糖尿病肾病合并脑血管病变的辩证规律研究探讨
摘要
目的：随着生活方式的改变和老龄化进程的加速,2型糖尿病已经成为全球性健康危害因素,糖尿病脑血管病、糖尿病性心脏病和糖尿病性肾病一起被医学界并称为威胁糖尿病病人生命的三大最主要的慢性并发症。而糖尿病的肾脏病变可能与心脑血管等并发症的发展有关,西医对其防治只局限于危险因素的控制,治疗效果较差,且需终身服药,故深入研究糖尿病肾病和糖尿病脑血管病的机理及其之间的中西医等多方面的关系,对指导临床有重要而深远的意义。本课题通过对糖尿病性肾病、糖尿病脑血管病的临床检测标准研究及证候研究,试从中医阳气运行角度阐述糖尿病性肾病及糖尿性脑血管病之间的关系特点,探讨糖尿病主要并发症之间关系的认识、糖尿病肾病的脑血管病病因病机及防治办法,为防治糖尿病肾病的脑血管病提供辩证治疗依据,为中医对糖尿病肾病的脑血管病的临床治疗提供参考。
方法：本研究通过回顾性分析308例在2006年10月至2009年9月期间在广州中医药大学第一附属医院住院治疗的糖尿病脑血管病的患者病例资料,将这308例病人分为两组：其中172例合并有糖尿病肾病,称为糖尿病肾病组(简称DN组),其它136例不伴有糖尿病肾病,即非糖尿病肾病组(简称非DN组),制定统一的调查表,通过比较中医证候归类统计、观察糖尿病脑血管病西医指标,比较HbAlc、UA、CRP、血流变学指标、MRI、MRA、TCD和颈动脉等的各项指标,比较其在DN组与非DN组中的不同。
结果：DN组与非DN组比较,证候分析中DN组以阳虚、肾虚、肾阳虚、燥热、血瘀、气郁和热痰较多有明显差异(P<0.05)。DN组与非DN组相比,HbAlc、UA、CRP、血液流变学,MRA、MRI、TCD中大脑中动脉(MCA)和椎动脉(VA)收缩期峰值血流速度(Vp)及舒张末期血流速度(Vd)、PI及颈动脉超声中的阻力指数(RI)、内-中膜厚度(IMT)和斑块指数(PI)存在显著差异(P<0.05)。
结论：糖尿病脑血管病患者合并糖尿病肾病时更易出现风、火、痰、瘀、郁、虚杂合为病的现象,且脑动脉血管损伤程度和脑供血不足的情况均大于非DN组,且随糖尿病肾病病程的进展逐渐加重。提示我们糖尿病性肾病与脑动脉硬化的严重程度之间可能存在着某种联系,且与糖尿病病程进展密切相关,提示我们在临床治疗糖尿病肾病过程中要积极预防脑血管病的发生。
Objective
Along with life style's change and the aging advancement's acceleration, 2 diabetes already became the global health risk factor, diabetes cerebrovascular disease, diabetes heart disease and diabetes nephrosis together and are called by the medical arena the threat diabetes patient life three big most main chronic complications. But diabetes'kidney pathological change is possible and complication and so on heart blood vessel of brain development related, the Modern medicine only limits to its prevention to the risk factor control, the treatment result is bad, and must lifelong take medicine, therefore the deep research diabetes nephrosis and diabetes cerebrovascular disease's mechanism and between doctor practicing western medicine and so on various relations, to instruct clinical to have vital and the profound significance. This topic through to diabetes nephrosis, diabetes cerebrovascular disease's clinical examination standard research and the card period of five days research, tries from the Chinese medicine Yang spirit movement angle elaboration diabetes nephrosis and saccharorrhea cerebrovascular disease relational characteristic, discusses understanding which, diabetes nephrosis cerebrovascular disease cause of disease pathogenesis and prevention means between the diabetes main complication relates, provides the dialectical treatment basis for the prevention diabetes nephrosis's cerebrovascular disease, provides the reference for the Chinese medicine to the diabetes nephrosis's cerebrovascular disease's clinical care.
