妊娠期糖尿病的证素辨证初探

Differentiation of syndrome factors of gestational diabetes mellitus

目的提取妊娠期糖尿病的证素,分析证素分布及组合规律,探讨该病临床治疗的中医辨证思路。方法制定妊娠期糖尿病中医证候调查量表,选取204例妊娠期糖尿病孕妇进行辨证,确定病位和病性证素,采用频数分析、因子分析等统计学方法探讨妊娠期糖尿病证素分布及组合规律。结果妊娠期糖尿病的病位证素有肾、心神、脾、胃,肾出现频率最高(63.73%);病性证素有气虚、阴虚、阳虚、热、湿、血虚及阳亢,气虚的出现频率最高(91.67%),其次是阴虚(74.51%)。各证素的组合形式有25种,其中以2、3、4项证素组合者居多。11个证素经主成分因子分析可选出3个主成分,第一主成分Z1与证素肾、气虚、阳虚密切相关,第二主成分Z2与气虚、阴虚密切相关,第三主成分Z3与肾、阴虚、热密切相关,总贡献度为70.91%。结论妊娠期糖尿病的病位证素主要为肾,病性证素主要为气虚和阴虚;最主要的证型为肾气虚、气阴两虚和肾阴虚;气虚和阴虚是该病的关键病机。

Objective To extract the syndrome factors of gestational diabetes mellitus （GDM）, analyze the distribution and combination laws of these syndrome factors, and explore the ideas of TCM syndrome differentiation for GDM. Methods A questionnaire of TCM syndromes of GDM was designed and 204 patients were selected and given syndrome differentiation for deciding disease location and disease nature. The distribution and combination laws of GDM syndrome factors were studied by using frequency analysis and factor analysis. Results The disease-location factors of GDM included kidney, mind, spleen and stomach, and kidney had the highest occurrence frequency （63.73%）. The disease-natures factors of GDM included qi deficiency, yin deficiency, yang deficiency, heat, dampness, blood deficiency and yang hyperactivity, and qi deficiency had the highest occurrence frequency （91. 67% ） and yin deficiency had the secondary highest frequency （74.51% ）. There were 25 combinations of syndrome factors and commonly were 2-factor combination, 3-factor combination and 4-factor combination. There were 3 principal components selected from 11 syndrome factors after factor analysis on principal components. The first principal component Z1 was closely correlated to syndrome factors of kidney, qi deficiency and yang deficiency, the second principal component Z2 was closely correlated to syndrome factors of qi deficiency and yin deficiency, and the third principal component Z3 was closely correlated to syndrome factors of kidney, yin deficiency and heat. The total contribution degree was 70. 91%. Conclusion The major disease-location factor of GDM is kidney, and disease-nature factors includemainly qi deficiency and yin deficiency. The most deficiency of qi and yin and kidney yin deficiency. esis of GDM. common syndrome types are kidney qi deficiency, dual Qi deficiency and yin deficiency are the key pathogen-