147例2型糖尿病患者中医辨证分型及临床指标相关性分析

Correlation between syndrome types and clinical indexes in 147 patients with type 2 diabetes

目的探讨2型糖尿病中医辨证分型特点,分析各临床常规指标与证型的关系,为2型糖尿病中医辨证提供客观依据。方法收集147例合格2型糖尿病病例,按阴虚热盛、湿热困脾、气阴两虚、阴阳两虚辨证分型,同时配以30例同期健康体检者做对照。分析不同证型与年龄、病程、体质指数(BMI)、胰岛素敏感指数(ISI)、糖代谢、脂代谢等的关系。结果气阴两虚最多见;阴阳两虚型女性比例大于男性;年龄与病程变化趋势相同:阴虚热盛型<湿热困脾型<气阴两虚型<阴阳两虚型。各证型的BMI、空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、糖基化血红蛋白(HbA1c)、ISI、高密度脂蛋白(HDL)、载脂蛋白AⅠ(ApoAⅠ)、甘油三酯(TG)、载脂蛋白B(ApoB)与对照组比较差异均有统计学意义(P<0.05);其中气阴两虚、阴阳两虚型HDL、ApoAⅠ与阴虚热盛、湿热困脾型比较差异有统计学意义(P<0.05);气阴两虚型的低密度脂蛋白(LDL)与对照组、阴阳两虚型差异有统计学意义(P<0.05)。结论 2型糖尿病辨证分型以气阴两虚型最多,证型变化有从阴虚热盛、湿热困脾、气阴两虚到阴阳两虚的趋势;2型糖尿病中医辨证分型与多项临床常规检查指标间存在相关性,对中医辨证客观化具有参考价值。

Objective To discuss the characteristics of TCM syndrome classification of type 2 diabetes, analyze the relationship between clinical routine indexes and syndrome types, and provide the objective evidences for syndrome differentiation. Methods The cases of type 2 diabetes （ n = 147） were collected and divided into groups of yin deficiency and heat excess, dampness-heat encumbering spleen, dual deficiency of qi and yin and dual deficiency of yin and yang. Other 30 healthy cases were chosen as control group. The relationship between syndrome types and age, disease course, body mass index （BMI）, insulin sensitivity index （ISI）, glycometabolism and lipid metabolism was analyzed. Results The most common type was dual deficiency of qi and yin. The percentage of dual deficiency of yin and yang was higher in female cases than in male cases. Age and disease course had the same change tendency, i.e. yin deficiency and heat excess 〈 dampness-heat encumbering spleen 〈 dual deficiency of qi and yin 〈 dual deficiency of yin and yang. There was statistical difference in BMI, fasting plasma glucose （FPG）, 2-hour postprandial blood glucose （2hPBG）, glycated hemoglobin （HbAlc）, ISI,high-density lipoprotein （HDL）, apolipoprotein A I （ApoA I ）, triglyceride （TG） and apolipoprotein B （ApoB） between all syndrome groups and control group （ P 〈 0.05 ）. The differences in HDL and Apo A I had statistical significance （P 〈 0.05 ） between group of dual deficiency of qi and yin or group of dual deficiency of yin and yang and group of yin deficiency and heat excess or group of dampness-heat encumbering spleen. The differences in low-density lipoprotein （LDL） had statistical significance （P 〈 0.05 ） between group of dual deficiency of qi and yin and control group or group of dual deficiency of yin and yang. Conclusion The most common syndrome type of type 2 diabetes is dual deficiency of qi and yin, and the changes have a tendency from yin deficiency and heat excess to dampness-heat encumbering spleen to dual deficiency of qi and yin to dual deficiency of yin and yang. There is a correlation between syndrome types and multiple clinical routine indexes, which has reference value for the objectification of TCM syndrome differentiation.