Methods
This research through review analysis 308 examples in October,2006 to September,2009 period in Guangzhou Chinese medicine University first affiliated hospital hospital treatment's diabetes cerebrovascular disease's patient case material, divides into this 308 example patient two groups:And 172 example merges have diabetes nephrosis, is called diabetes nephrosis group (DN group), other 136 examples are not accompanied by diabetes nephrosis, namely the non-diabetes nephrosis group (non-DN group), formulates the unified survey form, through comparison Chinese medicine card period of five days classification statistics, observation diabetes cerebrovascular disease doctor practicing western medicine target, compared with HbAlc, UA, CRP, blood rheology target, MRI, MRA, TCD and carotid artery and so on each target, compared with it in the DN group and non-DN group's difference.
Results
The DN group compares with the non-DN group, proves in the period of five days analysis the DN group by the deficiency of yang, the kidney empty, the kidney deficiency of yang, dry and hot, the blood stasis, gas Yu Here the phlegm to have the obvious difference much (P<0.05). The DN group compares with the non-DN group, HbAlc, UA, CRP, the blood rheology, in MRA, MRI, TCD the cerebrum median artery (MCA) and the arteria vertebralis (VA) the systole peak value blood stream speed (Vp) and the diastole last stage blood stream speed (Vd), PI and the carotid artery supersonic drag index (RI), in-film thickness (IMT) and the mottling index (PI); has the remarkable difference (P<0.05).
Conclusions
Diabetes cerebrovascular disease patient merges when diabetes nephrosis changes presents the wind, the fire, the phlegm, the stasis, strongly fragrant, empty heterozygous for the phenomenon which gets sick, and the cerebral artery blood vessel extent of damage and the brain blood supply are insufficient the situation is bigger than the non-DN group, and aggravates gradually along with diabetes nephrosis course's progress. Prompts between the order of severity which our diabetes nephrosis and the cerebral artery harden possibly to have some kind of relation, and progresses closely with diabetes course related, prompts us, in clinical care in diabetes nephrosis process to prevent the cerebrovascular disease positively the occurrence.
方法：本研究通过回顾性分析308例在2006年10月至2009年9月期间在广州中医药大学第一附属医院住院治疗的糖尿病脑血管病的患者病例资料,将这308例病人分为两组：其中172例合并有糖尿病肾病,称为糖尿病肾病组(简称DN组),其它136例不伴有糖尿病肾病,即非糖尿病肾病组(简称非DN组),制定统一的调查表,通过比较中医证候归类统计、观察糖尿病脑血管病西医指标,比较HbAlc、UA、CRP、血流变学指标、MRI、MRA、TCD和颈动脉等的各项指标,比较其在DN组与非DN组中的不同。
结果：DN组与非DN组比较,证候分析中DN组以阳虚、肾虚、肾阳虚、燥热、血瘀、气郁和热痰较多有明显差异(P<0.05)。DN组与非DN组相比,HbAlc、UA、CRP、血液流变学,MRA、MRI、TCD中大脑中动脉(MCA)和椎动脉(VA)收缩期峰值血流速度(Vp)及舒张末期血流速度(Vd)、PI及颈动脉超声中的阻力指数(RI)、内-中膜厚度(IMT)和斑块指数(PI)存在显著差异(P<0.05)。
结论：糖尿病脑血管病患者合并糖尿病肾病时更易出现风、火、痰、瘀、郁、虚杂合为病的现象,且脑动脉血管损伤程度和脑供血不足的情况均大于非DN组,且随糖尿病肾病病程的进展逐渐加重。提示我们糖尿病性肾病与脑动脉硬化的严重程度之间可能存在着某种联系,且与糖尿病病程进展密切相关,提示我们在临床治疗糖尿病肾病过程中要积极预防脑血管病的发生。
Objective
Along with life style's change and the aging advancement's acceleration, 2 diabetes already became the global health risk factor, diabetes cerebrovascular disease, diabetes heart disease and diabetes nephrosis together and are called by the medical arena the threat diabetes patient life three big most main chronic complications. But diabetes'kidney pathological change is possible and complication and so on heart blood vessel of brain development related, the Modern medicine only limits to its prevention to the risk factor control, the treatment result