社区老年人中医体质分型及组合与2型糖尿病的关系研究
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摘要
背景 2型糖尿病的发生、发展、预后效果与中医偏颇体质有所关联。但在此方面,目前国内主要集中于一般人群的研究,且多为单一偏颇体质的分析。目的辨识分析社区老年人的中医体质及兼夹情况,探索社区老年人中医体质分型及组合与2型糖尿病发病的关系。方法抽取2016年6月—2017年6月于珠三角某社区体检科进行常规健康体检且居住于该社区的1 600例老年人为研究对象。采用中医体质分类与判定进行中医体质辨识,并采集血液,检测空腹血糖(FPG)。对比分析中医体质分型与2型糖尿病发病的关系,以因子分析法探索单一偏颇体质的兼夹组合。结果在样本筛选中排除60例体检资料不完整者,有效样本1 540例,有效率为96.25%。1 540例社区老年人糖尿病检出率为21.49%(331/1 540);中医体质分型平和质878例(57.01%),偏颇体质主要为痰湿质197例(12.79%)、阳虚质192例(12.47%)、气虚质182例(11.82%)、阴虚质170例(11.04%)。经因子分析,8种偏颇体质共提取3个公因子,其中痰湿质、血瘀质、湿热质、气郁质、特禀质为淤湿组合;阳虚质与阴虚质为体虚组合;气虚质独为一类。痰湿质、阳虚质、阴虚质、血瘀质、湿热质、气郁质、特禀质与2型糖尿病的发病有关(P<0.05),其OR值排序依次为:特禀质(OR=4.482)、气郁质(OR=3.129)、湿热质(OR=2.871)、阳虚质(OR=2.201)、血瘀质(OR=1.936)、阴虚质(OR=1.668)、痰湿质(OR=1.588)。淤湿组合体质、体虚组合体质与2型糖尿病的发病有关(P<0.05),其中淤湿组合体质OR值为1.360,体虚组合体质OR值为1.729。结论辨识为特禀质、气郁质、湿热质、阳虚质,兼夹痰湿质、湿热质、血瘀质、气郁质、特禀质,兼夹阳虚质、阴虚质的社区老年人更易发生2型糖尿病。在社区预防与干预中应根据老年人的不同体质给予针对性的健康指导,采取中西医综合保健策略改善老年人的健康水平。
Backgroud The occurrence,development and prognosis of type 2 diabetes are related to pathological constitutions of Chinese medicine.But in this respect,the research is mainly focused on the general population in China,and most of them analysis of single pathological constitutions.Objective To identify and analyze Traditional Chinese Medicine Constitutions(TCMCs) in elderly community members and their mixed constitutions,in order to determine the relationship between TCMCs(or mixed TCMCs) and the development of type 2 diabetes in elderly members of the community.Methods From June 2016 to June 2017,1 600 elders living in a community in the Pearl River Delta who underwent routine physical examination in the community medical examination department were selected as the study subjects.The TCMCs were determined using classification and diagnosis basis of constitutions in Chinese medicine,and fasting plasma glucose(FPG) was determined from blood samples.A comparative analysis of the relationship between TCMCs and the development of type 2 diabetes was conducted,and factor analysis was used to assess the mixing and combination of single biased constitutions.Results A total of 1 540 valid samples were screened from 1 600 samples with an effective rate of 96.25%.Sixty samples with incomplete physical examination data were excluded.The detection rate of diabetes among the 1 540 elderly subjects in the community was 21.49%(331/1 540).With regard to TCMCs,there were 878 cases(57.01%) of normal constitution,while biased constitutions were observed in 197 cases(12.79%) of phlegm-dampness constitution,192 cases(12.47%) of Yang-deficiency constitution,182 cases(11.82%) of Qi-deficiency constitution,and 170 cases(11.04%) of Yin-deficiency constitution.Following factor analysis,three common factors were extracted from eight types of biased constitutions.Of these,phlegm-dampness,blood stasis,dampness-heat,Qi-stagnation,and special constitution constituted the stasis-dampness mix;Yang-deficiency constitution and Yin-deficiency constitution constituted the deficiency-mix;and Qi-deficiency constitution alone constituted a unique common factor.Phlegm-dampness,Yang deficiency,Yin deficiency,blood stasis,dampness-heat,Qi stagnation,and special constitution were related to the development of type 2 diabetes(P<0.05),with OR values ranked in order as follows:special constitution(OR=4.482),Qi-stagnation constitution(OR=3.129),dampness-heat constitution(OR=2.871),Yangdeficiency constitution(OR=2.201),blood stasis constitution(OR=1.936),Yin-deficiency constitution(OR=1.668),and phlegm-dampness constitution(OR=1.588).Hydration and the combination of body composition and physical fitness were related to the occurrence of type 2 diabetes(P<0.05),in which the combined OR value of the dampness constitution was 1.360,and the OR value of the combined fitness was 1.729.Conclusion In community elders,those with special constitution,Qi-stagnation constitution,dampness-heat constitution,Yang-deficiency constitution;mixed phlegm-dampness constitution,dampness-heat constitution,blood stasis constitution,Qi-stagnation constitution,special constitution;or mixed Yangdeficiency constitution and Yin-deficiency constitution,were more likely to develop type 2 diabetes.In community prevention and intervention programs,targeted health guidance should be provided for different constitutions in the elderly,and an integrated health care strategy of Chinese and Western medicine should be adopted to improve their health status.
