肝与糖尿病周围神经病变证候特点的相关性研究
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摘要
本课题在中医文献整理的基础上,观察了厦门地区566例2型糖尿病患者糖尿病周围神经病变的患病情况及首发临床症状特点。另外,采用证素辨证方法,采集144例糖尿病周围神经病变患者的四诊信息,研究其证候特点,以期找到糖尿病周围神经病变的主要病机及从肝治疗糖尿病周围神经病变的临床依据。
一、糖尿病周围神经病变的发病及症状学特点研究
目的：研究糖尿病周围神经病变的患病情况及主要症状特点。
方法：以2011年12月-2012年11月在厦门大学附属第一医院内分泌糖尿病科住院的2型糖尿病周围神经病变患者为研究对象,其中糖尿病西医诊断依据1999年WHO糖尿病诊断标准,周围神经病变参照《中国糖尿病防治指南》2010版中的诊断标准。采集患者的临床资料,并分为糖尿病周围神经病变组(DPN组)和非糖尿病周围神经病变组(NDPN组)进行描述统计分析。
结果：
1、566例患者中,312例为DPN患者,占55.12%。DPN组平均年龄显著高于NDPN组,分别为(60.62±11.02)岁和(58.15±14.23)岁,差异有统计学意义(P<0.05)。
2、病程方面,最小病程10天,最大病程40年,平均病程7.5年,DPN组平均病程(8±6.87)年,NDPN组平均病程(6.82±7.39)年,两组间比较有统计学差异(P<0.05)。
3、性别方面,男性282例,其中,DPN组141例,平均年龄为(58.92±11.7)岁,高于NDPN组(55.16±14.17)岁(P<0.05)。女性284例,DPN组171例,平均年龄(62.02±11.7)岁,NDPN组113例,平均年龄(61.87±13.47)岁,两组年龄比较无统计学差异(P>0.05)。男性DPN人群集中在50岁-65岁,而女性DPN人群从50岁后增长趋势明显,在65岁左右达到高峰。
4、DPN组171例女性患者,平均年龄(62.02±11.7)岁,停经人数占85.39%,初潮年龄(14.53±2.35)岁,停经年龄(49.23±4.60)岁；而NDPN组113例女性患者,平均年龄(61.87±13.47)岁,初潮年龄(14.22±1.88)岁,停经年龄(49.53±3.36)岁,两组间比较,差异无统计学意义(P>0.05)。
5、312例DPN患者中171例有肢体麻木,伴发刺痛、蚁爬感、灼热感、瘙痒、乏力、肢寒畏冷、触电样感等症状。
结论：糖尿病周围神经病变患病率高,群体老龄化,患者以中老年女性居多,糖尿病周围神经病变患者发病隐匿性,但临床研究发现有症状的糖尿病周围神经病变患者多于无症状者,四肢麻木是糖尿病周围神经病变常见的首发症状特点。
二、糖尿病周围神经病变中医证候特点研究
目的：通过研究糖尿病周围神经病变患者的证候特点,探讨其主要病机,寻找从肝治疗糖尿病周围神经病变的临床依据。
方法：以来自厦门大学附属第一医院及厦门眼科中心,符合糖尿病周围神经病变诊断标准与排除标准(同第一部分)的患者为研究对象,采集患者的症状、体征,在四诊的基础上,借助证素辨证系统对四诊信息进行分析,研究糖尿病周围神经病变患者的中医证候特点,并运用相关统计方法研究肝与糖尿病周围神经病变证候特点的相关性。
结果：
1、144例患者中,年龄最小35岁,最大80岁,平均年龄(60.28±10.30)岁。女性76例(52.78%),男性68(47.22%)。在年龄分层上,30-39岁4人,40-49岁21人,50-59岁37人,60-69岁54人,70-79岁27人,80-85岁1人。最短病程1.5个月,最长病程30年,平均病程8.05年,其中病程在5年内的有49例,病程在5-9年的有38例,病程10-19年的有44例,病程在20-30的有13例。
2、主要证候特点有手足麻木、夜尿频多、视物模糊、舌淡红、舌苔薄、舌苔白、脉细、脉弦。
3、病位证素涉及15处,分别为肝、肾、经络、脾、肺、肌肤、筋骨、胞宫、胃、心、表、胆、心神、膀胱、大肠。五脏病位所占比例分别为肝58.33%,肾56.94%,脾21.53%,肺6.94%,心4.17%。而证素积分方面,肝、肾高于脾、肺、心(PO.05)。
4、虚性证素积分超过100的分别为血虚、阳虚、阴虚和气虚；实性证素积分超过100的分别为湿、痰和血瘀。
5、病位在肝的归为肝病位组有84例,其他病位统归为非肝病位组有60例,肝病位组和非肝病位组患者的年龄、性别无统计学差异(P>0.05)。肝病位组患者血虚、阴虚、阳虚和气虚证素积分均高于非肝病位组,差异具有统计学意义(P<0.01,P<0.05,P<0.01,P<0.01),但湿、痰、血瘀证素积分,两组间无显著差异(P值均>0.05)。肝病位组血虚、阴虚和血瘀证素阳性率方面显著均高于非肝病位组(P值均<0.01)。
6、肝与血虚证素积分的Spearman相关系数为0.732(P<0.01)。肝与阴虚证素积分的Spearman相关系数为0.572(P<0.01)。
7、肝病位组急躁易怒的症状多于非肝病位组(P 8、麻木、肢寒畏冷及刺痛症状,肝病位组显著高于非肝病位组(P<0.01,P<0.01,P<0.01)。
结论：
1、糖尿病周围神经病变的症状复杂,涉及的病位较多,主要的五脏病位有肝、肾。
2、肝血虚是糖尿病周围神经病变主要病机之一。
Based on fully study of previous researches to discuss the relationship between liver and diabetic peripheral neuropathy, this research observed566type2diabetes mellitus patients from Xiamen area in order to find out the prevalence and clinical characteristics of diabetic peripheral neuropathy. In addition, we used the method of syndrome factor to observe the clinical symptoms of144cases of patients with diabetic peripheral neuropathy to discover the chief pathogenesis characteristics of diabetic peripheral neuropathy.
