy and providing evidence of clinical treatment of metabolic syndrome through the way of evidence-based medicine,and also laying a foundation for the followed clinical trial;(2)to evaluate the efficacy and safety of abdominal vibrating tuina therapy in the treatment of metabolic syndrome by its effects on waist circumference,visceral fat thickness,TCM syndrome score,blood lipid level and blood glucose;(3)to analyze the effect of patients with metabolic syndrome by abdominal vibrating tuina therapy and explore the mechanism of the treatment based on the method of metabonomics.Methods:1 Systematic reviewSearch randomized controlled trials of the metabolic syndrome by tuina in English and Chinese database of Pubmed,The Cochrane Library,Web of Science,CNKI,Wanfang,VIP.Two evaluators extract the data and evaluate the quality independently.Assess bias risk by The Cochrane bias risk tools and evaluate the quality of the literature by PEDro scale.Two or more articles with the same index of the same intervention will be meta-analyzed,and RevMan5.3 software will be used provided by The Cochrane Collaboration.2 Clinical research120 cases of patients with the metabolic syndrome from the department of tuian in Dongzhimen hospital,Beijing university of Chinese medicine from March 201 8 to June 2019 were randomly divided into treatment group and control group,60 cases in each group.Two groups take health education,diet control,regular exercise and other lifestyle intervention as the basis of treatment,the treatment group combined abdominal vibrating tuina therapy and the control group combined the plaster placebo.Both of two groups are treated every other day,and 12 times for a period of treatment.After one period of treatment,we observe the following indicators before and after treatment:(1)main outcome indicators:Waist circumference and waist-to-hip ratio,visceral fat thickness;(2)secondary outcome indicators:TCM syndrome score,body weight and body mass index,blood pressure,blood lipid level and blood glucose;(3)Safety indicators:general physical examination,blood routine test,liver and kidney function test,adverse event record,etc.3 Mechanism research32 patients with metabolic syndrome in the treatment group were randomly selected,and fasting blood was collected in the morning before and after treatment.32 healthy subjects aged 1 8-65 years from March 2018 to June 2019 were randomly selected from the tuina department of Dongzhimen hospital,Beijing University of Chinese Medicine,and fasting blood was collected as the healthy control group.The intervention and course of treatment for patients with metabolic syndrome were equivalent to the clinical trial.Blood samples were centrifuged at low temperature and the upper serum was collected.In this experiment,we find the differentially expressed metabolites by the VIP value of OPLS-DA model(threshold>1)and the p value of t test(P<0.05).The local databases(600 compounds)and online databases(HMDB and fat MAPS)were searched,and the difference metabolites were obtained finally.The metabolic pathways were searched through logging in the Kyoto Encyclopedia of Genes and Genomes Pathway(KEGG).By comparing the patients with metabolic syndrome before treatment with the healthy control group,different metabolites were obtained,and then the change trend of different metabolites was obtained by comparing the patients with metabolic syndrome before and after treatment,so as to clarify the metabolic pathways.Results:1 Systematic reviewFive articles were included,all in Chinese,and a total of 486 subjects met the diagnostic criteria for metabolic syndrome were included.Most of the studies have limitations.in random sequence generation,allocation and concealment,blind method,etc.PEDro scale carries out evidence quality evaluation,and there are 3 literatures with 6 points or above.Since there was no identical treatment regimen between the experimental group and the control group,meta-analyze could not be carried out,and only descriptive analysis was carried out.Only 1 study had a clear record of adverse reactions and safety evaluation,and the remaining 4 studies were not mentioned.2 Clinical research120 cases were included while 4 cases were removed in the treatment group and 5 cases in the control group.There are 56 cases in the treatment group expulsed 5 cases and 55 cases of the control group expulsed 5 cases.Finally,51 cases in the treatment group and 50 cases in the control group were analyzed statistically.There were no statistically significant differences in age,gender,height,weight,waist circumference,hip circumference,visceral fat thickness,blood pressure,blood lipid level,blood glucose and other baseline data(P>0.05),indicating comparability..2.1 main outcome indicators:compared with before treatment,waist circumference,waist-to-hip ratio,visceral fat thickness of the treatment group were significantly decreased after treatment(P<0.01),and the indicators of the control group showed no difference(P>0.05).Compared with the control group,waist circumference,waist-to-hip ratio,visceral fat thickness in the treatment group were significantly decreased(P<0.01).2.2 secondary outcome indicators:compared with before treatment,TCM syndrome scores,weight,body mass index,fasting blood glucose,TG,TC in the treatment group were significantly decreased and HDL-C significantly increased after treatment(P<0.01),while TCM syndrome scores of the control group were significantly decreased(P<0.01).Compared with the control group,TCM syndrome scores,TG and TC in the treatment group decreased(P<0.05).2.3 The total efficiency was 76.4%in the treatment group and 6.0%in the control group,with a significant difference(P<0.01),suggesting that the clinical efficacy of the treatment group was better than the control group.2.4 There were no obvious abnormal changes in blood routine test and liver and kidney function test before and after treatment in both groups,and no serious adverse reactions occurred.3 Mechanism research3.1 Compared with the healthy control group,14 substances with rising trend such as lysophosphatidylcholine and 11 substances with descending trend such as lysophosphatidylglycolamine appeared in the patients with metabolic syndrome before treatment(VIP>1 and P<0.05).3.2 Compared before and after treatment in patients with metabolic syndrome,11 substances with rising trend such as lysophosphatidylcholine and 7 substances with descending trend such as lysophosphatidylethanolamine(VIP>1 and P<0.05)in which the amide(d18:1/25:0),sphingomyelin(d18:1/12:0),L-histidine are substances with the metabolic syndrome patients before treatment group compared with healthy controls.It is concluded that after abdominal vibrating tuina therapy,4 kinds of material have benign adjustment trend,and the content is close to the level of healthy controls.3.3 Four metabolic pathways were obtained after treatment in patients with metabolic syndrome,of which the main pathways were sphingolipid and histidine metabolic pathways.Conclusions:The systematic review showed that tuina is effective in improving the total effective rate and body mass index of metabolic syndrome,and may be effective in improving blood glucose and blood lipid,with few adverse reactions.However,due to the lack of studies and poor literature quality,high-quality randomized controlled trials are needed combined with the evidence-based medicine and obtain meaningful clinical evidence.The randomized controlled trial showed that abdominal vibrating tuina therapy can significantly improve metabolic syndrome in waist circumference,visceral fat thickness,TCM syndrome score,TG,TC,and has a good safety.Abdominal vibrating tuina therapy may exert its therapeutic effect of regulating glucose and lipid metabolism by affecting the levels of ceramide,sphingomyelin,L-histidine and dimethylarginine in patients with metabolic syndrome,and its mechanism may be related to the sphingomyelin metabolism pathway and histidine metabolism pathway. |