Backgroud The occurrence,development and prognosis of type 2 diabetes are related to pathological constitutions of Chinese medicine.But in this respect,the research is mainly focused on the general population in China,and most of them analysis of single pathological constitutions.Objective To identify and analyze Traditional Chinese Medicine Constitutions(TCMCs) in elderly community members and their mixed constitutions,in order to determine the relationship between TCMCs(or mixed TCMCs) and the development of type 2 diabetes in elderly members of the community.Methods From June 2016 to June 2017,1 600 elders living in a community in the Pearl River Delta who underwent routine physical examination in the community medical examination department were selected as the study subjects.The TCMCs were determined using classification and diagnosis basis of constitutions in Chinese medicine,and fasting plasma glucose(FPG) was determined from blood samples.A comparative analysis of the relationship between TCMCs and the development of type 2 diabetes was conducted,and factor analysis was used to assess the mixing and combination of single biased constitutions.Results A total of 1 540 valid samples were screened from 1 600 samples with an effective rate of 96.25%.Sixty samples with incomplete physical examination data were excluded.The detection rate of diabetes among the 1 540 elderly subjects in the community was 21.49%(331/1 540).With regard to TCMCs,there were 878 cases(57.01%) of normal constitution,while biased constitutions were observed in 197 cases(12.79%) of phlegm-dampness constitution,192 cases(12.47%) of Yang-deficiency constitution,182 cases(11.82%) of Qi-deficiency constitution,and 170 cases(11.04%) of Yin-deficiency constitution.Following factor analysis,three common factors were extracted from eight types of biased constitutions.Of these,phlegm-dampness,blood stasis,dampness-heat,Qi-stagnation,and special constitution constituted the stasis-dampness mix;Yang-deficiency constitution and Yin-deficiency constitution constituted the deficiency-mix;and Qi-deficiency constitution alone constituted a unique common factor.Phlegm-dampness,Yang deficiency,Yin deficiency,blood stasis,dampness-heat,Qi stagnation,and special constitution were related to the development of type 2 diabetes(P<0.05),with OR values ranked in order as follows:special constitution(OR=4.482),Qi-stagnation constitution(OR=3.129),dampness-heat constitution(OR=2.871),Yangdeficiency constitution(OR=2.201),blood stasis constitution(OR=1.936),Yin-deficiency constitution(OR=1.668),and phlegm-dampness constitution(OR=1.588).Hydration and the combination of body composition and physical fitness were related to the occurrence of type 2 diabetes(P<0.05),in which the combined OR value of the dampness constitution was 1.360,and the OR value of the combined fitness was 1.729.Conclusion In community elders,those with special constitution,Qi-stagnation constitution,dampness-heat constitution,Yang-deficiency constitution;mixed phlegm-dampness constitution,dampness-heat constitution,blood stasis constitution,Qi-stagnation constitution,special constitution;or mixed Yangdeficiency constitution and Yin-deficiency constitution,were more likely to develop type 2 diabetes.In community prevention and intervention programs,targeted health guidance should be provided for different constitutions in the elderly,and an integrated health care strategy of Chinese and Western medicine should be adopted to improve their health status.