Part1The Study on the Clinical incidence and Symptoms of Diabetic Peripheral Neuropathy
Objective:To study the prevalence and clinical characteristics of diabetic peripheral neuropathy, providing the basis for further theoretical and clinical research.
Methods:The cases with type2diabetes mellitus hospitalized in the First Affiliated Hospital of Xiamen University, from December2011to November2012were for the study, and their western diagnostic of diabetes according to the1999WHO diagnostic criteria for diabetes, peripheral neuropathy lesions with reference to the diagnostic criteria for diabetes Guide2010Edition. We collected the patient's clinical status, divided patients into diabetic peripheral neuropathy group and non-diabetic peripheral neuropathy group and described datas by the statistical analysis.
Results:
1There were566cases with diabetes mellitus hospitalized together, including312cases of patients with DPN patients, whose prevalence was55.12%. The average age of the the DPN group was significantly higher than the NDPN group, the former were (60.62±11.02) years old, and the latter were (58.15±14.23) years old, the difference was statistically significant (P<0.05).
2Among the566patients, the minimum duration of diabetes mellitus was10 days, and the maximum duration was40years, the average duration of7.5years, the average duration in DPN group was (8±6.87) years, higer than that in NDPN group, the average duration (6.82±7.39) years, there was a significant difference between the two groups (P<0.05).
3The male282cases, in whom the DPN group were141cases, and the average age of the DPN group of men was (58.92±11.7) years, higher than that of NDPN group (55.16±14.17) years old, a significant difference between the two groups(P <0.05). The female284cases, female patients in the DPN group of171cases, NDPN group of113cases, and there was no significant difference between the two groups (P>0.05). The age of men DPN population concentrated in50-65years old and women in DPN group from the age of50years old showed growth trend evident and reached the peak by65-year-old.
4Among171cases of DPN female patients, the average age was (62.02±11.7) years old, menopause figure represented85.39%, age at menarche was (14.53±2.35) years, and age at menopause was (49.23±4.60) years old, while in NDPN group, among the113cases of female patients, the average age was (61.87±13.47) years old, and age at menarche was(14.22±1.88) years old, age at menopause was (49.53±3.36) years, the comparison between the two groups, the difference was not statistically significant(P>0.05).