is bad, and must lifelong take medicine, therefore the deep research diabetes nephrosis and diabetes cerebrovascular disease's mechanism and between doctor practicing western medicine and so on various relations, to instruct clinical to have vital and the profound significance. This topic through to diabetes nephrosis, diabetes cerebrovascular disease's clinical examination standard research and the card period of five days research, tries from the Chinese medicine Yang spirit movement angle elaboration diabetes nephrosis and saccharorrhea cerebrovascular disease relational characteristic, discusses understanding which, diabetes nephrosis cerebrovascular disease cause of disease pathogenesis and prevention means between the diabetes main complication relates, provides the dialectical treatment basis for the prevention diabetes nephrosis's cerebrovascular disease, provides the reference for the Chinese medicine to the diabetes nephrosis's cerebrovascular disease's clinical care.
Methods
This research through review analysis 308 examples in October,2006 to September,2009 period in Guangzhou Chinese medicine University first affiliated hospital hospital treatment's diabetes cerebrovascular disease's patient case material, divides into this 308 example patient two groups:And 172 example merges have diabetes nephrosis, is called diabetes nephrosis group (DN group), other 136 examples are not accompanied by diabetes nephrosis, namely the non-diabetes nephrosis group (non-DN group), formulates the unified survey form, through comparison Chinese medicine card period of five days classification statistics, observation diabetes cerebrovascular disease doctor practicing western medicine target, compared with HbAlc, UA, CRP, blood rheology target, MRI, MRA, TCD and carotid artery and so on each target, compared with it in the DN group and non-DN group's difference.
Results
The DN group compares with the non-DN group, proves in the period of five days analysis the DN group by the deficiency of yang, the kidney empty, the kidney deficiency of yang, dry and hot, the blood stasis, gas Yu Here the phlegm to have the obvious difference much (P<0.05). The DN group compares with the non-DN group, HbAlc, UA, CRP, the blood rheology, in MRA, MRI, TCD the cerebrum median artery (MCA) and the arteria vertebralis (VA) the systole peak value blood stream speed (Vp) and the diastole last stage blood stream speed (Vd), PI and the carotid artery supersonic drag index (RI), in-film thickness (IMT) and the mottling index (PI); has the remarkable difference (P<0.05).
Conclusions
Diabetes cerebrovascular disease patient merges when diabetes nephrosis changes presents the wind, the fire, the phlegm, the stasis, strongly fragrant, empty heterozygous for the phenomenon which gets sick, and the cerebral artery blood vessel extent of damage and the brain blood supply are insufficient the situation is bigger than the non-DN group, and aggravates gradually along with diabetes nephrosis course's progress. Prompts between the order of severity which our diabetes nephrosis and the cerebral artery harden possibly to have some kind of relation, and progresses closely with diabetes course related, prompts us, in clinical care in diabetes nephrosis process to prevent the cerebrovascular disease positively the occurrence.
引文
[1]张锡纯,医学衷中参西录.2009：山西科学技术出版社.
[2]陈修园,陈修园医学全书.2003：中国中医药出版社.
[3]郑钦安,医理真传.2009：学苑出版社
[4]沈金鳌,沈金鳌医学全书.2003：中国中医药出版社.
[5]蔡敦保,吴华强,黄丽丽等,45例中老年人糖尿病合并脑血管病变的临床分析.中国糖尿病杂志,1997.5(2)：p.117.
