糖尿病周围神经病变的中医证型及相关因素研究

发布时间：2018-09-01 12:03

【摘要】：目的:分析中医证型分布规律,并调查患者相关临床资料,探讨相关指标与各证型间的相关性,以期总结中医证型分布规律,了解各危险成分于各证型中具体表现,进而对其发展变化做深入分析与探索,期于中医辨证治疗DPN提供理论、临床基础。材料与方法:选取2015年2月至2016年1月我院内分泌科诊治的DPN患者160例为研究对象,据《糖尿病中医防治指南》DPN中医辨证以及相关诊断标准明确诊断。且进行辨证分型,具体包含:肝肾亏虚证、痰瘀阻络证、阴虚血瘀证、气虚血瘀证。记录所有患者的年龄,性别,体重指数,糖尿病病程,糖化血红蛋白,甘油三脂,高、低密度脂蛋白等指标,将之与不同分型做相关性分析。结果:1.所选160例DPN患者中,男性64例,女性96例,分别占比40%、60%。其中肝肾亏虚证52例(32.5%);痰瘀阻络证32例(20%);气虚血瘀证28例(17.5%);阴虚血瘀证48例(30%)。不同证型患者的性别比无明显差异,无统计学意义(P0.05)。2.各组间两两比较,肝肾亏虚证年龄与阴虚血瘀证、气虚血瘀证年龄相比差异显著有统计学意义(P0.05),表明肝肾亏虚证组年龄较阴虚血瘀证、气虚血瘀证大。痰瘀阻络证年龄与气虚血瘀证年龄相比差异显著有统计学意义(P0.05);而肝肾亏虚证、痰瘀阻络证两组间年龄相比无显著性差异(P0.05)。气虚血瘀证与阴虚血瘀证两组间相比无显著性差异,不具有统计学意义。(P0.05)。3.各证型患者的体重指数比较,痰瘀阻络证气虚血瘀证阴虚血瘀证肝肾亏虚证;其中两组间比较提示痰瘀阻络证组与肝肾亏虚证组相比差异显著(P0.01),痰瘀阻络证组与其他各组相比有差异(P0.05),肝肾亏虚证组与气虚血瘀证组相比差异显著(P0.05),肝肾亏虚证组与阴虚血瘀证组相比差异显著(P0.05),而气虚血瘀证组与阴虚血瘀证组相比无显著性差异(P0.05)。4.各证型患者病程比较,肝肾亏虚证痰瘀阻络证阴虚血瘀证气虚血瘀证。各组间两两比较,肝肾亏虚证病程与气虚血瘀证及阴虚血瘀证相比差异显著有统计学意义(P0.05);而肝肾亏虚证与痰瘀阻络证组间病程相比无显著性差异(P0.05);痰瘀阻络证与气虚血瘀证、阴虚血瘀证之间相比有显著差异(P0.05);气虚血瘀证组与阴虚血瘀证组间病程相比无明显差异(P0.05)。5.各证型血糖相关指标如空腹血糖、餐后2小时血糖、糖化血红蛋白比较,结果显示阴虚血瘀证患者的空腹血糖、餐后2小时血糖为所有证型中最高,且与肝肾亏虚证组患者比较差异显著(P0.05);不同证型患者的糖化血红蛋白水平均高于正常值,阴虚血瘀证患者最高,痰瘀阻络证次之,肝肾亏虚最低;其中阴虚血瘀证与肝肾亏虚证组患者比较差异显著(P0.05),其余各组间比较无显著差异(P0.05)。6.各证型血脂相关指标如TC、TG、HDL-C与LDL-C比较,结果显示TC方面,阴虚血瘀证组的TC较高,与气虚血瘀证组和肝肾亏虚证组的比较有显著性差异具有有统计学意义(P0.05),与痰瘀阻络证组比较无显著性差异(P0.05),而气虚血瘀证组、肝肾亏虚证组与痰瘀阻络证组三组之间比较差异不显著(P0.05);LDL-C方面,以阴虚血瘀证组最高,与气虚血瘀证组比较有显著性意义(P0.05),其余各组间比较无显著性差异(P0.05);TG、HDL-C方面,痰瘀阻络证组的TG、HDL-C值均较高,但各组间两两比较差异均不显著(P0.05)。结论:1.糖尿病周围神经病变中医证型分布由多到少依次为肝肾亏虚证,阴虚血瘀证,痰瘀阻络证,气虚血瘀证。2.肝肾亏虚型糖尿病周围神经病变病程较长且年龄偏大。3.痰瘀阻络型患者BMI均值明显高于其他各组。4.不同证型组间均存在不同程度的血糖、血脂异常。
[Abstract]:Objective: To analyze the distribution of TCM syndromes, investigate the clinical data of patients, and explore the correlation between the relevant indicators and syndromes, so as to summarize the distribution of TCM syndromes, to understand the specific manifestations of various dangerous components in each syndromes, and to make in-depth analysis and exploration of its development and change, so as to provide theory and clinical evidence for the treatment of DPN by TCM syndrome differentiation. Materials and Methods: 160 cases of DPN diagnosed and treated in the Department of Endocrinology of our hospital from February 2015 to January 2016 were selected as the research object, and the diagnosis was made according to the syndrome differentiation of traditional Chinese medicine and relevant diagnostic criteria. The age, sex, body mass index, course of diabetes, glycosylated hemoglobin, triglyceride, high, low density lipoprotein and other indicators of all patients were recorded and correlated with different types. Results: 1. Among 160 DPN patients, 64 were males and 96 were females, accounting for 40% and 60% respectively. There was no significant difference in sex ratio among different syndrome types (P 0.05). 2. There was significant difference between the age of liver and kidney deficiency syndrome and yin deficiency and blood stasis syndrome, and the age of qi deficiency and blood stasis syndrome was significantly different (P 0.05). The age of phlegm-stasis obstructing collateral syndrome was significantly different from that of Qi-deficiency and blood-stasis syndrome (P 0.05), but there was no significant difference between the two groups of liver-kidney deficiency and phlegm-stasis obstructing collateral syndrome (P 0.05). 