5Among312cases of DPN patients,171cases treated numbness as the first symptom, associating with tingling sense of ants crawling, burning sensation, itching, fatigue, cold feeling, intermittent claudication, swelling pain and so on.
Conclusions:The diabetic peripheral neuropathy patients have high prevalence, most of them are aging, middle-aged women, in patients with diabetic peripheral neuropathy incidence of occult, but clinical studies have found that symptoms of diabetic peripheral neuropathy patients more than those who are asymptomatic, and numb limbs are the chief clinical characteristics.
Part2The Study of TCM Syndromes on Diabetic Peripheral Neuropathy
Objective:To study the syndromes characteristics of diabetic peripheral neuropathy, and explore the chief pathogenesis characteristics, in order to provide clinical evidence for liver treatment of diabetic peripheral neuropathy.
Methods:Diabetic peripheral neuropathy patients from the First Affiliated Hospital of Xiamen University and Xiamen Eye Center were for the study, and their DPN diagnostic criteria and exclusion criteria the same as first part. Collected the patient's symptoms and signs. And the Four Diagnostics and TCM syndrome element differentiation were used, the former employed Inspection, Auscultation and Olfaction, Interrogation, Feeling Pulse and Palpation, in order to obtain objective evidences and indications of the clinical status. The latter is the procedure to analyse and synthesize such evidences and indications, which supplied by Fujian Traditional Chinese Medicine University. Then we used the statistical methods to study the relationships between liver and the syndromes of DPN.
Results:
1Among144case DPN patients, the youngest was35years old, and the oldest was80years old, the average age of the DPN patients were (60.28±10.30) years old. Female accounted for52.78%, while men accounted for47.22%. In the age stratification, there were4persons in30-39years old goup,21persons in40-49years old group,54persons in60-69years old group,27persons in70-79years old group, and only1person in80-85years old group. The minimum duration of diabetes mellitus was1.5months, and the maximum duration was30years, the average duration of8.05years, in which the durations less than5years were49cases, between5-9years were38cases,10-19years were44cases, and20-30years were13cases.
2The characteristics of the syndromes were numbness, urinate very much at night, blurred vision, pale red tongue, thin coating, white tongue, thready pulse and taut pulse.
3There first15syndrome elements of the disease location in DPN patients were respectively the liver, kidney, meridians, spleen, lung, skin, bones, uterus, stomach, heart, tables, gallbladder, mind(brain), bladder and colon. In the Five Parenchymatous Viscera syndrome elements of the disease location, the liver proportion was58.33%, kidney56.94%, spleen21.53%, lung6.94%, heart4.17%. The syndrome elements scores of the liver, kidney were relatively high.
4Deficiency syndrome element scores over100were Blood Deficiency, Yang Deficiency, Yin Deficiency and Qi Deficiency. Empirical syndrome element scores over100were Wet, Phlegm and Blood Stasis.
5According to the syndrome element of the disease location in liver or not,144DPN patients were divided into two groups, namely, liver group (84cases) and non-liver group (60cases), there were no significant difference of age and gender between the two groups(P>0.05). Blood Deficiency, Yin Deficiency, Yang Deficiency and Qi Deficiency syndrome elemen scores in liver group were higher than that in the non-liver group, the differences were statistically significant (P <0.01, P<0.05, P<0.01, P<0.01). Blood Deficiency, Yin Deficiency and Blood Stasis syndrome elemens positive rate in liver group were significantly higher than that in non-liver group (P<0.01).
6The liver showed best positive correlation with Blood Deficiency (Spearman=0.732, P value<0.01). And there was also positive correlation between the liver and Yin Deficiency (Spearman=0.572, P value<0.01).
7Compared with non-liver group, patients in liver group had significantly impatient irritability, blurred vision, taut pulse syndromes.(P<0.05, P<0.01, P<0.01).
