摘要
目的 研究2型糖尿病大血管病变患者的中医证候要素分布特征与疾病转归关键要素。方法 采用多中心、横断面研究方法,纳入5家医院2型糖尿病患者445例,根据是否存在大血管病变分为糖尿病本病组120例和糖尿病大血管病变组325例。糖尿病大血管病变组患者根据外周血管彩色多普勒超声结果并按照血管病变程度分级标准分为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级。采集两组患者一般资料,包括性别、年龄、2型糖尿病病程、体重指数(BMI),调查中医四诊资料并根据中医证候要素诊断标准分为气虚、血虚、阴虚、阳虚、气滞、痰湿、血瘀、实热、实寒9种。比较两组患者一般资料、中医证候要素分布情况,糖尿病大血管病变组不同血管病变程度分级的中医证候要素分布情况,采用Logistic回归分析方法分析各中医证候要素对2型糖尿病大血管病变发生发展的影响。结果 糖尿病本病组与糖尿病大血管病变组性别、BMI比较差异无统计学意义(P>0.05);糖尿病大血管病变组年龄、糖尿病病程高于糖尿病本病组(P<0.01)。糖尿病大血管病变严重程度随年龄、糖尿病病程增加呈加重趋势(P<0.05或P<0.01)。2型糖尿病患者各中医证候要素间BMI、病程比较差异无统计学意义(P>0.05);血瘀平均年龄最高(P<0.05);实热与阴虚患者性别分布比较差异有统计学意义(P<0.05)。糖尿病本病组提取中医证候要素240个,糖尿病大血管病变组提取中医证候要素731个,两组高频中医证候要素前2位均为气虚、阴虚(频率>50%);痰湿、血瘀在糖尿病大血管病变组分布比例高于糖尿病本病组(P<0.01)。气虚、阴虚、痰湿、血瘀、实热在糖尿病大血管病变组不同血管病变程度分级间分布比较差异有统计学意义(P<0.01);气虚、阴虚频率在0~Ⅲ级中均为高频中医证候要素,痰湿频率随疾病进展从0~Ⅳ级逐渐升高,血瘀频率整体呈升高趋势。Logistic回归分析显示,痰湿、血瘀是2型糖尿病大血管病变疾病进展的关键中医证候要素(P<0.05或P<0.01)。结论 气虚、阴虚是贯穿2型糖尿病及大血管病变全程的基本中医证候要素,痰湿、瘀血与2型糖尿病大血管病变的血管病变程度相关,是2型糖尿病大血管病变进程中的关键中医证候要素。
Objective To explore the distribution characteristics of traditional Chinese medicine(TCM)syndrome elements of macroangiopathy in patients with type 2 diabetes mellitus(T2DM)and the key elements of occurrence,development and progression of disease.Methods A multicenter cross-sectional study was conducted to enroll 445T2DM patients from five hospitals,and according to the presence or absence of macroangiopathy,the patients were divided into a T2DM group(120 cases)and a diabetic macroangiopathy(DM)group(325 cases).Patients in DM group were divided into gradeⅠ,Ⅱ,ⅢandⅣaccording to the peripheral vascular color Doppler ultrasound results and the vascular anomalies classification standard.The general data including gender,age,duration of T2DM and body mass index(BMI)were collected,and the data of four examinations were obtained for syndrome differentiation.According to the diagnostic criteria of TCM syndrome elements,the patients can be divided into 9 patterns including qi deficiency,blood deficiency,yin deficiency,yang deficiency,qi stagnation,blood stasis,excess heat,and excess cold.The general data and distribution of TCM syndrome elements were compared between the two groups.The distribution of TCM syndrome elements in different vascular anomalies grades in the DM group was analyzed.Logistic regression analysis was used to explore the influence of various TCM syndrome elements on the occurrence of macroangiopathy in T2DM.Results There was no significant difference in gender and BMI between groups(P>0.05).The age and duration of diabetes in the DM group were older and longer than those in the T2DM group(P<0.01).With the increase of age and prolonged course of disease,the severity of diabetic macroangiopathy increases gradually(P<0.05 or P<0.01).There was no significant difference in BMI and course of disease among the different TCM syndrome elements(P>0.05).The average age of patients with blood stasis syndrome was the oldest(P<0.05).There was significant difference in gender distribution between the excess heat syndrome and yin deficiency syndrome(P<0.05).A total of 240 TCM syndrome elements were extracted from the T2DM group,while 731 TCM syndrome elements extracted from the DM group.The top two high-frequency syndrome elements in the two groups were qi deficiency and yin deficiency,with a frequency of larger than 50%.The distribution of phlegm-damp syndrome and bloodstasis syndrome were significantly higher in the DM group than in the T2DM group(P<0.01).There were significant differences in the distribution of qi deficiency syndrome,yin deficiency syndrome,phlegm-damp syndrome,blood stasis syndrome,and excess heat syndrome among different grades of vascular anomalies(P<0.01);qi deficiency and yin deficiency were both high-frequency TCM syndrome elements in patients at grades 0 toⅢ;phlegm-damp syndrome increased in frequency with the progression of the disease from grades 0 toⅣ,and the frequency of blood stasis syndrome showed an overall upward trend.The frequency of phlegm-dampness syndrome increased from grades 0 toⅣwith the progression of the disease,and the frequency of blood stasis syndrome showed an overall upward trend.Logistic regression analysis showed that phlegm-damp syndrome and blood stasis syndrome were important TCM syndrome elements related to the vascular anomalies degree of macrovascular disease in T2DM(P<0.05 or P<0.01).Conclusion Qi deficiency and yin deficiency are the basic TCM syndrome elements throughout the whole process of T2DM and diabetic macrovascular disease.Phlegm-damp and blood stasis are related to the degree of vascular anomalies in diabetic macrovascular disease and are the key TCM syndrome elements in the progression of macroangiopathy in T2DM.
作者
冷玉琳
高泓
富晓旭
徐刚
谢红艳
卓兴卫
周小芹
杨义
袁小丽
王智彪
谢春光
LENG Yulin;GAO Hong;FU Xiaoxu;XU Gang;XIE Hongyan;ZHUO Xingwei;ZHOU Xiaoqin;YANG Yi;YUAN Xiaoli;WANG Zhibiao;XIE Chunguang(Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu,610072;Sichuan Provincial Key Laboratory of Traditional Chinese Medicine Regulating Metabolic Diseases;Research Center of Clinical Epidemiology and EvidenceBased Medicine,West China Hospital,Sichuan University;School of Management of Chengdu University of Traditional Chinese Medicine;State Key Laboratory of Ultrasound in Medicine and Engineering,Chongqing Medical University)
出处
《中医杂志》
CSCD
北大核心
2024年第17期1794-1801,共8页
Journal of Traditional Chinese Medicine
基金
国家中医药管理局岐黄学者支持项目(国中医药人教函[2022]6号)
国家中医药管理局中医药创新团队及人才支持项目(ZYYCXTD-C-202209)
四川省科学技术厅重大科技专项(2022ZDZX0022)。
关键词
2型糖尿病
糖尿病大血管病变
中医证候要素
气虚
阴虚
痰湿
瘀血
type 2 diabetes mellitus
diabetic macrovascular disease
traditional Chinese medicine syndrome elements
qi deficiency
yin deficiency
phlegm-damp
blood stasis
作者简介
通讯作者:谢春光,xiecg@cdutcm.edu.cn。
