2型糖尿病中医证型分布与踝肱指数和血液流变学的相关性研究

发布时间：2018-06-22 16:33

本文选题：2型糖尿病 + 中医辨证分型　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:观察2型糖尿病不同中医证型的分布规律和发展趋势,探讨不同中医证型与踝肱指数、血液流变学的相关性,为中医证型规范化和系统化分类提供实验室依据,为临床重点预防及治疗2型糖尿病患者动脉硬化等血管并发症提供理论依据。方法:选取2016年4月至2016年8月于无锡市中西医结合医院内分泌科病房2型糖尿病住院患者共120例作为研究组,入选患者均符合2013年中华医学会糖尿病分会《中国2型糖尿病防治指南》提出的诊断标准、1999年WHO糖尿病专家委员会提出的分型标准以及排除标准。中医辩证分型2002年参照卫生部《中医新药临床研究指导原则》及2007年中华医药学会《糖尿病中医防治指南》,结合临床观察分为气阴两虚证、血瘀脉络证、阴虚火旺证和阴阳两虚证。同时选取该院健康体检者共50例作为对照组。收集两组基本情况(姓名、性别、年龄、病史等),分别观察分析各组的空腹血糖、糖化血红蛋白、踝肱指数、血液流变学等指标。结果:1.2型糖尿病各中医证型所占比例由低到高依次为阴阳两虚证(17.5%)阴虚火旺证(23.3%)血瘀脉络证(26.7%)气阴两虚证(32.5%)。2.T2DM各中医证型组中,病程随阴虚火旺组、气阴两虚组、血瘀脉络组、阴阳两虚组递增;其中阴虚火旺组病程最短,阴阳两虚组病程最长,与其余各组之间有统计学差异(P0.05、P0.01)。空腹血糖水平随阴虚火旺组、气阴两虚组、血疲脉络组、阴阳两虚组递增;糖化血红蛋白水平随阴虚火旺组、气阴两虚组、血瘀脉络组、阴阳两虚组递增。3.右侧踝肱指数及左侧踝肱指数均随血瘀脉络组、阴阳两虚组、阴虚火旺组、正常对照组、气阴两虚组递增;其中血瘀脉络组及阴阳两虚组的双侧踝肱指数均较低,且阴阳两虚组与正常对照组以及其余各中医证型组两两之间比较有统计学差异(P0.05),血瘀脉络组与正常对照组以及其余各中医证型组两两之间比较有明显统计学差异(P0.01)。4.T2DM组与正常对照组比较,血液流变学指标较高,差异具有统计学意义(P0.05),其中两组在全血黏度(高切)、毛细管血浆黏度及血沉方面比较具有显著的统计学意义(P0.01)。T2DM各中医证型组中,全血黏度(低切)、全血黏度(高切)、毛细管血浆黏度、血沉、红细胞压积与红细胞聚集指数均随气阴两虚组、阴虚火旺组、阴阳两虚组、血瘀脉络组递增;两两相比,T2DM各中医证型组间差异均有统计学意义(P0.05、P0.01),其中血瘀脉络组与阴虚火旺组,气阴两虚组与血瘀脉络组、阴阳两虚组之间的差异有显著统计学意义(p0.01)。结论:1.气阴两虚证为2型糖尿病临床中最为常见的中医证型,其次为血瘀脉络证、阴虚火旺证,阴阳两虚证例数最少。2.2型糖尿病患者病程及空腹血糖水平由低到高依次为阴虚火旺证气阴两虚证血瘀脉络证阴阳两虚证,阴虚火旺证糖化血红蛋白水平最低,阴阳两虚证最高,2型糖尿病病程越长,病情逐渐加重。3.2型糖尿病患者右侧踝肱指数及左侧踝肱指数由低到高依次为血瘀脉络证阴阳两虚证阴虚火旺证气阴两虚证;其中血瘀脉络证组双侧踝肱指数最低,可将踩肱指数的测定作为预估糖尿病动脉硬化等慢性血管并发症的参考指标之一。4.2型糖尿病患者较健康体检者血液流变学指标水平异常升高,由低到高依次为气阴两虚证阴虚火旺证阴阳两虚证血瘀脉络证,其中血瘀脉络证的血液流变学指标最高,可将血液流变学指标的测定作为防治糖尿病尤其是老年糖尿病的血管并发症的量化指标之一;血瘀贯穿于糖尿病的发展始终,临床上适当应用活血化瘀疗法对改善糖尿病并发症及改善预后有重要意义。
[Abstract]:Objective: To observe the distribution and development trend of different TCM Syndrome Types in type 2 diabetes, explore the correlation between different TCM Syndrome Types and the ankle brachial index and hemorheology, provide laboratory basis for the standardization and systematic classification of TCM syndrome type, and provide the theory for prevention and treatment of vascular complications such as arteriosclerosis in patients with type 2 glycan disease. Methods: a total of 120 hospitalized patients with type 2 diabetes in the Department of endocrinology of the integrated traditional Chinese medicine and Western medicine hospital in Wuxi from April 2016 to August 2016 were selected as the research group. All the patients were in conformity with the standard of diagnosis and treatment of type 2 diabetes prevention and control of China in 2013, the Chinese Medical Association of China, in 1999, and the WHO diabetes expert committee in 1999 proposed In 2002, the dialectical classification of traditional Chinese medicine was divided into two deficiency syndrome of Qi Yin, blood stasis choroid syndrome, yin deficiency fire flourish syndrome and Yin Yang two deficiency syndrome, and 50 healthy persons in the hospital were selected. Two groups of basic conditions (name, sex, age, medical history, etc.) were collected to observe and analyze the fasting blood glucose, glycosylated hemoglobin, ankle brachial index and hemorheology, respectively. Results: the proportion of TCM syndrome types of type 1.2 diabetes from low to high was in the order of Yin Yang two deficiency syndrome (17.5%) yin deficiency and fire prosperity (23.3%) blood stasis vein Syndrome (26.7%) Qi Yin two deficiency syndrome (32.5%).2.T2DM syndrome type group, the course of disease with Yin deficiency fire group, Qi Yin deficiency group, blood stasis choroid group, yin and yang two deficiency group increasing; among them, yin deficiency group with the shortest course of disease, yin and yang two virtual group course is the longest, and the other groups between the statistical difference (P0.05, P0.01). Fasting blood glucose level with Yin deficiency flourishing group, Qi Yin Two