2型糖尿病合并原发性高血压证型分析

Distribution of Traditional Chinese Medicine Syndromes in Type 2 Diabetes Mellitus Complicated with Essential Hypertension

目的观察2型糖尿病合并原发性高血压患者的中医证候分布和演变规律。方法共收集318例2型糖尿病合并原发性高血压患者的病历资料,对患者的证型进行分析,并按病程分层对证候演变规律进行分析。结果 318例患者中,单纯虚证68例,占21.4%;单纯实证27例,占8.5%;虚实夹杂证223例,占70.1%。病程0～2年者可见以痰(湿)热互结为主的实证,病程2年以上者气阴两虚证最为多见,病程10年以上者多见脾肾阳虚证、阴阳两虚证。随着病程延长,血瘀证逐渐增多。结论随着病程进展,2型糖尿病合并高血压的证型由热盛津伤、痰热互结逐渐向肝肾阴虚、气阴两虚、脾肾阳虚、阴阳两虚证转化,血瘀证、痰浊证是贯穿于整个病程的常见兼夹证。

Objective To observe the distribution and developing tendency of traditional Chinese medicine （TCM） syndromes in type 2 diabetes mellitus complicated with essential hypertension. Methods The medical records were collected from a total of 318 patients with type 2 diabetes mellitus complicated with essential hypertension. The TCM syndrome types were analyzed and the developing tendency of TCM syn- dromes was also analyzed according to the stratification of disease course. Results Of 318 patients, 68 were diagnosed with pure asthenia syndromes （accounting for 21.4%）, 27 with pure sthenia syndromes （accounting for 8.5 %）, 223 with asthenia syndromes complicated with sthenia syndromes （accounting for 70.1 %）. The patients with 0 to 2 years of disease course were diagnosed with sthenia syndromes mainly characterized by the combination of heat and phlegm or dampness. The patients with two or more than two years of disease course were mostly diagnosed with both deficiency of qi and yin. Both deficiency of spleen- yang and kidney-yang and both deficiency of yin and yang were mostly found in patients with ten or more than ten years of disease course. The incidence of blood stasis syndrome increased along with the prolonga- tion of disease course. Conclusion As the developing of type 2 diabetes mellitus complicated with essential hypertension, syndromes of excessive heat induced fluid deficiency and the combination of heat and phlegm at the early stage gradually develop into both deficiency of liver-yin and kidney-yin, both deficiency of qi and yin, both deficiency of spleen-yang and kidney-yang, and both deficiency of yin and yang at the late stage. Syndromes of blood stasis and turbid phlegm are complicated syndromes commonly found over the whole course of this disease.