糖尿病性轻度认知功能障碍的中医证型分布及临床表现特点分析

Analysis on the distribution of TCM syndrome types and clinical features of diabetic mild cognitive impairment

目的研究糖尿病性轻度认知功能障碍(MCI)的中医证型分布情况,并对其临床表现特点进行分析。方法选取上海市宝山区中西医结合医院老年科门诊及住院的糖尿病性MCI患者60例,入组后收集患者的一般资料情况,由专业医师对患者中医辨证分型(包括肾虚髓减型、痰浊阻窍型、气滞血瘀型及气阴两虚型)情况进行评定,并对不同证型患者的年龄、糖尿病病程、体质量指数(BMI)、肾功能[选择血尿素氮(BUN)、肌酐(Cr)及尿酸(UA)]、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)及同型半胱氨酸(Hcy)水平情况进行分析,并观察患者颈动脉粥样硬化斑块形成情况,比较不同证型患者的临床表现特点。结果60例糖尿病性MCI患者中肾虚髓减型26例,痰浊阻窍型19例,气阴两虚型9例,气滞血瘀型6例。糖尿病性MCI不同证型患者的年龄、糖尿病病程及BMI组间比较差异均有统计学意义(P<0.05),其中肾虚髓减型患者的年龄明显大于其他3种证型,糖尿病病程明显长于其他3种证型,而痰浊阻窍型患者的BMI明显高于其他3种证型。糖尿病性MCI不同证型患者的UA、FINS及HbA1c组间比较差异均有统计学意义(P<0.05),其中肾虚髓减型患者的UA及HbA1c水平明显高于其他3种证型,而痰浊阻窍型患者的FINS水平明显高于其他3种证型,BUN、Cr及Hcy不同证型组间比较差异均无统计学意义(P>0.05)。糖尿病性MCI不同证型患者颈动脉粥样硬化斑块形成情况比较差异有统计学意义(P<0.05),肾虚髓减型患者颈动脉粥样硬化斑块形成情况最严重。结论糖尿病性MCI临床以肾虚髓减证和痰浊阻窍证为主,其中肾虚髓减型患者的年龄最大,糖尿病病程最长,UA与HbA1c水平最高,颈动脉粥样硬化斑块形成情况最严重,而痰浊阻窍型患者的BMI值最大,FINS水平最高。

Objective To study the distribution of TCM syndrome types of diabetic mild cognitive impairment(MCI) and analyze its clinical characteristics. Methods 60 cases of diabetic MCI patients were selected from the department of geriatrics of Baoshan integrated hospital of traditional Chinese and western medicine. The general information of the patients was collected after being enrolled in the group. The TCM syndrome differentiation types(including kidney deficiency and marrow reduction type, phlegm turbidity and obstruction of orifices type, qi stagnation and blood stasis type and qi-yin deficiency type) were evaluated by professional doctors, and the age, course of diabetes, body mass index(BMI), renal function [ blood urea nitrogen(BUN), creatinine(Cr)and uric acid(UA)], glycosylated hemoglobin(HbA1c), fasting insulin(FINS) and homocysteine(Hcy) of patients were analyzed. The formation of carotid atherosclerotic plaque were observed. The clinical characteristics of different syndrome types were compared. Results Among the 60 patients with diabetic MCI, 26 cases were kidney deficiency and marrow reduction type, 19 cases were phlegm turbid and obstruction of orifices type, 9 cases were qi-yin deficiency type, and 6 cases were qi stagnation and blood stasis type. There were statistically significant differences in age, course of diabetes and BMI among different types of diabetic MCI(P<0.05). The age of the patients with kidney deficiency and marrow reduction type was significantly older than the other three types, the course of diabetes was significantly longer than the other three types, while the BMI of the patients with phlegm turbidity and obstruction of orifices type was significantly higher than the other three types. There were significant differences among UA, FINS and HbA1c in different types of diabetic MCI(P<0.05), among which UA and HbA1c levels in patients with kidney deficiency and marrow reduction type were significantly higher than the other three types, while FINS levels in patients with phlegm turbidity and obstruction of orifices type were significantly higher than the other three types, and there were no significant differences among BUN, Cr and Hcy in different types of diabetic MCI(P>0.05). There was a significant difference in the formation of carotid atherosclerotic plaques in different types of diabetic MCI(P<0.05). The formation of carotid atherosclerotic plaques is the most serious in patients with kidney deficiency and marrow reduction type. Conclusion The main clinical manifestations of diabetic MCI are kidney deficiency and marrow reduction type and phlegm turbidity and obstruction of orifices type. The patients with kidney deficiency and marrow reduction type have the largest age, the longest course of diabetes, the highest levels of UA and HbA1c, and the most serious formation of carotid atherosclerotic plaque. The patients with phlegm turbidity and obstruction of orifices type have the largest BMI and the highest levels of FINS.