不同海拔地区2型糖尿病周围神经病变患者中医证候特点分析

Analysis of TCM Syndrome Characteristics of Patients with Type 2 Diabetes Peripheral Neuropathy at Different Altitudes

目的:探究来自不同海拔地区DPN患者的危险因素、中医证候特点及其分布规律,以及对今后高原地区DPN的中医临床辨证论治提供客观的理论依据。方法:对来自西宁地区(市区海拔2261m)、玉树地区(平均海拔4200m以上)于我科就诊的327例DPN患者,采用舌诊仪、脉诊仪、肌电图等现代诊断仪器结合我科自拟的《DPN患者中医证候调查表》,进行西医疾病诊断及中医证候诊断,并建立高原地区DPN患者数据库,通过SPSS 24.0统计学软件进行数据分析,比较不同海拔地区DPN患者的危险因素及中医证候分布特点的差异。结果:从高原不同海拔地区DPN患者的年龄大小来看,两地DPN患者在(51~60)岁、(61~70)岁、>70岁这三个年龄段的西宁地区人数远多于玉树地区(P<0.01)。从病程长短来看,两地DPN患者病程大于10年的西宁地区人数远多于玉树地区,分别占当地DPN患者总人数的56.7%、25.3%,因此西宁地区DPN患者的病程长于玉树地区(P<0.01)。从吸烟情况来看,西宁地区不吸烟的患者多于玉树地区(P<0.01);从饮酒情况来看,西宁及玉树不饮酒的患者均多于饮酒的患者,差异无统计学意义(P>0.05);从生活压力情况来看,西宁地区无生活压力的患者多于玉树地区(P<0.01)。从体重情况来看,西宁地区超重及肥胖的DPN患者,分别占当地总患者人数的37.6%、7.0%,玉树地区超重、肥胖的DPN患者分别占当地总患者人数的49.4%、38.8%,因此玉树地区超重及肥胖的DPN患者远多于西宁地区(P<0.01)。从合并其他疾病来看,两地DPN患者单独合并高血压及脂代谢紊乱方面无明显差异,但同时合并高血压或脂代谢紊乱的人数有差异,西宁地区远多于玉树地区(P<0.05)。从合并其他并发症来看,两地DPN患者单独合并糖尿病眼病的人数比较,差异无统计学意义(P>0.05);但单独合并糖尿病肾病和同时合并糖尿病眼病及肾病的人数有明显差异,其中西宁地区单独合并糖尿病肾病与同时合并糖尿病眼病及肾病的人数远多于玉树地区(P<0.05)。从中医证候分布来看,在西宁低海拔地区,157例DPN患者中出现频率最高的中医证候是阴虚证(28.7%),其次是痰湿证(17.8%)、阳虚证(13.4%)、血瘀证(11.5%),而其他证候相对较少;在玉树高海拔地区,170例DPN患者中出现频率最高的中医证候是血瘀证(45.3%),其次是阴虚证(37.1%),而其他证候类型则相对较少。其中,阴虚证、血瘀证候在玉树地区DPN患者中的分布明显多于西宁地区,差异有统计学意义(P<0.01)。结论:阴虚证、血瘀证是高原地区DPN患者中最为常见的证候类型,且这一分布特点在相对高海拔的玉树地区愈加显著;除了内因所致DPN患者的阴虚证、血瘀之外,我们考虑,在高海拔影响下高原地区特有的寒冷、干燥的气候是导致DPN患者阴虚证、血瘀证的一个重要因素。

Abstrct Objective:This study is aimed to explore the risk factors,characteristics of TCM syndromes and their distribution rules of DPN patients from different altitudes,in order to provide objective theoretical basis for the clinical dialectical treatment of DPN in plateau areas in the future.Methods:For the 327 DPN patients treated in our department from Xining area(average altitude above 2261 meters)and Yushu area(average altitude above 4200 meters),their tongue diagnosis instrument,pulse diagnosis instrument,electromyography and other modern objective diagnostic instruments were combined with our own"DPN Patient TCM Syndrome Questionnaire"to carry out the diagnosis of Western medicine diseases and TCM syndromes,establish a DPN patient database in the plateau area,and perform data analysis through SPSS 24.0 statistical software so as to compare the risk factors and TCM of DPN patients at different altitudes Differences in the characteristics of syndrome distribution.Results:Judging from the age of DPN patients at different altitudes in the plateau,the number of DPN patients in Xining between(51~60)years old,(61~70)years old,and more than 70 years old is much higher than that in Yushu.The age of DPN patients in Xining area is much older than that in Yushu area(P<0.01).In terms of the length of the disease,the number of DPN patients more than 10 years in Xining area is much more than that in Yushu area,accounting for 56.7%and 25.3%of the total number of local DPN patients.Therefore,the disease duration of DPN patients in Xining area is much longer than the Yushu area(P<0.01).From the perspective of smoking,there are more non-smokers in Xining than in Yushu(P<0.01);from the drinking situation,in Xining and Yushu there were more non-drinking patients than drinkers without statistically significant Significance of learning(P>0.05).As the perspective of life stress,patients without stress in Xining area were more than in Yushu area(P<0.01).From the perspective of weight,overweight and obese DPN patients in Xining area accounted for 37.6%and 7.0%of the total number of local patients,respectively,which in Yushu area accounted for 49.4%and 38.8%of the total number of local patients,respectively.The number of overweight and obese DPN patients in Yushu area is much higher than that in Xining area(P<0.01).From the point of view of combining other diseases,there is no significant difference in the combination of hypertension and lipid metabolism disorders in patients with DPN alone,but there are differences in the number of people with hypertension and lipid metabolism disorders at the same time,with more in Xining(P<0.05).From the point of view of combining other complications,there is no difference in the number of patients with DPN combined with diabetic eye disease alone(P>0.05);but there is a significant difference in the number of patients with diabetic nephropathy alone and with diabetic eye disease and kidney disease at the same time.The number of patients with diabetic nephropathy and diabetic eye disease and nephropathy in Xining was far more than in Yushu area(P<0.05).From the perspective of the distribution of TCM syndromes,in the low altitude area of Xining,the most frequent TCM syndromes among 157 DPN patients are Yin deficiency syndrome(28.7%),followed by phlegm and dampness syndrome(17.8%)and Yang deficiency syndrome(13.4%),Blood stasis syndrome(11.5%),and other syndromes are relatively few.In the high altitude area of Yushu,the most frequent TCM syndrome in 170 DPN patients is blood stasis syndrome(45.3%),followed by Yin deficiency(37.1%),while other types of syndromes are relatively few.Among them,the syndromes of Yin deficiency and blood stasis were more significantly distributed in DPN patients in Yushu area than in Xining area,with statistically significant difference(P<0.01).Conclusion:Yin deficiency and blood stasis syndromes are the most common syndrome types in DPN patients in plateau area,and this distribution characteristic is more significant in Yushu at relatively high altitudes.Except for Yin deficiency and blood stasis caused by internal factors in DPN patients,we consider that the unique cold and dry climate in the plateau area under the influence of high altitude is an important factor leading to Yin deficiency and blood stasis syndrome in DPN patients.