糖尿病周围神经病变的中医证型聚类及其与病变程度的关系

Clustering Analysis of TCM Syndromes in Diabetic Peripheral Neuropathy and The Relations with the Pathological Severity

目的应用数理统计方法归纳糖尿病周围神经病变(DPN)的中医证型,探讨中医证型与其病变程度的对应关系。方法收集192例DPN患者,通过检索文献,初步拟定46个中医症状和体征,进行量化赋值。采用R型聚类、简单对应分析进行统计学推断。结果在聚类图的适当位置截取,46个中医症状聚为5个基本证型:气虚证、阴虚证、阳虚证、瘀血痹阻证和痰湿阻络证。对应分析显示,中医证型与病变程度分级相关联(χ2=30.752,P<0.01),气虚证与DPN的Ⅰ级(无症状的DPN)最近,阴虚证与Ⅱ级(有症状的DPN)最近,阳虚证与Ⅲ级(功能受累的DPN)最近。瘀血痹阻证和痰湿阻络证在二维投影图的中间,与DPN病变程度某个分级的关系均不十分明确。结论气虚、阴虚、阳虚、瘀血痹阻和痰湿阻络是DPN的中医基本证型。随着DPN病变程度的进展,中医证型也发生由气虚、阴虚到阳虚的转化,而瘀血、痰湿贯穿于疾病的始终。

Objective Using mathematical statistics method to generalize the TCM syndromes of diabetic peripheral neuropathy（DPN） for studying the corresponding relations with the severity of pathological damage.Methods The data of 192 DPN cases were collected.After literature retrieval,46 TCM symptoms and signs were drafted and quantitatively assigned.The R-clustering and simple correspondence analysis were adopted for statistical inference.Results The interception at a proper location of clustering graph showed that the 46 TCM symptoms and signs were clustered into five basic syndromes,i.e.qi deficiency syndrome,yin deficiency syndrome,yang deficiency syndrome,obstruction of blood stasis syndrome,and retention of phlegm damp syndrome.The correspondence analysis showed that TCM syndromes and pathological severity were related with each other（χ2 = 30.752,P0.01）.Qi deficiency syndrome was most closed to DPN levelⅠ（asymptomatic DPN）,yin deficiency syndrome most closed to DPN level Ⅱ（symptomatic DPN）,and yang syndrome most closed to DPN level Ⅲ（function affected DPN）.Obstruction of blood stasis syndrome and retention of phlegm damp syndrome were in the middle of projection graph,without very clear relation to a certain degree of DPN pathological severity.Conclusion Qi deficiency,yin deficiency,yang deficiency,obstruction of blood stasis,and retention of phlegm damp are the basic syndromes of DPN.Along with the progress of pathological damage,its TCM syndromes are also changed from qi deficiency,yin deficiency,to yang deficiency,while blood stasis and phlegm damp are existing throughout the whole process of DPN.