糖尿病周围血管病变中医证候规律探析

Traditional Chinese Medicine Syndrome Rules of Diabetic Peripheral Vascular Disease

目的:揭示糖尿病周围血管病变中医辨证分型的发病规律,为临床诊断治疗提供可靠的客观依据。方法:将898例糖尿病周围血管病变患者按照中医辨证分为气阴两虚兼血瘀组、气阴两虚兼湿热组、阴阳两虚组,检测血糖、餐后2 h血糖、糖化血红蛋白、血脂、纤维蛋白原、红细胞压积、血管超声等,研究不同证型之间的差异性。结果:各组空腹血糖、餐后2 h血糖、糖化血红蛋白无差异性;阴阳两虚组腰围、臀围、腰臀比、体重、体质指数(BMI)、甘油三酯、胆固醇、低密度脂蛋白、纤维蛋白原及红细胞压积等指标明显偏高(P<0.05,P<0.01),气阴两虚兼湿热组次之,气阴两虚兼血瘀组最低;下肢血管超声检查足背动脉血流量阴阳两虚组明显低于气阴两虚兼湿热组(P<0.05),气阴两虚兼湿热组、气阴两虚兼血瘀组、阴阳两虚组股动脉、腘动脉管径依次变窄,血流量依次减少。结论:阴阳两虚证是糖尿病周围血管病变的最严重阶段,气阴两虚兼湿热型患者较轻,气阴两虚兼血瘀型最轻。从而揭示糖尿病周围血管病不同证型之间的发病规律,为临床分型提供可靠的理论依据,以利于正确的辨证施治。

Objective： Toreveal the traditional Chinese medicine（ TCM） syndromerules of diabetic peripheral vascular disease,and provide reliable and objective basis for clinical diagnosis and treatment. Method：Based on the TCM symptoms,898 patients with diabetic peripheral angiopathy were divided into 3 groups,Qi and Yin deficiency with blood stasis group,Qi and Yin deficiency with dampness-heat group and Yin and Yang deficiency group. Different tests were carried out to examine the differences among groups on fasting plasma glucose（ FPG）,2 hour postprandial blood glucose（ 2 h PG）,glycosylated hemoglobin（ Hb Alc）,blood fat,fibrinogen,packed red cell volume and vascular ultrasound,et al. Result： There was no difference in the levels of FPG,2 h PG and Hb Alc among groups. The levels of waistline,hip circumference,waist / hip ratio,body weight,body mass index（ BMI）,triglyceride,cholesterol,low density lipoprotein,fibrinogen and packed red cell volume were significantly higher in Yin and Yang deficiency group（ P〈0. 05,P〈0. 01）,followed by Qi and Yin deficiency with dampness-heat group,and the values were lowest in Qi and Yin deficiency with blood stasis group. Vascular ultrasound showed that the blood flow volume of dorsal artery of foot in Yin and Yang deficiency group was significantly lower than that of Qi and Yin deficiency with dampness-heat group（ P〈0. 05）. In addition,calibers of femoral artery and popliteal artery were gradually narrowed and blood flow volume was gradually reduced in turn from Qi and Yin deficiency with blood stasis group,Qi and Yin deficiency with dampness-heat group to Yin and Yang deficiency group. Conclusion： The Yin and Yang deficiency was the most severe stage of diabetic peripheral vascular disease,followed by Qi and Yin deficiency with dampness-heatand then Qi and Yin deficiency with blood stasis. The occurrence regularity of diabetic peripheral vascular disease was revealed so as to provide reliable theoretical basis for clinical classification,and it was good for determining the treatment based on differentiation of symptoms and signs.