[6]杨文军,赵孔华,脾肾气机升降失常与糖尿病肾病关系探讨.山东中医药大学学报,2005.29(3)：p.188-189.
[7]江映红,中西医结合治疗糖尿病肾病30例分析.中国医药学报,2000(1)：p.78.
[8]李小会,董正华,丁辉,糖尿病肾病病因病机的探讨.陕西中医,2005.26(6)：p.552-553.
[9]林兰,中西医结合糖尿病学.1999,北京：中国医药科技出版社.395-407.
[10]王景春,中老年糖尿病性脑血管病临床分析.现代中西医结合杂志,2000.9(16)：p.8.
[11]王钢柱,疏肝调气法治疗2型糖尿病的临床观察.河北中医,2001.3(2)：p.4.
[12]刘志龙,消渴与肝的关系浅探.浙江中医杂志,1999.
[13]童彦墼,坦重,辨证谨守痰虚瘀论治慎选中西药辨治糖尿病脑血管病的经验.辽宁中医杂志,2000.6(6)：p.11.
[14]吕仁和,时振声,糖尿病肾病中医诊治.北京中医,989(2)：p.8.
[15]李可,李可老中医急危重症疑难病经验专辑.2005,山西：山西科技出版社.11.
[16]System, U.S. R.D., USRDS 1997 Annual Data Report Bethescla, in MD.1997, National Institutes of Health, National.Institute of Diabetes and Digestive and Kidney Diseases.
[17]陈玲,肾素血管紧张素系统与糖尿病肾病研究进展.国外医学·泌尿系统分册,2002.22(378)：p.81.
[18]Group, P. D.S.U., Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet,1998. 352(837).
[19]al, P. N. S. J.M. C. e., Effects of aldose reductase inhibitors (tolreatat) on urinary albumin excretion rate and glomerular filtration rate IDDM subjects with nephro. Diabetes Care,1993.16(5): p.789.
[20]GD, etal, P. J. M. M. C., NIDDM asa disease of the innate immune system: association of acute phase reactants and interleukin-6with metabolic syndrme X. Diabetologia,1997.40(1286):p.92.
[21]CE, M., How to protect the kindey in diabetic patientswith special reference to IDDM. Diabetes,1997.46:p. s104-s111.
[22]al, M. R. M. P. S. v. e., Endothelial perturbation in children and adolescents with type 1 diabetes. Diabetes Care,2001.24:p.1674.
[23]al, H. C. J. Y. S. J. e., Insulin and heparin suppress superoxide prodution in diabetic rat glomeruli stimulated with low density lipoprotein. Kidney Int,2001:p.59.
[24]Group, T.C.a. C. T. R., The effect of intensive treatment of diabrtes on the development and progression of long term complications in insulin depentment diabetes mellitus. N Engl Med,1993(329):p.42.
[25]al, A. S. R. R. C. J. e., High glucose increase diacylglycerol mass and activates protein kinase C in mesangial cell culture. AMJ Physiol, 1991.261(F571):p.7.
[26]LJ, B. K., Increased risk ofAlzheimer's disease inType II diabetes: insulin resistance of the brain or insulin-induced amyloid pathology. Biochem Soc Trans,2005.33(5):p.1041-1044.
[27]Association, A. D., Diabetic nephrophathy. Diabetes Care. Position statement,1988.21:p. S50.
[28]al, S. R. S. R. A. N. e., High glucose decreases. Matrix metallo proteinase activity in rat mesangoal cells via transforming growth factor β 1. Exp Nephrol,2001.9(249):p.57.
[29]al, Z. P. C.J.A.B.e., Role of metalloproteinase and inhibitors in the occurrence and progression of diabetic renal lesions. Diabetes Metal, 2000.26(25):p.9.
[30]IS, W., Lipotoxicity and glucotoxicity in type 2 diabetes. Postgraduate Medicine,2001.109(55):p.845.
