糖尿病足中医证型及其临床特点的分析

发布时间：2018-04-25 19:21

本文选题：糖尿病足 + 中医证型　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:通过对133例住院糖尿病足病患者的中医证候分布情况及临床资料的研究,探讨糖尿病足的中医证候分布规律和中医证型间临床检验指标、下肢动脉彩超、Wagner分级、内科治疗有效率之间的关系,以期为糖尿病足的辨证论治提供客观的依据。材料与方法:选取2015年2月至2016年10月于锦州市中心医院内分泌科住院的糖尿病足患者共计133例,通过中医望、闻、问、切四诊进行辨证分型,统计纳入患者的性别、年龄、病程、体重指数和白细胞计数、血糖、血脂、下肢动脉彩超、Wagner分级、有效率等临床资料,对其进行回顾性分析,并且分析中医证型间临床资料的关系。结果:1.一般资料的情况:男性80例,女性53例,男:女=1.51:1;年龄大于60岁的患者占总体的57.89%;糖尿病病程大于5年的患者占总体的87.22%;BMI大于25 kg/m2的患者占总体的89.47%。2.中医证型分布:血脉瘀阻证气血两虚证湿热壅盛证寒湿阻络证热毒伤阴证。3.中医证型间年龄的关系,气血两虚证最大,与血脉瘀阻证、寒湿阻络证相比,差异有统计学意义(p㩳0.05);糖尿病病程的关系,气血两虚证最长,与血脉瘀阻证、热毒伤阴证相比,差异有统计学意义(p㩳0.05);体重指数的关系,湿热壅盛证最大,与其他四组证型相比,差异有统计学意义(p㩳0.05)。4.中医证型间白细胞计数的关系,湿热壅盛证最高,与其他四组证型相比较,差异有统计学意义(p㩳0.05);空腹血糖的关系,湿热壅盛证最高,与血脉瘀阻证、气血两虚证相比,差异有统计学意义(p㩳0.05);糖化血红蛋白的关系,热毒伤阴证最高,与其他四组证相比,差异有统计学意义(p㩳0.05)。5.中医证型间甘油三酯的关系,寒湿阻络证最高,与血脉瘀阻证、气血两虚证、湿热壅盛证相比,差异有统计学意义(p㩳0.05);总胆固醇的关系,寒湿阻络证最高,与血脉瘀阻证相比,差异具有统计学意义(p㩳0.05);高密度脂蛋白的关系,各组证型相比无统计学差异(p0.05);低密度脂蛋白的关系,寒湿阻络证最高,与血脉瘀阻证、湿热壅盛证型相比,差异有统计学意义(p㩳0.05)。6.中医证型间下肢动脉病变情况的关系:血脉瘀阻证以轻中度为主,与其他四组证型相比较,差异有统计学意义(p㩳0.05);气血两虚证以重度及闭塞为主,与其他四组证型相比较,差异有统计学意义(p㩳0.05)。7.中医证型与Wagner分级的关系:血脉瘀阻证以轻型为主,与其他四组证型相比较,差异有统计学意义(p㩳0.05);气血两虚证以重型为主,与其他四组证型行比较,差异有统计学意义(p㩳0.05)。8.中医证型间有效率的比较:经过内科治疗后,血脉瘀阻证有效率为85.00%,气血两虚证有效率为78.13%,湿热壅盛证有效率为72.00%,热毒伤阴证有效率为66.67%,寒湿阻络证有效率为79.17%。血脉瘀阻证与气血两虚证、湿热壅盛证、热毒伤阴证、寒湿阻络证与相比,差异有统计学意义(p㩳0.05)。结论:1.糖尿病足以血脉瘀阻证最常见,其次是气血两虚证、湿热壅盛证、寒湿阻络证,热毒伤阴证最少见。2.病程长、年龄大、超重和肥胖的男性糖尿病患者可能发生糖尿病足。3.血脉瘀阻证多见于糖尿病足初期,患者下肢血管病变程度较轻,内科治疗有效率较高。4.气血两虚证多见于糖尿病足后期,患者年龄较大,糖尿病病程较长,下肢动脉病变较重,下肢缺血明显。5.湿热壅盛证患者体重控制差,感染程度较重,空腹血糖升高明显。6.所有患者糖化血红蛋白均升高,热毒伤阴证患者升高明显,血糖控制最差,内科治疗效果较差。7.大部分患者均存在血脂代谢异常,寒湿阻络证患者甘油三酯、总胆固醇和低密度脂蛋白水平最高,血脂紊乱明显。
[Abstract]:Objective: To explore the distribution of TCM syndromes and clinical data of 133 patients with diabetic foot disease, and to explore the distribution of TCM syndromes and the clinical test index between TCM syndrome types, color Doppler ultrasound of lower extremity, Wagner classification, and the relationship between medical treatment efficiency, so as to provide customers with the syndrome differentiation and treatment of diabetic foot. Materials and methods: a total of 133 diabetic foot patients hospitalized in Department of endocrinology of Jinzhou Central Hospital from February 2015 to October 2016 were divided into 133 cases by TCM looking, hearing, asking, and cutting diagnosis. The statistics were included in the patients' sex, age, course of disease, body mass index and white blood cell count, blood sugar, blood lipid, arterial color Doppler of lower extremity, Wagn Er classification, efficiency and other clinical data, retrospective analysis and analysis of the relationship between the clinical data of TCM syndrome. Results: 1. general information: male 80 cases, female 53 cases, male: female =1.51:1; patients older than 60 years accounted for 57.89% of the total; patients with diabetes course for more than 5 years accounted for 87.22% of the total; BMI greater than 25 kg/m2 The patients accounted for the overall 89.47%.2. syndrome type distribution: Blood Stasis Syndrome Qi and blood two deficiency syndrome of damp heat syndrome, cold dampness and dampness and collaterals syndrome.3. TCM syndrome age relationship, Qi and blood two deficiency syndrome maximum, compared with blood stasis syndrome and cold dampness obstruction syndrome, the difference has statistical significance (P? 0.05); the relationship between diabetes course, Qi and blood two deficiency syndrome is the longest, Compared with blood stasis syndrome, the difference was statistically significant (P 0.05). The relationship between body mass index and damp heat syndrome was the largest, compared with the other four groups, the difference was statistically significant (P? 0.05) the relationship between the white blood cell count of.4. syndrome type, the highest damp heat syndrome, compared with the