糖尿病周围神经病变患者血小板活化与中医证型分布的关系研究

Study on the Relationship between Platelet Activation and TCM Syndrome Distribution in Patients with Diabetic Peripheral Neuropathy

[目的]探讨糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者血小板活化与中医证型分布的关系。[方法]收集2020年2月至2022年12月于本院住院确诊的DPN患者188例。中医证型采用指标聚类分析,绘制聚类图。采用简单对应分析中医证型与病变程度的对应性,比较不同中医证型的一般临床资料、血小板参数及血小板活化物,从而探讨血小板活化与中医证型分布的关系。[结果]截取聚类图的不同位置,证型分型不同,其中D点截取分为5个证型:阳虚证、气虚证、阴虚证、瘀血痹阻证及痰湿阻络证。188例DPN患者中,痰湿阻络证18例(9.57%)、瘀血痹阻证53例(28.19%)、阳虚证28例(14.89%)、阴虚证39例(20.74%)、气虚证50例(26.60%)。DPN病变程度分级为Ⅰ级56例(29.79%)、Ⅱ级76例(40.43%)、Ⅲ级56例(29.79%)。痰湿阻络证和瘀血痹阻证在二维投影图中间,并未偏向DPN病变程度某一分级;阳虚证偏向Ⅲ级,阴虚证偏向Ⅱ级,气虚证偏向Ⅰ级。与气虚证比较,阴虚证、阳虚证患者的血小板(blood platelet,PLT)计数、平均血小板体积(mean platelet volume,MPV)、血小板分布宽度(platelet distribution width,PDW)、E26转录因子-1(E26 transformation specific-1,ETS-1)、血小板活化因子(platelet activating factor,PAF)及血小板颗粒膜蛋白-140(granular membrane protein-140,GMP-140)均明显升高(P<0.05);与阴虚证比较,阳虚证患者的PLT、MPV、PDW、GMP-140、PAF、ETS-1均明显升高(P<0.05)。[结论]临床可常规将DPN分为阳虚、气虚、瘀血痹阻、阴虚和痰湿阻络5个证型。随着DPN进展,中医证型也发生从气虚到阴虚到阳虚的转化,而瘀血痹阻和痰湿阻络伴随DPN患者各阶段。在DPN进展中,血小板活化可能参与中医证型转化过程。

[Objective]To investigate the relationship between platelet activation and traditional Chinese medicine(TCM)syndrome distribution in patients with diabetic peripheral neuropathy(DPN).[Methods]A total of 188 DPN patients admitted to our hospital from February 2020 to December 2022 were collected.The TCM syndrome type usesd the index cluster analysis to draw the cluster diagram.The correspondence between TCM syndrome type and lesion degree was analyzed by simple correspondence analysis,and shown on the twodimensional plan.It compared the general clinical data,platelet parameters and platelet activation of different TCM syndrome types,so as to explore the relationship between platelet activation and the distribution of TCM syndrome types.[Results]The syndrome types summarized in different positions of the cluster map were different.Among them,D-point interception could be divided into five syndrome types:Qi deficiency syndrome,Yin deficiency syndrome,Yang deficiency syndrome,stagnation of blood stasis syndrome and phlegmdampness blocking collaterals syndrome.Among the 188 DPN patients,phlegm-dampness blocking collaterals syndrome was found in 18 cases(9.57%),stagnation of blood stasis syndrome in 53 cases(28.19%),Yang deficiency syndrome in 28 cases(14.89%),Yin deficiency syndrome in 39 cases(20.74%),and Qi deficiency syndrome in 50 cases(26.60%).The grade of DPN lesion was gradeⅠin 56 cases(29.79%),gradeⅡin 76 cases(40.43%),and gradeⅢin 56 cases(29.79%).The syndrome of phlegm-dampness blocking collaterals and stagnation of blood stasis in the middle of the two-dimensional projection map did not deviate to a certain grade of DPN lesion degree;Yang deficiency syndrome inclined to gradeⅢ,Yin deficiency syndrome to gradeⅡ,and Qi deficiency syndrome to gradeⅠ.Compared with Qi deficiency syndrome,platelets(PLT),mean platelet volume(MPV),platelet distribution width(PDW),granular membrane protein-140(GMP-140),platelet activating factor(PAF)and E26 transformation specific-1(ETS-1)in patients with Yin deficiency syndrome and Yang deficiency syndrome were significantly higher(P<0.05),and PLT,MPV,PDW,GMP-140,PAF and ETS-1 in patients with Yang deficiency syndrome were higher than those of Yin deficiency syndrome(P<0.05).[Conclusion]DPN can be routinely divided into five basic syndrome types:Qi deficiency,Yin deficiency,Yang deficiency,stagnation of blood stasis and phlegm-dampness blocking collaterals.With the development of DPN,TCM syndromes are transformed from Qi deficiency to Yin deficiency to Yang deficiency,while blood stasis and phlegm-dampness blocking collaterals are accompanied by various stages of DPN patients.In the progress of DPN,platelet activation may be involved in the transformation of TCM syndrome types.