[31]al, H. J. G. J.H. W. e., Role of the Janus kinase (JAK)/signal transducters and activators of transcription (STAT) cascade in advanced glycation end product induced cellular mitogenesis in NKK 49F, cells. Biochem J,1999.342(231):p.8.
[32]GL, K. D. K., Protein Kinase C activation and the development of diabetic complications. Diabetes,1998.47(859):p.66.
[33]al, K. S. J. S. H. T. e., Stroke is more common than myocardial infarction in hypertension:analysis based on 11 major randomized intervention trials. Blood Press,2001.10(4):p.190-192.
[34]al, D. J. T. N. X. W. e., Studies of renal injury III:Lipid induced nephropathy in type Ⅱ. Kidey Int,2002.3(196):p.8.
[35]刘颖慧,TNF-a与糖尿病肾病.国外医学·内分泌学分册,2002.22(253)：p.5.
[36]S, N., Aldose reductase and it in inhibition in the control of diabetic complications. Ann Clin Lab Sci,1993.23(2):p.244.
[37]CR, D. J.O., Modification of adenosine A(1) and A(2A) receptor density in the hippocampus of streptozotocin-induced diabetic rats. Neurochem Int,2006.48(2):p.144-150.
[38]郑国静,常瑜,程益春,糖尿病肾病的中医治疗思路和方法.湖北中医杂志,2004.26(1)：p.23.
[39]何冰,韩萍,吕先科,2型糖尿病患者急性时相蛋白与糖尿病肾病的关系.中华内分泌代谢杂志,2003.19(4)：p.260-262.
[40]董砚虎,钱荣立,糖尿病及其并发症当代治疗.1994,济南：山东科学技术出版社.45-46.
[41].董砚虎,李娟娟,2型糖尿病与心脑血管障碍.中国医师进修杂志,2006.29(2)：p.12.
[42]冷玉清,脾虚在糖尿病发病中的重要地位.河南中医,1999.3(45)：p.、9.
[43]黄元御,四圣心源.2009：中国中医药出版社.
[44]张志聪,张志聪医学全书.2010：中医药出版社.
[45]陈雅静,Ⅳ型胶原酶与糖尿病肾病.国外医学·内分泌学分册,2002.22(256)： p.8.
[46]许曼音,陆广华,陈名道,糖尿病学.3 ed.2003,上海：上海科学技术出版社.435.
[47]蒋国彦,实用糖尿病学.1992,北京：人民卫生出版社.258.
[48]廖二元,超楚生,内分泌学.第一版ed.2004,北京：人民卫生出版社.1545-1546.
[49]朴春丽,南红梅,姜喆,等,从炎症发病机制探讨中医治疗糖尿病肾病的思路与方法.中国中西医结合杂志,2005.25(4)：p.365-366.
[50]曾桄伦,邵燕,章成国,颈动脉粥样硬化与脑梗死复发的关系.临床神经病学杂志,2005(18)：p.61.
[51]高山,黄家星,黄一宁等,动脉粥样硬化性大脑中动脉狭窄梗死的发病机制.中华神经科杂志,2003(36)：p.155.
[52]周利,贺禄,2型糖尿病并发脑卒中临床分析.中华神经科杂志,1996.29(6)：p.379.
[53]黄元御,黄元御医学全书.2005：中国中医药出版社.
[54]朱丹溪,朱丹溪医学全书.2006：中国中医药出版社.
[55]赵献可,医贯.2005：人民卫生出版社.
[56]喻嘉言,喻嘉言医学三书.2004：中医古籍出版社.
[57]彭子益,圆运动的古中医学.2007：中国中医药出版社
[58]张景岳,景岳全书.2006：山西科学技术出版社
[2]陈修园,陈修园医学全书.2003：中国中医药出版社.
[3]郑钦安,医理真传.2009：学苑出版社
[4]沈金鳌,沈金鳌医学全书.2003：中国中医药出版社.