3. Comparing the body mass index of the patients with different syndrome types, the syndrome of phlegm-stasis obstructing collaterals with Qi deficiency and blood stasis with Yin deficiency and blood stasis with liver and kidney deficiency syndrome is of deficiency of liver and kidney; the comparison between the two groups indicates that there is a significant difference between the syndrome of phlegm-stasis obstructing collaterals and the syndrome of liver and kidney deficiency (P 0.01), the syndrome of phlegm-stasis obstructing collaterals is different from the other groups (P 0.05 Significant (P 0.05), liver and kidney deficiency syndrome group and Yin deficiency and blood stasis syndrome group was significantly different (P 0.05), but Qi deficiency and blood stasis syndrome group and Yin deficiency and blood stasis syndrome group was no significant difference (P 0.05). 4. Comparing the course of disease of each syndrome type, liver and kidney deficiency syndrome of phlegm and blood stasis syndrome of Yin deficiency and blood stasis syndrome. Stasis syndrome and yin deficiency and blood stasis syndrome were significantly different (P 0.05); liver and kidney deficiency syndrome and phlegm stagnation collateral syndrome were not significantly different (P 0.05); phlegm stagnation collateral syndrome and Qi deficiency and blood stasis syndrome, Yin deficiency and blood stasis syndrome were significantly different (P 0.05); Qi deficiency and blood stasis syndrome and yin deficiency and blood stasis syndrome were not significantly different (P 0.05); The results showed that the fasting blood glucose of the patients with Yin deficiency and blood stasis syndrome and the blood glucose of 2 hours after meal were the highest among all the syndrome types, and there was significant difference between the patients with liver and kidney deficiency syndrome and the patients with different syndrome types (P 0.05). Compared with the normal value, the patients with Yin deficiency and blood stasis syndrome were the highest, phlegm and blood stasis obstructing collaterals syndrome was the second, liver and kidney deficiency was the lowest; the difference between the patients with Yin deficiency and blood stasis syndrome and the patients with liver and kidney deficiency syndrome was significant (P 0.05), and there was no significant difference between the other groups (P 0.05). 6. TC in group A was higher than that in group B (P 0.05), but there was no significant difference between group B (P 0.05), group B (P 0.05), group B (P 0.05), and group B (P 0.05). Syndrome group was the highest, compared with Qi deficiency and blood stasis syndrome group, there was significant difference (P 0.05), there was no significant difference between the other groups (P 0.05); TG, HDL-C, the phlegm stasis collateral syndrome group TG, HDL-C values were higher, but there was no significant difference between the two groups (P 0.05). Conclusion: 1. Diabetic peripheral neuropathy of traditional Chinese medicine syndrome distribution from more to less in turn is liver. Kidney deficiency syndrome, Yin deficiency and blood stasis syndrome, phlegm and blood stasis syndrome, Qi deficiency and blood stasis syndrome. 2. Liver and kidney deficiency diabetes mellitus peripheral neuropathy longer course and older. 3. Phlegm and blood stasis collateral type patients BMI was significantly higher than other groups. 4. There were different degrees of blood glucose and blood lipid abnormalities between different syndrome groups.
【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】：2016
【分类号】：R259;R277.7

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