2型糖尿病患者中医证型分析及其与糖尿病慢性并发症关系的探讨

作者	单位
尹德海	北京协和医院中医科
梁晓春	北京协和医院中医科
朴元林	北京协和医院中医科
刘世炜	北京协和医学院流行病学教研室
刘晋河	北京协和医院中医科
郝伟欣	北京协和医院中医科
潘明政	北京协和医院中医科
田国庆	北京协和医院中医科

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中文摘要:

目的分析2型糖尿病患者的中医证型分布,探讨各种中医证型与血糖控制水平和糖尿病慢性并发症的关系。方法对557例2型糖尿病患者中医辨证,归属于:肺胃阴虚热盛、脾气虚、肾气虚、脾肾气虚、肝肾阴虚、气阴两虚、阴阳两虚,共7个中医证型,对患者兼夹的实证不作证型分类的依据。对各种证型的血糖水平、糖尿病病程和各种慢性并发症的发生率进行比较。结果557例患者中气阴两虚型最多(264例,占47.4%),其次为肾气虚和肝肾阴虚(分别为95例,17.1%和92例,16.5%);兼夹证中,绝大部分患者兼夹瘀血,发生率达89.9%(501例);其次为肝气郁结,占40.4%(225例),兼夹湿热的比例也很高,占32.3%(180例)。各中医证型的糖尿病病程比较,差异有统计学意义(P<0.01),阴阳两虚型病程最长,其后依次为脾肾气虚、肾气虚、气阴两虚、肝肾阴虚,病程较短者为肺胃阴虚热盛型和脾气虚型。空腹血糖(FBG)水平在肺胃阴虚热盛型、气阴两虚型、肾气虚型、脾肾气虚型和阴阳两虚5种证型中均较高,而脾气虚型和肝肾阴虚型FBG水平较低。阴阳两虚型糖化血红蛋白(HbA1c)水平最高,其次为肺胃阴虚热盛型。脾气虚型和肝肾阴虚型HbA1c水平较低。糖尿病周围神经病变(DPN)、糖尿病眼底病变(DR)、糖尿病肾病(DN)、脑梗塞(CI)和动脉粥样硬化症(AS)发生率在脾气虚型和肺胃阴虚热盛型中均较低,与另外5种中医证型比较,差异有统计学意义(P<0.05);多种慢性并发症的发生率在脾肾气虚和阴阳两虚型中最高;冠心病(CHD)在肾气虚和阴阳两虚型中发生率较高,与其他5种中医证型比较,差异有统计学意义(P<0.01)。结论肺胃阴虚热盛和脾气虚为2型糖尿病早期的常见中医证型;肾气虚、脾肾气虚、肝肾阴虚和气阴两虚则见于糖尿病中期,可以出现各种糖尿病慢性并发症;阴阳两虚则见于2型糖尿病患者出现多种慢性并发症,且血糖长期控制不佳时。

英文摘要:

Objective To analyze the Chinese medicine (CM) syndrome pattern of patients with type 2 diabetes mellitus (DM2) and the relationship of CM patterns with the different blood glucose levels controlled and the incidences of diabetic chronic complications. Methods CM syndromes in 557 DM2 patients were sorted into 7 patterns,A: the Fei-Wei yin-deficiency with exuberant heat pattern;B: the Pi-qi deficiency pattern;C: the Shen-qi deficiency pattern;D: the Pi-Shen qi-deficiency pattern;E: the Gan-Shen yin-deficiency pattern;F: the both qi-yin deficiency pattern;and G: the both yin-yang deficiency pattern,the concurrent or accompanied excessive syndromes were not taken as the indication for sorting. The blood glucose level,duration of illness and incidence of diabetic chronic complications in patients of different patterns were compared. Results The CM syndrome patterns commonly encountered in mostly of the 557 patients was pattern F (in 264 patients,accounting for 47.4%);the next was pattern C (95 patients,17.1%) and E (92 patients,16.5%). The concurrent syndromes appeared in most patients was blood stasis (501 patients,89.9%),Gan-qi stagnation was the second (225 patients,40.4%),and the portion of damp-heat syndrome was also rather large (180 patients,32.3%). The duration of diabetes mellitus for patients with various patterns was significantly different (P<0.01),the longest appeared in patients of pattern G,followed by pattern D,C,F,and E in sequence,and patients of pattern A and B had a rather shorter duration. Level of fasting blood glucose was rather higher in patients of pattern A,C,D,F,and G than in those of pattern B and E. Level of glycosylated hemoglobin in patients of pattern G was the highest and in pattern A the second,while in pattern B and E was rather lower. Incidences of diabetic chronic complications,including diabetic peripheral neuropathy,diabetic retinopathy,diabetic nephropathy,cerebral infarction,and atherosclerosis in patients of pattern A and B were lower than in those of other 5 patterns (P<0.05);but the highest incidence of multiple chronic complications revealed in pattern D and G,and that of coronary heart disease revealed in pattern C and G,all showed significant different as compared with other patterns (P<0.01). Conclusion The most commonly encountered CM syndrome patterns in DM2 patients of early stage are pattern A and B;and those of middle stage are pattern C,D,E and F,various diabetic chronic complications may reveal in this stage;pattern G could be found in patients accompanied with multiple chronic complications and with uncontrolled blood glucose for a long time.

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