[5]蔡敦保,吴华强,黄丽丽等,45例中老年人糖尿病合并脑血管病变的临床分析.中国糖尿病杂志,1997.5(2)：p.117.
[6]杨文军,赵孔华,脾肾气机升降失常与糖尿病肾病关系探讨.山东中医药大学学报,2005.29(3)：p.188-189.
[7]江映红,中西医结合治疗糖尿病肾病30例分析.中国医药学报,2000(1)：p.78.
[8]李小会,董正华,丁辉,糖尿病肾病病因病机的探讨.陕西中医,2005.26(6)：p.552-553.
[9]林兰,中西医结合糖尿病学.1999,北京：中国医药科技出版社.395-407.
[10]王景春,中老年糖尿病性脑血管病临床分析.现代中西医结合杂志,2000.9(16)：p.8.
[11]王钢柱,疏肝调气法治疗2型糖尿病的临床观察.河北中医,2001.3(2)：p.4.
[12]刘志龙,消渴与肝的关系浅探.浙江中医杂志,1999.
[13]童彦墼,坦重,辨证谨守痰虚瘀论治慎选中西药辨治糖尿病脑血管病的经验.辽宁中医杂志,2000.6(6)：p.11.
[14]吕仁和,时振声,糖尿病肾病中医诊治.北京中医,989(2)：p.8.
[15]李可,李可老中医急危重症疑难病经验专辑.2005,山西：山西科技出版社.11.
[16]System, U.S. R.D., USRDS 1997 Annual Data Report Bethescla, in MD.1997, National Institutes of Health, National.Institute of Diabetes and Digestive and Kidney Diseases.
[17]陈玲,肾素血管紧张素系统与糖尿病肾病研究进展.国外医学·泌尿系统分册,2002.22(378)：p.81.
[18]Group, P. D.S.U., Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet,1998. 352(837).
[19]al, P. N. S. J.M. C. e., Effects of aldose reductase inhibitors (tolreatat) on urinary albumin excretion rate and glomerular filtration rate IDDM subjects with nephro. Diabetes Care,1993.16(5): p.789.
[20]GD, etal, P. J. M. M. C., NIDDM asa disease of the innate immune system: association of acute phase reactants and interleukin-6with metabolic syndrme X. Diabetologia,1997.40(1286):p.92.
[21]CE, M., How to protect the kindey in diabetic patientswith special reference to IDDM. Diabetes,1997.46:p. s104-s111.
[22]al, M. R. M. P. S. v. e., Endothelial perturbation in children and adolescents with type 1 diabetes. Diabetes Care,2001.24:p.1674.
[23]al, H. C. J. Y. S. J. e., Insulin and heparin suppress superoxide prodution in diabetic rat glomeruli stimulated with low density lipoprotein. Kidney Int,2001:p.59.
[24]Group, T.C.a. C. T. R., The effect of intensive treatment of diabrtes on the development and progression of long term complications in insulin depentment diabetes mellitus. N Engl Med,1993(329):p.42.
[25]al, A. S. R. R. C. J. e., High glucose increase diacylglycerol mass and activates protein kinase C in mesangial cell culture. AMJ Physiol, 1991.261(F571):p.7.
[26]LJ, B. K., Increased risk ofAlzheimer's disease inType II diabetes: insulin resistance of the brain or insulin-induced amyloid pathology. Biochem Soc Trans,2005.33(5):p.1041-1044.
[27]Association, A. D., Diabetic nephrophathy. Diabetes Care. Position statement,1988.21:p. S50.
[28]al, S. R. S. R. A. N. e., High glucose decreases. Matrix metallo proteinase activity in rat mesangoal cells via transforming growth factor β 1. Exp Nephrol,2001.9(249):p.57.
[29]al, Z. P. C.J.A.B.e., Role of metalloproteinase and inhibitors in the occurrence and progression of diabetic renal lesions. Diabetes Metal, 2000.26(25):p.9.