deficiency group, blood exhaustion choroid group, Yin Yang two deficiency group increased progressively; the level of glycosylated hemoglobin with Yin deficiency fire group, Qi Yin deficiency group, blood stasis choroid group, Yin Yang two deficiency group increased.3. right ankle brachial index and left ankle brachial index in the group of blood stasis vein group, Yin yang two deficiency group, yin deficiency fire flourish group, normal control group, Qi Yin deficiency group increasing; among them blood stasis choroid group Both yin and yang two deficiency group had lower bilateral ankle brachial index, and there was a statistical difference between the group of Yin Yang two deficiency and the normal control group and the other TCM syndrome type group (P0.05). There was significant difference between the blood stasis choroid group and the normal control group and the other TCM Syndrome group 22 (P0.01).4.T2DM group and the normal control group. The blood rheology index was higher and the difference was statistically significant (P0.05). The two groups had significant statistical significance (P0.01) in the whole blood viscosity (Gao Qie), capillary plasma viscosity and erythrocyte sedimentation rate (P0.01), the whole blood viscosity (low shear), whole blood viscosity (Gao Qie), capillary plasma viscosity, erythrocyte sedimentation, and hematocrit And the index of red blood cell aggregation with Qi and yin deficiency group, yin deficiency fire group, yin and yang two deficiency group, blood stasis choroid group increased progressively; compared with 22, T2DM each of the TCM syndrome types were statistically significant (P0.05, P0.01), among which blood stasis choroid group and yin deficiency group, Qi Yin deficiency group and blood stasis group, Yin Yang two deficiency group have significant statistics P0.01. Conclusion: 1. Qi Yin two deficiency syndrome is the most common type of TCM syndrome in type 2 diabetes, followed by blood stasis choroid syndrome, yin deficiency and fire prosperity syndrome, Yin Yang two deficiency syndrome, the course of the least.2.2 type diabetes and the level of fasting blood glucose from low to high in turn are yin deficiency, Qi Yin, Qi Yin, Qi Yin, two deficiency syndrome, blood stasis, Yin Yang two deficiency syndrome and yin deficiency. The level of glycosylated hemoglobin is the lowest, the deficiency of yin and yang two is the highest, the course of type 2 diabetes is longer, the disease progressively aggravates the right ankle brachial index and the left ankle brachial index from low to high in order for the patients with type.3.2 diabetes, which is the blood stasis vein syndrome Yin Yang two deficiency syndrome Yin deficiency and the Qi Yin two deficiency syndrome, and the bilateral ankle brachial index in the blood stasis choroid group is the lowest. The measurement of the brachial index can be used as one of the reference indexes for predicting the chronic vascular complications such as diabetes arteriosclerosis, the abnormal elevation of hemorheological indexes in the patients with type.4.2 diabetes mellitus, from low to high is the blood stasis syndrome of yin and yang two deficiency syndrome of yin deficiency of yin deficiency of two of Qi Yin and the blood stasis of blood stasis. The hemorrheology index is the highest, which can be used to measure the hemorrheology index as one of the quantitative indexes for the prevention and treatment of diabetic vascular complications, especially in the elderly diabetes. The blood stasis is throughout the development of diabetes. The clinical application of blood circulation and stasis therapy is of great significance in improving the complications of diabetes and improving the prognosis.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】