代谢综合征微血管病变的调查分析及中医证型的研究

Epidemiology of Microvascular Complications and Research of TCM Syndrome Types of Metabolic Syndrome

[目的]调查代谢综合征(Metabolic Syndrome,MS)患者微血管病变特点,分析MS微血管病变与中医虚实证型间的关系。[方法]收集温州市中西医结合医院符合标准的MS患者,按是否伴发微血管病变分组,检测血糖、血脂、血肌酐(serum creatinine,Scr)、24小时尿蛋白(24h urinary protein,24h UP)、24小时尿微量蛋白(24h urinary microalbumin,24h MA)等指标,并采集辨证分型资料,确定中医证型,对MS患者微血管病变的发生情况及与中医证型关系进行探讨。[结果]MS微血管病变的发生率与病程呈正相关(P<0.05)。MS微血管病变者与无微血管病变者在血糖、血脂、Scr、24h MA方面比较有统计学意义(P<0.05)。被纳入的365例MS患者中,伴微血管病变者238例,其中实证患者127例,虚证患者111例;无微血管病变者127例,其中实证患者53例,虚证患者74例;两组实证中医证型以热盛证为主,比较有统计学意义(P<0.05),两组虚证以气阴两虚证为主,比较无统计学意义(P>0.05)。MS微血管病变发生率实证组中以血瘀证、热盛证最高,湿热证最低,比较有统计学差异(P<0.05);虚证组中,微血管病变发生率以气阴两虚证最高,阴阳两虚证和肝肾阴虚证的微血管病变发生率相对较低,不同证型间比较有统计学差异(P<0.05)。[结论]MS患者随病程延长,微血管并发症的发生率呈上升趋势,与血糖、血脂、Scr、24h MA相关,在中医辩证方面以热盛、血瘀、气阴两虚表现突出,临床上需提高重视程度。

[Objective]To investigate the characteristics of microvascular complications,explore the correlation between the TCM syndromes and microvascular complications of metabolic syndrome. [Methods]Collected MS patients with the diagnostic criteria,classified according to whether with microvascular complications,the laboratory tests were performed.Gathered the Chinese syndrome differentiation materials and determined the TCM types. It also observed the incidence of microvascular complications,analyzed the relationship between features of TCM syndrome distribution and microvascular complications in MS patients.[Resuhs]The incidence of microvascular complications in MS patients was positively correlated with duration（P〈0.05）. Compared with patients without microvascular complications,patients with microvascular complications in MS were different among the glucose,blood lipid,serum creatinine,and twenty-four hours urinary microalbumin（P〈0.05）. Among the 365 patients with MS,238 patients had microvascular complications, including 127 cases of the TCM sufficient syndrome and 111 cases of the TCM deficiency syndrome.There were 127 patients without microvascular complications,among which 53 were the TCM sufficient syndrome and 74 were deficiency syndrome. The syndrome of excessive heat was dorminant in the TCM sufficient syndrome and there was significant difference between the two groups in the sufficient syndrome（P〈0.05）, the syndrome of qi-yin deficiency was dorminant in the TCM deficiency syndrome between two goups and no significance in the two groups of deficiency syndrome（P〉0.05）. The incidence of MS microvascular complications was the highest in the blood stasis syndrome and the excessive heat syndrome,the lowest in the dampness heat syndrome,there was significant differences（P〈0.05）. The incidence of MS microvascular complications was the highest in syndrome of qi-yin deficiency, the deficiency of yin-yang and deficiency of liver-kidney were relatively low.There was significant difference among different syndromes（P〈0.05）. [Conclusions]The incidence of MS microvascular complications increased with the duration and was associated with the glucose, blood lipid, serum creatinine, twenty-four hours urinary microalbumin; syndrome of excessive heat, syndrome of blood stasis, syndrome of qi-yin deficiency were common and frequent in TCM,we needed to improve the attention.