糖尿病患者舌、面诊参数与实验室检查指标的相关性及其治疗前后的参数变化分析研究

Pre-and Post-treatment Changes in Tongue and Face Diagnosis Parameters and Their Associations with Laboratory Indices in Patients with Diabetes

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.