基于因子分析的代谢综合征兼血糖异常中医证候的横断面研究

Cross-sectional study on the traditional Chinese medicine pattern of metabolic syndrome with abnormal blood glucose based on factor analysis

目的研究代谢综合征(MS)兼血糖异常的中医证候特征及分布情况,为中医临床干预提供依据。方法基于7个省、直辖市,9个研究中心的MS及健康受试者的临床流行病学调查数据库,提取MS兼血糖异常的完整有效病例数据,共计2284例,运用因子分析等统计方法,探究血糖异常的MS中医证候分布及特征。结果MS兼血糖异常的中医证候主要包括6种,按频率从高到低依次为痰热互结证、肝肾阴虚证、肝火亢盛证、兼夹血瘀证、痰湿中阻证、脾虚湿盛证。随年龄增长,MS兼血糖异常的主要证候由痰热互结证逐渐转为肝肾阴虚证。痰湿中阻证、兼夹血瘀证等实证男性居多;肝肾阴虚证、脾虚湿盛证等虚证为主的证候以女性居多。在空腹血糖受损(IFG)的患者中,肝肾阴虚证患者空腹血糖最高;在已确诊的糖尿病患者中,兼夹血瘀证平均血糖最低。血清甘油三酯(TG)在痰热互结证、痰湿中阻证、兼夹血瘀证的已确诊糖尿病患者中相对较高。结论通过对MS血糖异常患者流行病学数据的证候类型、分布规律及特点阐述,可为血糖异常的MS临床辨证论治提供思路和依据。

Objective To investigate the characteristics and distribution of TCM patterns of metabolic syndrome(MS)with abnormal blood glucose,so as to provide evidence for TCM clinical intervention of the disease.Methods Based on a clinical epidemiological investigation database of MS and healthy subjects from 9 research centers in 6 provinces and a munilipality directly under the Central Goverment,2284 cases of MS with abnormal blood glucose were extracted.The distribution and characteristics of TCM patterns of the disease were explored by factor analysis and other statistical methods.Results The TCM patterns of MS with abnormal blood glucose mainly fall into the following 6 categories(ranking in a descending order):phlegm-heat accumulation pattern,liver-kidney yin deficiency pattern,liver-fire exuberance pattern,quasi blood-stasis pattern,middle-energizer phlegm-damp stagnation pattern,and spleen deficiency with excessive dampness pattern.With the increase in age,the main pattern of MS with abnormal blood glucose gradually developed from phlegm-heat accumulation pattern into liver-kidney yin deficiency pattern.Male patients were more likely to suffer from excess patterns like the middle-energizer phlegm-damp stagnation pattern and quasi blood-stasis pattern.Female patients,on the other hand,were more liable to deficiency patterns such as liver-kidney yin deficiency pattern and spleen deficiency with excessive dampness pattern.Among patients with impaired fasting glycemia(IFG),fasting blood glucose(FBG)was the highest in the patients with liver-kidney yin deficiency pattern and the lowest in patients previously diagnosed with diabetes with quasi blood-stasis pattern.Among patients previously diagnosed with diabetes,TG levels were relatively high in those with the phlegm-heat accumulation pattern,middle-energizer phlegm-damp stagnation pattern and quasi blood-stasis pattern.Conclusion The investigation into the patterns,their distribution and characteristics of MS patients with abnormal blood glucose based on epidemiological data could provide reference and basis for clinical pattern differentiation and treatment of the disease.