8Compared with non-liver group, patients in liver group had significantly blurred vision, numbness, cold sensation, and tingling pain symptoms (P<0.01, P<0.01, P<0.01).
Conclusions:
1DPN symptoms are complicate. Liver and kidney are the major syndrome elements of disease locations, but other disease locations may involved in.
2Liver Blood Deficiency is one of the main pathogenesis of DPN.
一、糖尿病周围神经病变的发病及症状学特点研究
目的：研究糖尿病周围神经病变的患病情况及主要症状特点。
方法：以2011年12月-2012年11月在厦门大学附属第一医院内分泌糖尿病科住院的2型糖尿病周围神经病变患者为研究对象,其中糖尿病西医诊断依据1999年WHO糖尿病诊断标准,周围神经病变参照《中国糖尿病防治指南》2010版中的诊断标准。采集患者的临床资料,并分为糖尿病周围神经病变组(DPN组)和非糖尿病周围神经病变组(NDPN组)进行描述统计分析。
结果：
1、566例患者中,312例为DPN患者,占55.12%。DPN组平均年龄显著高于NDPN组,分别为(60.62±11.02)岁和(58.15±14.23)岁,差异有统计学意义(P<0.05)。
2、病程方面,最小病程10天,最大病程40年,平均病程7.5年,DPN组平均病程(8±6.87)年,NDPN组平均病程(6.82±7.39)年,两组间比较有统计学差异(P<0.05)。
3、性别方面,男性282例,其中,DPN组141例,平均年龄为(58.92±11.7)岁,高于NDPN组(55.16±14.17)岁(P<0.05)。女性284例,DPN组171例,平均年龄(62.02±11.7)岁,NDPN组113例,平均年龄(61.87±13.47)岁,两组年龄比较无统计学差异(P>0.05)。男性DPN人群集中在50岁-65岁,而女性DPN人群从50岁后增长趋势明显,在65岁左右达到高峰。
4、DPN组171例女性患者,平均年龄(62.02±11.7)岁,停经人数占85.39%,初潮年龄(14.53±2.35)岁,停经年龄(49.23±4.60)岁；而NDPN组113例女性患者,平均年龄(61.87±13.47)岁,初潮年龄(14.22±1.88)岁,停经年龄(49.53±3.36)岁,两组间比较,差异无统计学意义(P>0.05)。
5、312例DPN患者中171例有肢体麻木,伴发刺痛、蚁爬感、灼热感、瘙痒、乏力、肢寒畏冷、触电样感等症状。
结论：糖尿病周围神经病变患病率高,群体老龄化,患者以中老年女性居多,糖尿病周围神经病变患者发病隐匿性,但临床研究发现有症状的糖尿病周围神经病变患者多于无症状者,四肢麻木是糖尿病周围神经病变常见的首发症状特点。
二、糖尿病周围神经病变中医证候特点研究
目的：通过研究糖尿病周围神经病变患者的证候特点,探讨其主要病机,寻找从肝治疗糖尿病周围神经病变的临床依据。
方法：以来自厦门大学附属第一医院及厦门眼科中心,符合糖尿病周围神经病变诊断标准与排除标准(同第一部分)的患者为研究对象,采集患者的症状、体征,在四诊的基础上,借助证素辨证系统对四诊信息进行分析,研究糖尿病周围神经病变患者的中医证候特点,并运用相关统计方法研究肝与糖尿病周围神经病变证候特点的相关性。
结果：
1、144例患者中,年龄最小35岁,最大80岁,平均年龄(60.28±10.30)岁。女性76例(52.78%),男性68(47.22%)。在年龄分层上,30-39岁4人,40-49岁21人,50-59岁37人,60-69岁54人,70-79岁27人,80-85岁1人。最短病程1.5个月,最长病程30年,平均病程8.05年,其中病程在5年内的有49例,病程在5-9年的有38例,病程10-19年的有44例,病程在20-30的有13例。
2、主要证候特点有手足麻木、夜尿频多、视物模糊、舌淡红、舌苔薄、舌苔白、脉细、脉弦。
3、病位证素涉及15处,分别为肝、肾、经络、脾、肺、肌肤、筋骨、胞宫、胃、心、表、胆、心神、膀胱、大肠。五脏病位所占比例分别为肝58.33%,肾56.94%,脾21.53%,肺6.94%,心4.17%。而证素积分方面,肝、肾高于脾、肺、心(P
4、虚性证素积分超过100的分别为血虚、阳虚、阴虚和气虚；实性证素积分超过100的分别为湿、痰和血瘀。
5、病位在肝的归为肝病位组有84例,其他病位统归为非肝病位组有60例,肝病位组和非肝病位组患者的年龄、性别无统计学差异(P>0.05)。肝病位组患者血虚、阴虚、阳虚和气虚证素积分均高于非肝病位组,差异具有统计学意义(P<0.01,P<0.05,P<0.01,P<0.01),但湿、痰、血瘀证素积分,两组间无显著差异(P值均>0.05)。肝病位组血虚、阴虚和血瘀证素阳性率方面显著均高于非肝病位组(P值均<0.01)。
6、肝与血虚证素积分的Spearman相关系数为0.732(P<0.01)。肝与阴虚证素积分的Spearman相关系数为0.572(P<0.01)。
7、肝病位组急躁易怒的症状多于非肝病位组(P
结论：
1、糖尿病周围神经病变的症状复杂,涉及的病位较多,主要的五脏病位有肝、肾。
2、肝血虚是糖尿病周围神经病变主要病机之一。
Based on fully study of previous researches to discuss the relationship between liver and diabetic peripheral neuropathy, this research observed566type2diabetes mellitus patients from Xiamen area in order to find out the prevalence and clinical characteristics of diabetic peripheral neuropathy. In addition, we used the method of syndrome factor to observe the clinical symptoms of144cases of patients with diabetic peripheral neuropathy to discover the chief pathogenesis characteristics of diabetic peripheral neuropathy.
