CAJ | 학술논문

肥胖是一种代谢性疾病已成共识,肥胖的发生与基因、环境、生活方式及炎症关系密切,既往按体重指数作为唯一诊断标准的分类方法已不能满足临床对肥胖的诊治和治疗判断。因此,2013年的美国糖尿病学会(ADA)年会上引入了代谢性肥胖的概念,2014年的美国临床内分泌学会(AACE)年会上又提出了对肥胖按并发症分类的建议,究其原因,是专家们已认识到肥胖发病原因迥异,转归不同,治疗的目的是调节代谢而不是单纯减重。本研究组在长期的临床实践中,通过对形形色色的肥胖患者的临床观察,结合患者症状、体征和皮肤表征及代谢状态,提出了肥胖的代谢分类和个体化诊断原则,结合中国传统医学对肥胖的辩证论治把肥胖分为正常代谢性肥胖和异常代谢性肥胖两大类,并进一步将代谢状态异常性肥胖分为低代谢性肥胖、高代谢性肥胖和炎症代谢性肥胖,结合国外部分专家提出的体重正常代谢性肥胖,将肥胖按代谢状态分为5类,即正常代谢性肥胖(白胖子,“脂人”)、低代谢性肥胖(黄胖子,“膏人”)、高代谢性肥胖(红胖子,“肥贵人”)、炎症代谢性肥胖(黑胖子,“肉人”)和体重正常代谢性肥胖。期望本研究组提出的肥胖分类能起到抛砖引玉的作用,促使临床医师从代谢的角度去重新认识肥胖,根据患者的代谢状态制定具有针对性的个体化治疗方案,使肥胖的诊断和治疗达到预期的效果。
비반시일충대사성질병이성공식,비반적발생여기인、배경、생활방식급염증관계밀절,기왕안체중지수작위유일진단표준적분류방법이불능만족림상대비반적진치화치료판단。인차,2013년적미국당뇨병학회(ADA)년회상인입료대사성비반적개념,2014년적미국림상내분비학회(AACE)년회상우제출료대비반안병발증분류적건의,구기원인,시전가문이인식도비반발병원인형이,전귀불동,치료적목적시조절대사이불시단순감중。본연구조재장기적림상실천중,통과대형형색색적비반환자적림상관찰,결합환자증상、체정화피부표정급대사상태,제출료비반적대사분류화개체화진단원칙,결합중국전통의학대비반적변증론치파비반분위정상대사성비반화이상대사성비반량대류,병진일보장대사상태이상성비반분위저대사성비반、고대사성비반화염증대사성비반,결합국외부분전가제출적체중정상대사성비반,장비반안대사상태분위5류,즉정상대사성비반(백반자,“지인”)、저대사성비반(황반자,“고인”)、고대사성비반(홍반자,“비귀인”)、염증대사성비반(흑반자,“육인”)화체중정상대사성비반。기망본연구조제출적비반분류능기도포전인옥적작용,촉사림상의사종대사적각도거중신인식비반,근거환자적대사상태제정구유침대성적개체화치료방안,사비반적진단화치료체도예기적효과。
Obesity has been widely accepted as a metabolic disease and its occurrence is closely related to the genetics, environment, and inflammation. Up to now, body mass index is still regarded as the standard diagnostic criterion for obesity. It has not been revised for decades and could not meet the needs of clinical diagnosis and demands for specific treatment at present. In 2013, the concept of metabolic obesity was introduced at the American Diabetes Association ( ADA) annual conference, and it was further proposed that obesity should be classified according to the metabolic status and its related complications at the 2014 American Association of Clinical Endocrinologists ( AACE) annual conference. This means that scientists and clinicians have realized that the etiology of obesity may vary with different outcomes, the treatment should be focused on the metabolic regulation, not merely on weight loss. With years of clinical practice and research in obesity, we have observed and treated numerous obese patients, and we have found that obesity has a lot of phenotypes and clinical features which are related to the metabolic status. Based on our clinical findings, combined with the experience of Chinese traditional medicine, we now propose a new clinical classification and diagnosis of obesity based on individuals′ metabolic status, which, we believe, can facilitate clinicians′practice. Based on the metabolic status and skin features of obese patients, obesity is divided into metabolic healthy obesity (‘white obesity’) and metabolic unhealthy obesity. Then, the latter is further divided into three groups including high metabolic obesity (‘red obesity’ ) , low metabolic obesity (‘yellow obesity’ ) , and severe metabolic disorder with inflammation obesity (‘black obesity’ ) . If we also consider to add normal weight metabolic obesity to this classification, there should be five types of obesity to be classified as presented. We wish this proposed classification of obesity can play a valuable role in enabling clinicians to have a better understanding of obesity in relation to its metabolism, and to develop individualized treatment according to the metabolic status of the patient. As a result, we may finally achieve the desired outcomes through making appropriate diagnosis and treatments.