2型糖尿病中医证型分布特点及主要证型糖脂代谢与兼症的关系分析

Analysis of Distribution Characteristics of Traitional Chiense Medicine Syndromes in Type 2 Diabetes Mellitus and Relationship between Glucolipid Metabolism of Main Syndrome and Accompanied Symptom

目的:探究2型糖尿病(T2DM)的中医证型分布特点及主要证型糖脂代谢与兼症的关系。方法:选取我院2019年8月至2021年8月收治的296例T2DM患者。根据临床症状对所有患者进行辨证分型,统计分析各中医证型在性别、年龄、病程方面的分布情况,对比分析主要证型的糖脂代谢指标与兼症的关系。结果:(1)296例T2DM患者中医证型占比从高到低依次为气阴两虚证92例(31.08%)、湿热困脾81例(27.36%)、阴虚火旺73例(24.66%)、阴阳两虚27例(9.12%)、血瘀脉络23例(7.77%)。(2)各中医证型的性别分布无差异(P>0.05);T2DM患者各中医证型的年龄分布比较有差异(P<0.05),<45岁患者多表现为湿热困脾证或阴虚热盛证,45~60岁患者多表现为湿热困脾证,>60岁患者多表现为阴阳两虚证或血瘀脉络证;T2DM患者各中医证型的病程分布比较有差异(P<0.05),病程<5年的多表现为湿热困脾证或阴虚热盛证,5~10年及>10年病程的多表现为阴阳两虚证或血瘀脉络证。(3)气阴两虚证兼痰淤证及血瘀证患者的空腹血糖(FPG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)水平均显著高于无兼证患者;血瘀证患者的甘油三酯(TG)水平显著高于无兼证患者,FPG、TC水平均显著高于痰淤证患者(P<0.05)。(4)湿热困脾证兼气滞证及痰淤证患者的胰岛素抵抗指数(HOMA-IR)、TC、TG、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均显著高于无兼证患者;痰淤证患者的TC、TG、HDL-C、LDL-C水平均显著高于气滞证患者(P<0.05)。(5)阴虚热盛证兼血瘀证患者的HbAlc水平显著高于无兼证患者;痰淤证患者的FPG、HbAlc、TC水平均显著高于无兼证患者,FPG、TC水平均显著高于血瘀证患者(P<0.05)。结论:T2DM患者不同中医证型在年龄及病程间有差异,主要证型的糖脂代谢在不同兼证间有差异,湿热困脾证患者普遍存在胰岛素抵抗等情况,且主要证型中的兼痰淤证患者较血瘀证更易出现血脂水平的异常升高。

Objective:To explore the distribution characteristics of TCM syndromes in type 2 diabetes mellitus(T2 DM)and the relationship between glucolipid metabolism of main syndrome and accompanied symptom.Methods:296 patients with T2 DM treated in the hospital were selected between August 2019 and August 2021.According to the clinical symptoms,all patients were dialectically typed,and the distribution status of each TCM syndrome type in terms of gender,age and disease course were statistically analyzed,and the relationship between glucolipid metabolism indicators of main syndrome and accompanied symptom was comparatively analyzed.Results:(1)Among 296 patients with T2 DM,the proportions of TCM syndromes from high to low were shown as 92 cases(31.08%)of Qi-Yin deficiency syndrome,81 cases(27.36%)of damp-heat trapping spleen syndrome,73 cases(24.66%)of Yin deficiency and fire excess syndrome,27 cases(9.12%)of Yin-Yang deficiency and 23 cases(7.77%)of blood stasis syndrome.(2)There was no difference in the gender distribution among various TCM syndromes(P>0.05).There was a difference in the age distribution among patients with T2 DM of various TCM syndromes(P<0.05),and the patients with age<45 years old were mostly manifested as damp-heat trapping spleen syndrome or Yin deficiency and fire excess syndrome,and patients aged 45~60 years old were mainly with damp-heat trapping spleen syndrome,and patients over 60 years old were mostly manifested as Yin-Yang deficiency or blood stasis syndrome.The distribution of disease course was different among patients with T2 DM of different TCM syndromes(P<0.05).The patients with disease course less than 5 years were mostly manifested as damp-heat trapping spleen syndrome or Yin deficiency and fire excess syndrome,and the patients with disease course of 5~10 years and patients with course>10 years were mainly shown as Yin-Yang deficiency syndrome or blood stasis syndrome.(3)The levels of fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc)and total cholesterol(TC)of patients with Qi-Yin deficiency syndrome combined with phlegm stasis syndrome or blood stasis syndrome were significantly higher than those of patients without accompanied syndrome.The level of triglyceride(TG)of patients with blood stasis syndrome was significantly higher than that of patients without accompanied syndrome,and the levels of FPG and TC were significantly higher than those of patients with phlegm stasis syndrome(P<0.05).(4)The homeostasis model assessment of insulin resistance(HOMA-IR),TC,TG,high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)of patients with damp-heat trapping spleen syndrome accompanied by Qi stagnation syndrome or phlegm stasis syndrome were significantly higher than those of patients without accompanied syndrome.The levels of TC,TG,HDL-C and LDL-C of patients with phlegm stasis syndrome were significantly higher than those of patients with Qi stagnation syndrome(P<0.05).(5)The HbAlc level of patients with Yin deficiency and fire excess syndrome accompanied by blood stasis syndrome were significantly higher than those of patients without accompanied syndrome.The levels of FPG,HbAlc and TC of patients with phlegm stasis syndrome were significantly higher than those of patients without accompanied syndrome,and the levels of FPG and TC were significantly higher than those of patients with blood stasis syndrome(P<0.05).Conclusion:There are differences in age and course of disease among different T2 DM syndromes in patients with T2 DM.The glucolipid metabolism of main syndrome differs among different accompanied syndromes.Patients with damp-heat trapping spleen syndrome generally have insulin resistance,and among the main syndromes,patients with phlegm stasis syndrome are more prone to abnormal elevations of blood lipids than those with blood stasis syndrome.