Part1The Study on the Clinical incidence and Symptoms of Diabetic Peripheral Neuropathy
Objective:To study the prevalence and clinical characteristics of diabetic peripheral neuropathy, providing the basis for further theoretical and clinical research.
Methods:The cases with type2diabetes mellitus hospitalized in the First Affiliated Hospital of Xiamen University, from December2011to November2012were for the study, and their western diagnostic of diabetes according to the1999WHO diagnostic criteria for diabetes, peripheral neuropathy lesions with reference to the diagnostic criteria for diabetes Guide2010Edition. We collected the patient's clinical status, divided patients into diabetic peripheral neuropathy group and non-diabetic peripheral neuropathy group and described datas by the statistical analysis.
Results:
1There were566cases with diabetes mellitus hospitalized together, including312cases of patients with DPN patients, whose prevalence was55.12%. The average age of the the DPN group was significantly higher than the NDPN group, the former were (60.62±11.02) years old, and the latter were (58.15±14.23) years old, the difference was statistically significant (P<0.05).
2Among the566patients, the minimum duration of diabetes mellitus was10 days, and the maximum duration was40years, the average duration of7.5years, the average duration in DPN group was (8±6.87) years, higer than that in NDPN group, the average duration (6.82±7.39) years, there was a significant difference between the two groups (P<0.05).
3The male282cases, in whom the DPN group were141cases, and the average age of the DPN group of men was (58.92±11.7) years, higher than that of NDPN group (55.16±14.17) years old, a significant difference between the two groups(P <0.05). The female284cases, female patients in the DPN group of171cases, NDPN group of113cases, and there was no significant difference between the two groups (P>0.05). The age of men DPN population concentrated in50-65years old and women in DPN group from the age of50years old showed growth trend evident and reached the peak by65-year-old.
4Among171cases of DPN female patients, the average age was (62.02±11.7) years old, menopause figure represented85.39%, age at menarche was (14.53±2.35) years, and age at menopause was (49.23±4.60) years old, while in NDPN group, among the113cases of female patients, the average age was (61.87±13.47) years old, and age at menarche was(14.22±1.88) years old, age at menopause was (49.53±3.36) years, the comparison between the two groups, the difference was not statistically significant(P>0.05).