other four groups, the difference was statistically significant ( P? 0.05); the relationship between fasting blood glucose, the highest damp heat syndrome, the difference between the blood stasis syndrome and the Qi and blood two deficiency syndrome, the difference has statistical significance (P? 0.05); the relationship between the glycated hemoglobin and the heat toxin negative syndrome is the highest. Compared with the other four groups, the difference is statistically significant (P? 0.05) the relationship between triglycerides in the.5. TCM syndrome type, the highest cold dampness obstruction syndrome, and the highest Blood stasis syndrome, Qi and blood two deficiency syndrome, the syndrome of damp heat accumulation, the difference was statistically significant (P? 0.05); the relationship of total cholesterol, cold dampness obstruction syndrome was the highest, compared with blood stasis syndrome, the difference was statistically significant (P? 0.05); the relationship between high density lipoprotein, no statistical difference (P0.05), low density lipoprotein relationship, cold dampness The obstruction of collaterals was the highest, compared with blood stasis syndrome and damp heat syndrome, the difference was statistically significant (P? 0.05).6. TCM syndrome types of lower extremity artery disease: blood stasis syndrome was mainly light and moderate, compared with other four groups, the difference was statistically significant (P? 0.05); Qi and blood two deficiency syndrome was mainly severe and occlusion, and the other four groups The difference was statistically significant (P? 0.05).7. TCM syndrome type and Wagner classification: blood stasis syndrome was mainly light, compared with the other four groups, the difference was statistically significant (P? 0.05); Qi and blood two deficiency syndrome was mainly heavy, and compared with the other four groups, the difference was statistically significant (P? 0.05).8. TCM Syndrome Types Efficiency comparison: after medical treatment, the effective rate of blood stasis syndrome was 85%, the effective rate of Qi and blood two deficiency syndrome was 78.13%, the effective rate of damp heat syndrome was 72%, the effective rate of hot and toxic Yin Syndrome was 66.67%, the effective rate of cold dampness obstructing collaterals was 79.17%. blood stasis syndrome and Qi and blood two deficiency syndrome, damp heat obstructing syndrome, heat toxic injury Yin Syndrome, cold dampness obstructing collaterals syndrome and comparison, The difference was statistically significant (P 0.05). Conclusion: 1. diabetes is the most common blood stasis syndrome, followed by Qi and blood two deficiency syndrome, damp heat stagnation syndrome, cold dampness obstructing collaterals, the least.2. disease course long, age, overweight and obese male diabetic patients with diabetic foot.3. blood stasis may be seen in the early stage of diabetic foot. The lower extremity vascular disease degree is lighter, the effective rate of.4. Qi and blood two is more common in the late stage of diabetes foot, the patient is older, the course of diabetes is longer, the lower extremity artery disease is heavy, the lower limb ischemia obviously.5. damp heat syndrome, the weight control is poor, the infection degree is heavy, the fasting blood sugar is obviously increased.6. all patients saccharification blood The increase of erythropoiet was increased, the patients with heat and poison Yin Syndrome increased obviously, the blood sugar control was the worst, the most of the patients with poor therapeutic effect in internal medicine had abnormal lipid metabolism, the triglycerides in the cold dampness obstructing syndrome patients, the highest levels of total cholesterol and low density lipoprotein, and the obvious dyslipidemia in.7..

【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】