中医专家谈加味温胆汤治肥胖儿童的疗效

   摘要：目的：探讨加味温胆汤治疗肥胖儿童的疗效及对胰岛素抵抗、脂代谢的影响。方法：2018年5月-2019年5月间本院收治的肥胖症儿童120例，经随机数表法分为对照组、观察组各60例。对照组患儿接受单纯性肥胖常规治疗，观察组患儿在对照组基础上加入加味温胆汤进行联合干预。持续治疗14d后，对比两组患者的胰岛素抵抗程度、脂质代谢水平、整体疗效差异。结果：治疗后，观察组患儿FINS、HOMA-IR的水平低于对照组患儿；TG、TC、LDL-C水平低于对照组患儿，HDL-C的水平高于对照组患儿；疗效分级、总有效率优于对照组患儿（P＜0.05）。结论：加味温胆汤可进一步优化单纯性肥胖症患儿的病情，具体可能与其减轻胰岛素抵抗及脂质代谢紊乱的作用相关。

   Abstract: objective: to investigate the effect of supplemented gallbladder-warming decoction on insulin resistance, lipid metabolism in obese children. Methods: 120 cases of obese children admitted to our hospital from May 2018 to May 2019 were divided into control group and observation group each with 60 cases by random number table. Children in control group received routine treatment, and those in observation group were treated with supplemented gallbladder-warming decoction on the basis of control group. 14 days after continuous treatment, the differences in insulin resistance, lipid metabolism and overall efficacy between two groups were compared. Results: After treatment, levels of FINS and HOMA-IR in observation group were lower than those in control group; levels of TG, TC, LDL-C were lower than those in control group, HDL-C level was higher than that in control group; grade of efficacy and total effective rate were better than those of control group(P<0.05). Conclusion: Supplemented gallbladder-warming decoction can further optimize the condition of children with simple obesity, which may be related to the effect of reducing insulin resistance and lipid metabolism disorder.

   单纯性肥胖是一种临床多见的慢性代谢性疾病，儿童发病率较高，严重的肥胖可能影响其正常生长发育及心理健康。对单纯性肥胖儿童的干预主要包括饮食调节、运动干预等，但受肥胖患儿本人及家属的依从性影响较大。中医对单纯性肥胖症的研究也较为悠久，认为“利水湿、化痰浊”是主要治疗原则，且患儿服用中药汤剂的依从性较为可控，可能是强化肥胖患儿治疗效果的可靠手段之一。

   参考文献：

   [1]Zhou R, Wang Z, Chen W, et al. A prioritization regimen of the acupuncture treatment for simple obesity: Protocol for systematic review and network meta-analysis[J]. Medicine (Baltimore), 2019, 98(43): e17353.

   [2]Zhong YM, Lai DL, Chen Y, et al. Acupuncture vs sham acupuncture for simple obesity: A protocol for systematic review and meta-analysis[J]. Medicine (Baltimore), 2019, 98(42): e17562. 

   [3]丁宗一.儿童期单纯性肥胖症[M]. 郑州：河南科学技术出版社，2005.

   [4]李辉，季成叶，宗心南等．中国0～18岁儿童青少年体块指数的生长曲线[J].中华儿科杂志，2009，47（7）：244-249．

   [5]张野，刘明军，陈邵涛，等. 中医治疗单纯性肥胖症临床优选方案研究[J]. 吉林中医药，2019，39（1）：125-128.

   [6]杨艳. 加味温胆汤联合苯磺酸氨氯地平片与叶酸治疗H型高血压痰湿壅盛证的临床疗效观察[J]. 实用中西医结合临床，2019，19（7）：137-139.

   [7]Gao C, Rao M, Huang W, et al. Resistant starch ameliorated insulin resistant in patients of type 2 diabetes with obesity: a systematic review and meta-analysis[J]. Lipids Health Dis, 2019, 18(1): 205. 

   [8]Gyorkos A, Baker MH, Miutz LN, et al. Carbohydrate-restricted Diet and High-intensity Interval Training Exercise Improve Cardio-metabolic and Inflammatory Profiles in Metabolic Syndrome: A Randomized Crossover Trial[J]. Cureus, 2019, 11(9): e5596. 

     本文摘自（中国中医药现代远程教育 黄莉莉  吴亚楠   青州市妇幼保健院儿童保健科,山东 潍坊,262500）