5Among312cases of DPN patients,171cases treated numbness as the first symptom, associating with tingling sense of ants crawling, burning sensation, itching, fatigue, cold feeling, intermittent claudication, swelling pain and so on.
Conclusions:The diabetic peripheral neuropathy patients have high prevalence, most of them are aging, middle-aged women, in patients with diabetic peripheral neuropathy incidence of occult, but clinical studies have found that symptoms of diabetic peripheral neuropathy patients more than those who are asymptomatic, and numb limbs are the chief clinical characteristics.
Part2The Study of TCM Syndromes on Diabetic Peripheral Neuropathy
Objective:To study the syndromes characteristics of diabetic peripheral neuropathy, and explore the chief pathogenesis characteristics, in order to provide clinical evidence for liver treatment of diabetic peripheral neuropathy.
Methods:Diabetic peripheral neuropathy patients from the First Affiliated Hospital of Xiamen University and Xiamen Eye Center were for the study, and their DPN diagnostic criteria and exclusion criteria the same as first part. Collected the patient's symptoms and signs. And the Four Diagnostics and TCM syndrome element differentiation were used, the former employed Inspection, Auscultation and Olfaction, Interrogation, Feeling Pulse and Palpation, in order to obtain objective evidences and indications of the clinical status. The latter is the procedure to analyse and synthesize such evidences and indications, which supplied by Fujian Traditional Chinese Medicine University. Then we used the statistical methods to study the relationships between liver and the syndromes of DPN.
Results:
1Among144case DPN patients, the youngest was35years old, and the oldest was80years old, the average age of the DPN patients were (60.28±10.30) years old. Female accounted for52.78%, while men accounted for47.22%. In the age stratification, there were4persons in30-39years old goup,21persons in40-49years old group,54persons in60-69years old group,27persons in70-79years old group, and only1person in80-85years old group. The minimum duration of diabetes mellitus was1.5months, and the maximum duration was30years, the average duration of8.05years, in which the durations less than5years were49cases, between5-9years were38cases,10-19years were44cases, and20-30years were13cases.
2The characteristics of the syndromes were numbness, urinate very much at night, blurred vision, pale red tongue, thin coating, white tongue, thready pulse and taut pulse.
3There first15syndrome elements of the disease location in DPN patients were respectively the liver, kidney, meridians, spleen, lung, skin, bones, uterus, stomach, heart, tables, gallbladder, mind(brain), bladder and colon. In the Five Parenchymatous Viscera syndrome elements of the disease location, the liver proportion was58.33%, kidney56.94%, spleen21.53%, lung6.94%, heart4.17%. The syndrome elements scores of the liver, kidney were relatively high.
4Deficiency syndrome element scores over100were Blood Deficiency, Yang Deficiency, Yin Deficiency and Qi Deficiency. Empirical syndrome element scores over100were Wet, Phlegm and Blood Stasis.
5According to the syndrome element of the disease location in liver or not,144DPN patients were divided into two groups, namely, liver group (84cases) and non-liver group (60cases), there were no significant difference of age and gender between the two groups(P>0.05). Blood Deficiency, Yin Deficiency, Yang Deficiency and Qi Deficiency syndrome elemen scores in liver group were higher than that in the non-liver group, the differences were statistically significant (P <0.01, P<0.05, P<0.01, P<0.01). Blood Deficiency, Yin Deficiency and Blood Stasis syndrome elemens positive rate in liver group were significantly higher than that in non-liver group (P<0.01).
6The liver showed best positive correlation with Blood Deficiency (Spearman=0.732, P value<0.01). And there was also positive correlation between the liver and Yin Deficiency (Spearman=0.572, P value<0.01).
7Compared with non-liver group, patients in liver group had significantly impatient irritability, blurred vision, taut pulse syndromes.(P<0.05, P<0.01, P<0.01).
8Compared with non-liver group, patients in liver group had significantly blurred vision, numbness, cold sensation, and tingling pain symptoms (P<0.01, P<0.01, P<0.01).
Conclusions:
1DPN symptoms are complicate. Liver and kidney are the major syndrome elements of disease locations, but other disease locations may involved in.
2Liver Blood Deficiency is one of the main pathogenesis of DPN.
引文
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