冠心病合并2型糖尿病与单纯冠心病证治规律的对比研究

A Comparative Study on the Syndrome Differentiation of Coronary Heart Disease with Type 2 Diabetes Mellitus and Simple Coronary Heart Disease

目的探讨冠心病合并2型糖尿病与单纯冠心病的证治规律。方法选取2015年10月1日—2016年10月1日在北京中医药大学附属东直门医院心内科住院的冠心病合并2型糖尿病病人100例作为糖尿病组;不合并糖尿病的冠心病病人100例作为非糖尿病组。比较两组一般资料、中医主症积分、中医主要证型、舌象、脉象,并分析合并冠心病合并2型糖尿病病人的危险因素。结果糖尿病组病人主症居前5位的依次为乏力、胸闷、气短、口干口渴、心悸,非糖尿病组病人主症居前5位的依次为胸闷、气短、心悸、乏力、胸痛。两组中医主症积分中胸闷、心悸、乏力和总积分比较差异均有统计学意义(P<0.05)。糖尿病组舌质暗的病人共56例,红舌20例,裂纹舌15例,舌苔居前3位的依次为白腻苔、薄白苔、少苔;非糖尿病组舌质暗的病人共86例,舌苔居前3位的依次为白腻苔、黄腻苔、薄白苔。气虚血瘀证及心阳不振证为糖尿病组的主要证型,其次为气阴两虚证。气虚证为主要表现,占50%;兼证中痰浊占21%,水饮占12%。气虚血瘀证为非糖尿病组主要证型,其次为瘀血内阻证,血瘀证为主要表现,占70%;兼证中痰浊占22%,水饮占30%。结论冠心病合并2型糖尿病病人心血管症状不典型;单纯冠心病病人舌象、脉象比较单一,冠心病合并2型糖尿病病人的舌象、脉象比较复杂;气虚血瘀证及心阳不振证为冠心病合并2型糖尿病的主要证型,其次为气阴两虚证,气虚证为主要表现,痰浊为糖尿病组主要病理产物;气虚血瘀证为不合并糖尿病的冠心病病人主要证型,其次为瘀血内阻证,血瘀证为主要表现,水饮为非糖尿病组主要病理产物。

Objective To explore the syndrome rule of coronary heart disease with type 2 diabetes mellitus and simple coronary heart disease.Methods One hundred patients with coronary heart disease and type 2 diabetes mellitus were selected as diabetes group;and one hundred non-diabetic patients with coronary heart disease were selected as non-diabetic group.General information,scores of cardinal symptom,the main TCM syndromes,tongue picture,pulse condition were compared,and the risk factors for type 2 diabetes mellitus combined with coronary heart disease were analyzed.Results In the diabetic group,frequency of main symptoms in the top 5 were:chest tightness,shortness of breath,dry mouth,thirst,palpitations.In the non-diabetic group,frequency of main symptoms in the top 5 were:chest tightness,shortness of breath,palpitations,fatigue,chest pain.Chest tightness,palpitations,fatigue and total score were sta-tistically different compared with the in two groups(P<0.05).In diabetic group,there were 56 patients with dark tongue,20 patients with red tongue,15 patients with cracked tongue,the top three symptoms were white greasy moss,thin white moss,little moss.In non-di-abetic group,there were 86 patients with dark tongue,the top three symptoms white greasy grass,yellow greasy moss,thin white fur.In the diabetic group,Qi deficiency and blood stasis syndrome and heart yang deficiency syndrome were the main syndromes,followed by Qi and Yin Deficiency.Qi deficiency was the main performance,accounting for about 50%;phlegm accounted for 21%,and retained fluid for 12%.In the non-diabetic group,Qi deficiency and blood stasis were the main syndromes,followed by blood stasis syndrome,blood stasis as the main performance,accounting for about 70%;and phlegm phlegm accounted for 22%,and retained fluid for 30%.Conclusion Cardiovascular symptoms of coronary heart disease combined with type 2 diabetes patients were atypical.Tongue,pulse in simple coronary heart disease patients were relatively simple,and those in patients with coronary heart disease and type 2 diabetes were more complex.Qi deficiency and blood stasis syndrome and heart yang deficiency syndrome were the main syndromes in pa-tients with coronary heart disease and type 2 diabetes,followed by Qi and Yin deficiency,Qi deficiency as the main performance,phlegm was the main pathological products of diabetes;Qi deficiency and blood stasis were the main syndromes in non-diabetic pa-tients,followed by blood stasis syndrome,blood stasis as the main performance,retained fluid was the main pathological products.