2型糖尿病下肢血管病变气阴两虚兼血瘀证证候学观察

Observing Syndrome of Qi and Yin Deficient and Stagnation of Blood in Type 2 Diabetes Mellimus Patients Complicating Limb Vessel Pathological changes

目的:观察2型糖尿病下肢血管病变气阴两虚兼血瘀证患者证候学特点。方法:根据中医证候积分分级标准,将符合纳入病例标准的64例T2DM下肢血管病变患者分为轻、中、重3组,另设10例健康志愿者为对照组,观察各组糖化血红蛋白、脂代谢、胰岛素抵抗、胰岛分泌功能及血液流变性等多重危险因素变化情况。结果:证候积分轻、重组间及中、重组间在HbA1c方面差异有统计学意义(P<0.05),而轻、中组间差异无统计学意义(P>0.05)。轻、中、重3组HBCI、HDL分别与正常对照组比较均见有不同程度的降低,HOMA-IR、TG、LDL则有明显升高,其间差异均有统计学意义(P<0.05)。3组间HOMA-IR、HDL、TC差异无统计学意义(P>0.05),轻、重组间HOMA-IR、TG差异有统计学意义(P<0.05),而轻、中组间及中、重组间HOMA-IR差异均无统计学意义(P>0.05),轻、重组间及中、重组间LDL差异有统计学意义(P<0.05),而轻、中组间LDL差异无统计学意义(P>0.05)。轻、中、重3组干预前轻、重组间血浆黏度、血浆纤维蛋白原差异有统计学意义(P<0.05),而轻、中组间及中、重组间差异无统计学意义(P>0.05)。3组间其他血流变参数间比较其差异均无统计学意义(P>0.05)。结论:中医证候积分轻重与HbA1c、HOMA-IR、TG、LDL、血浆纤维蛋白原含量及血浆粘度有关。积分重者较积分轻者的血糖控制要差且胰岛素抵抗程度要重、其血清TG、LDL、血浆黏度及血浆纤维蛋白原水平要高。

Objective：Observing the characteristics of Syndrome of Qi and Yin Deficient and Stagnation of Blood （SQYDSB） in Type 2 Diabetes Mellimus （T2DM） Patients Complicating Limb Vessel Pathological changes（LVP）.Methods：According to the standard of TCM symptom accumulated points,we grouped sixty four T2DM complicating LVP patients into light,middle and heavy class. In addition,we established ten health volunteers for the controled group. To observe the changes of mulriple danger factors such as HbA1c,lipoproteinemia,HOMA-IR,HBCI and hemorheology by interclass comparing.Results：Among light,middle and heavy groups,HBCI and HDL are all lower than the controled group＇s,on the contrary,HOMA-IR,TG,LDLare obviously higher. Furthermore,these differences are all significant（P0.05）. Interclass comparison of light,middle,heavy groups,the differences of HBCI,HDL,and TC are not significant （P0.05）. The differences of HOMA-IR and TG are significant for interclass comparison of light and heavy groups （P0.05）,but the difference of HOMA-IR is unsignificant both for light,middle groups and for middle,heavy groups（P0.05）. The difference of LDL is significant not only for interclass comparison of light and heavy groups but for middle and heavy groups（P0.05）,however,the difference of LDL for light and middle groups is unsignificant（P0.05）. The differences of plasma viscosity and fibrinogen are significant for light,middle and heavy groups（P0.05）,but those are not significant both for interclass comparison of light and middle groups and for middle and heavy groups（P0.05）.The differences of other hemorheology indexes are all unsignificant for three groups（P0.05）. Conclusion TCM symptom accumulated points is correlated with HbA1c,HOMA-IR,TG,LDL,fibrinogen and plasma viscosity,but it＇s uncorrelated with HBCI,TC and HDL. The higher TCM symptom accumulated points is,the worse is plasma glucose level,the severitier is HOMA-IR,and the higher are TG,LDL,plasma viscosity and fibrinogen.