[30]IS, W., Lipotoxicity and glucotoxicity in type 2 diabetes. Postgraduate Medicine,2001.109(55):p.845.
[31]al, H. J. G. J.H. W. e., Role of the Janus kinase (JAK)/signal transducters and activators of transcription (STAT) cascade in advanced glycation end product induced cellular mitogenesis in NKK 49F, cells. Biochem J,1999.342(231):p.8.
[32]GL, K. D. K., Protein Kinase C activation and the development of diabetic complications. Diabetes,1998.47(859):p.66.
[33]al, K. S. J. S. H. T. e., Stroke is more common than myocardial infarction in hypertension:analysis based on 11 major randomized intervention trials. Blood Press,2001.10(4):p.190-192.
[34]al, D. J. T. N. X. W. e., Studies of renal injury III:Lipid induced nephropathy in type Ⅱ. Kidey Int,2002.3(196):p.8.
[35]刘颖慧,TNF-a与糖尿病肾病.国外医学·内分泌学分册,2002.22(253)：p.5.
[36]S, N., Aldose reductase and it in inhibition in the control of diabetic complications. Ann Clin Lab Sci,1993.23(2):p.244.
[37]CR, D. J.O., Modification of adenosine A(1) and A(2A) receptor density in the hippocampus of streptozotocin-induced diabetic rats. Neurochem Int,2006.48(2):p.144-150.
[38]郑国静,常瑜,程益春,糖尿病肾病的中医治疗思路和方法.湖北中医杂志,2004.26(1)：p.23.
[39]何冰,韩萍,吕先科,2型糖尿病患者急性时相蛋白与糖尿病肾病的关系.中华内分泌代谢杂志,2003.19(4)：p.260-262.
[40]董砚虎,钱荣立,糖尿病及其并发症当代治疗.1994,济南：山东科学技术出版社.45-46.
[41].董砚虎,李娟娟,2型糖尿病与心脑血管障碍.中国医师进修杂志,2006.29(2)：p.12.
[42]冷玉清,脾虚在糖尿病发病中的重要地位.河南中医,1999.3(45)：p.、9.
[43]黄元御,四圣心源.2009：中国中医药出版社.
[44]张志聪,张志聪医学全书.2010：中医药出版社.
[45]陈雅静,Ⅳ型胶原酶与糖尿病肾病.国外医学·内分泌学分册,2002.22(256)： p.8.
[46]许曼音,陆广华,陈名道,糖尿病学.3 ed.2003,上海：上海科学技术出版社.435.
[47]蒋国彦,实用糖尿病学.1992,北京：人民卫生出版社.258.
[48]廖二元,超楚生,内分泌学.第一版ed.2004,北京：人民卫生出版社.1545-1546.
[49]朴春丽,南红梅,姜喆,等,从炎症发病机制探讨中医治疗糖尿病肾病的思路与方法.中国中西医结合杂志,2005.25(4)：p.365-366.
[50]曾桄伦,邵燕,章成国,颈动脉粥样硬化与脑梗死复发的关系.临床神经病学杂志,2005(18)：p.61.
[51]高山,黄家星,黄一宁等,动脉粥样硬化性大脑中动脉狭窄梗死的发病机制.中华神经科杂志,2003(36)：p.155.
[52]周利,贺禄,2型糖尿病并发脑卒中临床分析.中华神经科杂志,1996.29(6)：p.379.
[53]黄元御,黄元御医学全书.2005：中国中医药出版社.
[54]朱丹溪,朱丹溪医学全书.2006：中国中医药出版社.
[55]赵献可,医贯.2005：人民卫生出版社.
[56]喻嘉言,喻嘉言医学三书.2004：中医古籍出版社.
[57]彭子益,圆运动的古中医学.2007：中国中医药出版社
[58]张景岳,景岳全书.2006：山西科学技术出版社