代谢综合征中医证候规律分析

Distribution analysis of Traditional Chinese medicine syndrome for metabolic syndrome

目的 研究四川地区成年代谢综合征（MS）住院患者中医证候分布情况,为MS的中医辨证论治的规范及中医诊疗方案和临床路径提供科学依据。方法 将541例MS患者统计人口学资料、既往史、家族史、个人史、人体测量学资料及相关理化检查,中医症状、舌、脉等,四诊合参,确定证型。结果 541例MS患者,脾虚痰湿证37.15%,气阴两虚证19.22%,瘀血阻滞证9.80%,痰火上冲证8.13%,心肝火旺证6.65%,阴虚火旺证6.47%,肝肾阴虚证3.14%,阴阳两虚证2.96%,痰瘀互结证2.59%,其他证型3.88%。20-40岁心肝火旺证最多,41-65岁脾虚痰湿证和气阴两虚证最多,66岁及以上脾虚痰湿证、气阴两虚证、瘀血阻滞证最多。当24≤体质量指数（BMI）〈28时,以脾虚痰湿证和气阴两虚证为主;当28≤BMI〈35时,以脾虚痰湿证为主。而当BMI逐渐增大时,脾虚痰湿证、瘀血阻滞证患者比例逐渐增加,而气阴两虚证患者比例逐渐降低。无既往史者以脾虚痰湿证为主。当MS伴有2型糖尿病时,以气阴两虚证和脾虚痰湿证为主。当MS伴有原发性高血压时,以脾虚痰湿证、痰火上冲证、心肝火旺证为主。当MS伴有血脂代谢异常时,以脾虚痰湿证为主。结论 四川地区成年MS住院患者,总体以脾虚痰湿证为主。随着年龄的增大,证型呈心肝火旺证→脾虚痰湿证、气阴两虚证→瘀血阻滞证、肝肾阴虚证、痰火上冲证→阴阳两虚证变化趋势。

Objective To observe the distribution of Traditional Chinese medicine （TCM） syndrome of met-abolic syndrome （MS） , to provide a scientific evidence for TCM syndrome differentiation standard , TCM diagnosis and treatment scheme and clinical pathway. Methods The demographic data, previous history, family history, per-sonal history, anthropometry date and correlative laboratory examination of 541 MS patients were measured, as well as the TCM symptoms, tongue picture and pulse. TCM syndrome type was determined by synthesis of the four diagnostic Methods. Results In 541 MS patients, the percentage of spleen - deficiency and phlegm - turbid stagnation type was 37.15% , Qi and Yin deficiency type was 19. 22% , the stagnation of blood stasis type was 9. 80% , phlegm - fire disturbing upward type was 8. 13% , the hyperactivity of heart - liver fire type was 6.65% , fire excess from Yin deficiency type was 6.47% , liver - kidney Yin deficiency type was 3. 14% , Yin - Yang deficiency type was 2. 96% ,phlegm and blood stasis type was 2.59% and the other type was 3. 88%. The most common type in 20 to 40 years was hyperactivity of heart - liver fire type, in 41 to 65 years was spleen - deficiency and phlegm - turbid stagnation type and Qi and Yin deficiency type, in 66 years and above was spleen - deficiency and phlegm - turbid stagnation type, Qi and Yin deficiency type and stagnation of blood stasis type. The most common type in body mass index （ BMI） among 24 to 28 was spleen - deficiency and phlegm -turbid stagnation type and Qi and Yin deficiency type, the BMI among 28 to 35 was spleen - deficiency and phlegm - turbid stagnation type. With increase of BMI, the percentage of spleen - deficiency and phlegm - turbid stagnation type and stagnation of blood stasis type were increased, and the Qi and Yin deficiency type was decreased. The most common type in patients without previous history was spleen - deficiency and phlegm - turbid stagnation type. The most com-mon type in MS patients with type 2 diabetes was Qi and Yin deficiency type and spleen - deficiency and phlegm - turbid stagnation type. The most common type in MS patients with primary hypertension was spleen - deficiency and phlegm - turbid stagnation type, phlegm - fire disturbing upward type and hyperactivity of heart - liver fire type. The most common type in MS patients with abnormal lipid metabolism was spleen - deficiency and phlegm - turbid stagna-tion type. Conclusion The most common TCM syndrome type of MS in Sichuan region was spleen - deficiency and phlegm - turbid stagnation type, with increase of age the TCM syndrome type show the variation tendency from hyper-activity of heart - liver fire type to spleen - deficiency and phlegm - turbid stagnation type, Qi and Yin deficiency type and then stagnation of blood stasis type, liver - kidney Yin deficiency type and phlegm - fire disturbing upward type, and finally become Yin - Yang deficiency type with age.