高尿酸血症患者舌象的图像特征研究

Study on Characteristics of Tone Image in Patients with Hyperuricemia

目的观察高尿酸血症患者的舌象图像特征,并探讨其影响因素。方法研究对象为229例高尿酸血症患者(高尿酸血症组)和健康体检者250例(健康组)。收集两组受试者一般资料[包括性别、年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)],测定血尿酸(UA)、尿素氮(BUN)、肌酐(SCr)、空腹血糖(FPG)、总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)。用TDA-1型小型舌像仪进行图像采集,观察舌象图像特征指标包括:舌质(TB)颜色指标包括TB-R、TB-G、TB-B、TB-H、TB-I、TB-S、TB-L、TB-a、TB-b;舌苔(TC)颜色指标包括TC-R、TC-G、TC-B、TC-H、TC-I、TC-S、TC-L、TC-a、TC-b,舌苔厚薄指数包括舌苔面积/全舌面积(perAll)、舌苔面积/无舌苔面积(perPart)。分析尿酸与舌象图像特征的相关性,采用Spearman相关性分析探讨舌象图像特征与尿酸的关系,运用多元线性回归、Logistic回归分析发生高尿酸血症的影响因素。结果高尿酸血症组患者BMI、SBP、BUN、SCr、UA、FPG,、TC、TG、LDL-C、Hb A1c均高于健康组,年龄、HDL-C低于健康组(P <0. 01)。高尿酸血症组患者TB-R、TB-G、TC-R、TB-H、TBI、TC-H、TB-L、TB-b、TC-a、TC-b、perPart水平低于健康组,TC-B、TB-S、TB-a、perAll水平高于健康组(P <0. 05或P <0. 01)。尿酸与perAll、TB-S、TB-a、TC-B均呈正相关(P <0. 05),与TB-R、TB-G、TBH、TB-I、TB-L、TB-b、TC-R、TC-H、TC-b均呈负相关(P <0. 05)。多元线性回归结果提示,性别、年龄、BMI、SCr、FPG、TG、TB-b与尿酸独立相关。Logistic回归结果显示,性别、BMI、BUN、TG、TB-a、TC-L、TC-b是发生高尿酸血症的影响因素,其相应的OR值分别为0. 085、1. 305、2. 370、16. 468、0. 704、0. 851、0. 714。结论高尿酸血症患者随着尿酸升高,舌质颜色变紫暗,舌苔变白厚腻,其发病可能与痰湿、血瘀有关。

Objective To observe the characteristics of tongue image in patients with hyperuricemia and to explore its influencing factors. Methods The study included 229 patients with hyperuricemia（hyperuricemia group）and 250 healthy subjects who received physical examination（healthy group）. General data of both groups were collected including gender,age,body mass index（BMI）,systolic blood pressure（SBP）,and diastolic blood pressure（DBP）. The serum uric acid（UA）,urea nitrogen（BUN）,creatinine（SCr）,fasting plasma glucose（FPG）,total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,glycated hemoglobin（HbA1 c） were determined. Image acquisition was performed using a TDA-1 small tongue imager. The characteristics of the tongue image such as the color of the tongue body（TB） including TBR,TB-G,TB-B,TB-H,TB-I,TB-S,TB-L,TB-a,TB-b,tongue coating（TC） color indicators including TC-R,TC-G,TC-B,TC-H,TC-I,TC-S,TC-L,TC-a,TC-b,and the thickness index of the tongue coating which included the area of the tongue coating/the area of the whole tongue（perAll）,the area of the tongue coating/the area of the tongue without the tongue（perPart） were observed. The correlation between uric acid and tongue image features was analyzed. Spearman correlation analysis was used to explore the relationship between tongue image features and uric acid. Multiple linear regression and logistic regression were used to analyze the risk factors of hyperuricemia.Results In the hyperuricemia group,the BMI,SBP,BUN,SCr,UA,FPG,TC,TG,LDL-C and Hb A1 c were higher than those in the healthy group,and the age and HDL-C were lower than those of the healthy group（P 0. 01）. The levels of TB-R,TB-G,TC-R,TB-H,TB-I,TC-H,TB-L,TB-b,TC-a,TC-b,and perPart were lower than those in the healthy group,while levels of TC-B,TB-S,TB-a,and perAll were higher than those in the healthy group（P 〈0. 05 or P 0. 01）. Uric acid was positively correlated with perAll,TB-S,TB-a,TC-B（P 〈0. 05）,and TB-R,TB-G,TB-H,TB-I,TB-L,TB-b,TC-R,TC-H and TC-b were negatively correlated（P 〈0. 05）. Multiple linear regression results suggested that gender,age,BMI,SCr,FPG,TG,TB-b were independently associated with uric acid. Logistic regression results showed that gender,BMI,BUN,TG,TB-a,TC-L,TC-b were the risk factors of hyperuricemia,and their corresponding OR values were 0. 085,1. 305,2. 370,16. 468,0. 704,0. 851,0. 714,respectively. Conclusion In patients with hyperuricemia,the color of the tongue becomes purple and the color of the tongue becomes white and thick with the increase of uric acid,and the onset may be related to phlegm,dampness and blood stasis.