2型糖尿病患者中医证型的分布特点及主要证型中患者体重指数与兼证的相关性

Patterns Distribution Characteristics of Type 2 Diabetes and the Correlation between Body Mass Index and Concomitant Syndromes for Main Traditional Chinese Medicine Patterns

目的分析2型糖尿病(T2DM)患者中医证型的分布特点,探讨其主要证型中患者体重指数与兼证的相关性。方法回顾性收集1400例T2DM患者相关资料,符合研究标准者共470例。将470例T2DM患者的临床资料依据临床症状及四诊信息进行辨证分型,主要证型包括热盛伤津证、阴虚燥热证、气阴两虚证和阴阳两虚证;兼证包括气滞证、痰湿证、湿热证、血瘀证。将其中主要证型患者按照肥胖诊断标准分为体重正常组、超重组和肥胖组,分析3组患者一般资料、实验室指标[包括年龄、性别、病史、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、空腹C肽(C-Peptide)、糖化血红蛋白(HbA1c)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]及兼证分布情况,并采用Logistic回归方法对T2DM主要证型患者超重和肥胖的影响因素进行分析。结果 470例T2DM患者中热盛伤津证32例(6.81%)、阴虚燥热证56例(11.92%)、气阴两虚证359例(76.38%)、阴阳两虚证23例(4.89%),提示气阴两虚证为主要证型。359例气阴两虚型T2DM患者中体重正常组116例,超重组122例,肥胖组121例。肥胖组患者的C-Peptide明显低于体重正常组,差异具有统计学意义(P<0.05);各组患者年龄、性别、病程、SBP、DBP、FPG、HbA1c、HDL、LDL组间差异均无统计学意义(P>0.05)。体重正常组的兼证以血瘀为主,超重组和肥胖组以痰湿、湿热为主;对气阴两虚型T2DM超重和肥胖患者而言,C-Peptide(P<0.05,β=-0.26<0,OR=0.77<1)是保护因素,痰湿是危险因素(P<0.05,β=1.39>0,OR=4.01>1),血瘀(P<0.05,β=-3.06<0,OR=0.047<1)较少见。结论在T2DM进展过程中,气阴两虚证为主要证型;体重正常的患者兼证以血瘀为主,超重和肥胖的患者兼证以痰湿、湿热为主。在T2DM治疗过程中,对超重或者肥胖的T2DM患者,在益气养阴的同时应重视健脾祛湿化痰;对体重正常的T2DM患者,在益气养阴的同时应注重活血化瘀。

Objective To analyze the distribution characteristics of traditional Chinese medicine(TCM) patterns in patients with type 2 diabetes(T2 DM), and to explore the correlation between body mass index(BMI) and concomitant syndromes regarding the main TCM patterns. Methods Four hundred and seventy out of 1400 T2 DM patients who met the inclusion criteria were retrospectively collected. The clinical symptoms and data from four examinations were used to differentiate the main TCM patterns and concomitant syndromes in the 470 patients. The main TCM patterns included exuberant heat damaging fluid pattern, yin deficiency and dryness-heat pattern, deficiency of both qi and yin pattern, yin and yang deficiency pattern;the concomitant syndromes were mainly qi stagnation, phlegm-damp, damp-heat and blood stasis. Patients of the dominant TCM pattern were divided into normal weight group, overweight group and obesity group according to obesity diagnostic criteria. The data on basic information, laboratory indicators including age, gender, medical history, BMI, systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), fasting C-Peptide(C-Peptide), hemoglobin A1 c(HbA1 c), high-density lipoprotein cholesterol(HDL), and low-density lipoprotein cholesterol(LDL), and concomitant syndromes were analyzed and compared between three groups. Logistic regression was used to analyze the influencing factors of overweight and obesity in T2 DM patients of the dominant TCM pattern. Results There were 32 cases(6.81%) of exuberant heat damaging fluid pattern, 56 cases(11.92%) of yin deficiency and dryness-heat pattern, 359 cases(76.38%) of deficiency of both qi and yin pattern, and 23 cases(4.89%) of yin and yang deficiency pattern, showing that deficiency of both qi and yin pattern was the dominant TCM pattern in 470 T2 DM patients. Of the 359 patients with deficiency of both qi and yin pattern, there were 116 normal weight cases, 122 overweight and 121 obesity cases;the obesity cases had significantly decreased C-Peptide value than the normal weight cases(P<0.05);there were no statistically significant differences between three groups in age, gender, disease course, SBP, DBP, FPG, HbA1 c, HDL and LDL(P>0.05). The concomitant syndrome was mainly blood stasis in normal weight cases, while that was mainly phlegm-damp and damp-heat in overweight and obesity cases, respectively;C-Peptide(P<0.05, β=-0.26<0, OR=0.77<1) was a protective factor for overweight and obesity patients of deficiency of both qi and yin pattern, while phlegm-damp was a risk factor(P<0.05, β=1.39>0, OR=4.01>1), and blood stasis was rarely seen(P<0.05, β=-3.06<0, OR=0.047<1). Conclusion Deficiency of both qi and yin is the dominant pattern of T2 DM patients;for those who has normal weight, blood stasis is usually accompanied, while phlegm-damp and damp-heat are mainly accompanied in overweight and obesity patients. Regarding the treatment, if there is overweight or obesity, more attention should be paid to fortifying the spleen, dispelling dampness and dissolving phlegm while boosting qi and nourishing yin;if the weight is normal, additional attention should be paid to invigorating blood and dissolving stasis based on qi-boosting and yin-nourishing.