糖尿病坏疽合并细菌感染中医辨证分型演变规律研究

Research on the Evolution Law of TCM Syndrome Differentiation of Diabetic Gangrene combined with Bacterial Infection

目的探讨合并细菌感染的糖尿病湿性坏疽中医辨证演变规律,为中西医治疗提供理论基础。方法随机观察2006年1月—2014年11月,本院中医外科收治的糖尿病湿性坏疽患者234例按照中医辨证分型理论,将234例糖尿病患者辨证分为3型,并对患者的标本进行细菌培养,随着中西医治疗进展,每3~7天辨证一次,观察革兰阳性菌和革兰阴性菌从感染到消失,中医辨证分型的变化特点。结果 90例气阴两虚型演变率为27.8%,气阴两虚型演变中,革兰阳性菌比革兰阴性菌更容易转型,差异具有统计学意义（P〈0.05）。108例热毒湿盛型演变率为27.8%,经过气阴两虚型到气血两虚型发生二次演变共4例,演变率为3.7%。36例气血两虚型患者有7例发生了中医证型演变,演变率为19.4%,其中真菌感染的气血两虚型未发生演变,其他三种感染类型中,革兰阳性菌明显高于革兰阴性菌和混合感染,差异具有统计学意义（P〈0.05）。结论糖尿病湿性坏疽的中医辨证演变规律和细菌感染有一定的相关性,为临床中西医施治提供理论基础。

Objective To investigate the evolution law of TCM syndrome differentiation of diabetic gangrene combined with bacterial in-fection. Methods Randomly observing 234 cases of patients with diabetic wet gangrene from January 2006 to November 2014, they were divided into three types according to the theory of traditional Chinese medicine syndrome differentiation, and patients ’ specimens were bacteriological cultured. Along with progress of therapy of integrated medicine, every 3 to 7 days differentiation once, and Gram-positive bacteria and gram-negative bacteria from infection to disappear, changes of TCM syndrome type were observed. Results 90 cases of deficiency of both qi and yin evolution was 27.8%, in deficiency of both qi and yin evolution, Gram-positive bacteria was more likely to change than Gram-negative bacteria, and the difference was statistically significant（ P 〈0.05）. The evolution rate of 108 cases of toxic heat dampness type were 27.8%, from deficiency of both qi and yin to deficiency of both qi and blood, total four cases occurred secondary evolution, and the evolution rate was 3.7%. In 36 cases of deficiency of bonth qi and blood, 7 cases were occurred TCM evolution, and the evolution rate was 19.4%. In fungal infections and deficiency of both qi and blood, evolution did not occur in the other three types of in-fection, Gram-positive bacteria was significantly higher than that of Gram-negative bacteria and mixed infections, and the difference was statistically significant（P 〈0.05）. Conclusion The evolution law of TCM syndrome differentiation of diabetic gangrene and bacterial in-fections had some relevance, and it provides a theoretical basis for the clinical treatment of integrated medicine.