摘要
背景由于糖尿病的病因病机较为复杂,所以利用具有中医诊断学特色的舌、面诊技术将其所包含的舌面诊信息加以整理和深入研究,并做进一步运用,才能让这种便捷、有效、可靠的诊断方法发挥其应有的作用。目的通过在临床上收集糖尿病患者的舌、面诊参数,探讨糖尿病患者舌、面诊参数与实验室检查指标的相关性以及治疗前后的舌、面诊参数变化特点。方法2017年9月—2018年12月,运用上海中医药大学自行研制的DKF-Ⅱ型中医舌、面诊数字化检测仪采集320例糖尿病患者舌、面诊图像,同步收集其相关实验室检查指标(血糖、糖化血红蛋白、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血尿素氮、血肌酐、血尿酸)。利用典型相关分析方法,探讨糖尿病患者舌、面诊参数与实验室检查指标的相关性。采集35例新发糖尿病患者治疗前后的舌、面诊参数,运用配对t检验,对比分析其治疗前后舌、面诊参数的差异。结果舌诊参数与实验室检查指标之间的典型相关系数为0.919(P<0.05),舌诊参数主要受舌色R值、腐腻特征值、厚薄特征值的影响(典型相关系数分别为-0.808、-0.791、-0.750,P<0.05),实验室检查指标主要受胆固醇、糖化血红蛋白、三酰甘油的影响(典型相关系数分别为-0.643、-0.590、-0.569,P<0.05)。面诊参数与实验室检查指标之间的典型相关系数为0.834(P<0.05),舌诊参数主要受面色Y值的影响(典型相关系数为0.732,P<0.05),实验室检查指标主要受血糖、糖化血红蛋白的影响(典型相关系数分别为0.737、0.397,P<0.05)。35例糖尿病患者治疗后舌诊参数中点刺特征值、苔色G值低于治疗前(P<0.05);其他舌、面诊参数治疗前后比较,差异无统计学意义(P>0.05)。结论糖尿病患者的舌、面诊参数与临床实验室检查指标存在一定的相关性,表明舌、面诊参数可能成为辅助临床诊断、预测疾病转归的中医特色指标之一。通过观察2型糖尿病患者治疗前后舌、面诊参数的变化情况,提示舌诊参数可以作为糖尿病疗效评价的手段之一。
Background The etiology and pathogenesis of diabetes are complex.We intensively studied and summarized TCM-based tongue and face diagnosis techniques to make better use of them to diagnose diabetes conveniently,effectively and reliably.Objective To investigate pre-and post-treatment changes in tongue and face diagnosis parameters derived from corresponding images and their associations with laboratory indices in patients with type 2 diabetes.Methods From September 2017 to December 2018,320 diabetic patients'tongue and face diagnosis parameters derived from images(taken by DKF-ⅡFace Digital Detector and DKF-ⅡTongue Digital Detector developed by Shanghai University of Traditional Chinese Medicine),and laboratory indices(plasma blood glucose,glycosylated hemoglobin,cholesterol,triacylglycerol,highdensity lipoprotein,low-density lipoprotein,blood urea nitrogen,blood creatinine,blood uric acid)were collected.Canonical correlation analysis was used to analyze the associations of tongue and face diagnosis parameters with laboratory indices.The paired t-test was used to analyze pre-and post-treatment changes in tongue and face diagnosis parameters in 35 of the participants.Results The canonical correlation coefficient between tongue diagnosis parameters and laboratory parameters was 0.919(P<0.05).The overall level of tongue diagnosis parameters were mainly influenced by the R value of tongue color,the characteristic value of rotten grease and the characteristic value of thickness of the tongue fur(canonical correlation coefficients were-0.808,-0.791,-0.750,P<0.05).And the overall level of laboratory indices were mainly influenced by cholesterol,glycosylated hemoglobin and triacylglycerol(canonical correlation coefficients were-0.643,-0.590,-0.569,P<0.05).The canonical correlation coefficient between the of face diagnosis parameters and laboratory indices was 0.834(P<0.05).The reference of tongue diagnosis was mainly affected by the Y of face(canonical correlation coefficient was 0.732,P<0.05).And the laboratory indices were mainly affected by the fasting blood glucose and glycosylated hemoglobin(canonical correlation coefficients were 0.737 and 0.397,P<0.05).Compared with pre-treatment,the characteristic value of prick and G value of tongue color in 35 diabetic patients decreased after treatment(P<0.05),but other tongue and face diagnosis parameters did not(P>0.05).Conclusion Tongue and face diagnosis parameters may be associated with clinical biochemical indices in type 2 diabetic patients to some extent,indicating that the former two may be used as TCM-based auxiliary predictive parameters for clinical diagnosis and outcome.The pre-and post-treatment changes in tongue and face diagnosis parameters show that tongue diagnosis parameters may be also used as an efficacy evaluation method in these patients.
作者
谢晟洁
李福凤
XIE Shengjie;LI Fufeng(Experimental Teaching Center,Shanghai University of Traditional Chinese Medicine,Shanghai 200232,China)
出处
《中国全科医学》
CAS
北大核心
2020年第21期2631-2634,2641,共5页
Chinese General Practice
基金
国家自然科学基金资助项目(81774205)
2017年上海市长宁区卫计委课题。
关键词
糖尿病
中医辨证
面诊
舌诊
实验室指标
Diabetes mellitus
TCM syndrome differentiation
Facial inspection
Tongue inspection
Laboratory indexes