外周血管诊断系统对糖尿病中医辨证分型的临床价值

Clinical Value of Peripheral Vessel Diagnostic System on TCM Syndrome Differentiation of Diabetes

目的观察糖尿病下肢血管功能与糖尿病中医辨证分型的相关性。方法将168例2型糖尿病患者分为阴虚热盛型(29例)、气阴两虚型(41例)、阴阳两虚型(30例)、血瘀脉络型(37例)和湿热困脾型(31例)5种证型,另选26名健康人为对照组。采用外周血管诊断系统,检查入组者足趾末端光电容积描记(PPG)和外周血管指数(ABI),以观察肢体末端的血流灌注情况及下肢动脉的功能状态。并对下肢血管功能与中医证型的相关性进行统计分析。结果糖尿病各组均与足趾末端动脉血供有一定的相关性,是影响末端血供的主要危险因素(P<0.05),其中血瘀脉络型是影响足趾末端动脉血供的第一高危因素,其次为湿热困脾型、阴阳两虚型、气阴两虚型、阴虚热盛型。健康对照组与5种证型的糖尿病患者间ABI比较差异均有统计学意义(P<0.05或P<0.01)。结论瘀血、湿浊等有形之邪在糖尿病下肢血管病变的发生中起着极为重要的作用,虚证是发生下肢血管病变的基础。

Objective To observe the relation between functions of vessels of lower extremities and TCM syndromes differentiation in diabetes patients. Methods Totally 168 diabetics of Type Ⅱ were differentiated into 5 syndromes, i.e. 29 cases of yin deficiency with excessive heat, 41 cases of qi and yin deficiency, 30 cases of yin and yang deficiency, 37 cases of blood stasis in channels, and 31 cases of damp heat affecting the spleen, and 26 healthy people were involved in the control group. The peripheral vessel diagnostic system was adopted to get the toe photoplethysmogram （PPG） and ankle brachial index （ABI） to observe the blood perfusion of limb terminals and the functional state of lower limb arteries. The relation between function of vessels of lower extremities and TCM syndrome was analyzed. Results All the diabetic groups were related with the arterial blood supply of toe terminals. Diabetes was the main risk factor in affecting the terminal＇blood supply （P〈0.05）, of which, the blood stasis in channels was the first risk factor, then it was the damp heat affecting the spleen, the yin and yang deficiency, the qi and yin deficiency, and the yin deficiency with excessive heat. The difference of ABI between the healthy control group and all the five patterns was significant（P〈0.05 or P〈0.01）. Conclusion The substantial pathogens such as blood stasis and damp turbidity are playing the important role in the vessel diseases of lower limbs of diabetes and deficiency is the basis of vessel diseases of lower limbs.