引文
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[4]夏君,谢晓娜,刚晓坤,等.老年糖尿病患者个体化治疗的研究进展[J].吉林大学学报(医学版),2016,42(1):191-194.DOI:10.3969/j.issn.1671-6450.2017.02.027.XIA J,XIE X N,GANG X K,et al.Progress research on individualized treatment of senile patients with diabetes[J].Journal of Jilin University(Medicine Edition),2016,42(1):191-194.DOI:10.3969/j.issn.1671-6450.2017.02.027.
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[6]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.DOI:10.3321/j.issn:1006-2157.2005.04.001.WANG Q.Classification and diagnosis basis of nine basic constitutions in Chinese medicine[J].Journal of Beijing University of Traditional Chinese Medicine,2005,28(4):1-8.DOI:10.3321/j.issn:1006-2157.2005.04.001.
[7]蔡海荣,黄永莲,郭永宁,等.广州地区中老年人群瘀血质、湿热质、平和质与心血管病危险因素关系分析[J].中国中医基础医学杂志,2017,23(6):810-812.CAI H R,HUANG Y L,GUO Y N,et al.Relationship between blood stasis type,dampness heat type,harmony type and cardiovascular risk factors in middle aged and elderly people in Guangzhou[J].Chinese Journal of Basic Medicine in Traditional Chinese Medicine,2017,23(6):810-812.
[8]石劢,刘兆兰,许美艳,等.北京城区老年人中医体质与慢性病的关系研究[J].山东中医杂志,2016,35(1):28-30.DOI:10.16295/j.cnki.0257-358x.2016.01.010.SHI M,LIU Z L,XU M Y,et al.Study on the relationship between traditional Chinese medicine body constitution and chronic diseases in the older population in the downtown area of Beijing[J].Shandong Journal of Traditional Chinese Medicine,2016,35(1):28-30.DOI:10.16295/j.cnki.0257-358x.2016.01.010.
[9]李红金,赵敏,綦雯雯,等.2010美国糖尿病协会糖尿病治疗指南[J].中国卒中杂志,2011,6(4):316-324.DOI:10.3969/j.issn.1673-5765.2011.04.013.LI H J,ZHAO M,QI W W,et al.Standards of medical care in diabetes-2010[J].Chinese Journal of Stroke,2011,6(4):316-324.DOI:10.3969/j.issn.1673-5765.2011.04.013.
[10]周仲芳,王庆稳,罗家红,等.中医体质辨识研究进展综述[J].内蒙古中医药,2016,35(9):138-139.DOI:10.16040/j.cnki.cn15-1101.2016.09.131.ZHOU Z F,WANG Q W,LUO J H,et al.Review of research progress on constitution identification of traditional Chinese medicine[J].Nei Mongol Journal of Traditional Chinese Medicine,2016,35(9):138-139.DOI:10.16040/j.cnki.cn15-1101.2016.09.131.
[11]袁尚华,富斌,陈斐斐,等.老年人中医体质特征及干预对策[J].中华中医药杂志,2015,30(10):3450-3452.YUAN S H,FU B,CHEN F F,et al.Traditional Chinese medicine constitution features in the aged and intervention strategy[J].China Journal of Traditional Chinese Medicine and Pharmacy,2015,30(10):3450-3452.
[12]井延杰,李军.中医体质与2型糖尿病的临床研究进展[J].国医论坛,2017,32(3):68-70.DOI:10.13913/j.cnki.41-1110/r.2017.03.038.JIN Y J,LI J.Clinical research progress of TCM constitution and type2 diabetes[J].Forum on Traditional Chinese Medicine,2017,32(3):68-70.DOI:10.13913/j.cnki.41-1110/r.2017.03.038.
[13]邸洁,朱燕波,王琦,等.不同年龄人群中医体质特点对应分析[J].中国中西医结合杂志,2014,34(5):627-630.DOI:10.7661/CJIM.2014.05.0627.DI J,ZHU Y B,WANG Q,et al.Correspondence analysis of Chinese medical constitution features in different ages population[J].Chinese Journal of Integrated Traditional and Western Medicine,2014,34(5):627-630.DOI:10.7661/CJIM.2014.05.0627.
[14]朱燕波.中医体质分类判定与兼夹体质的综合评价[J].中华中医药杂志,2012,27(1):37-39.ZHU Y B.Constitutional classification and comprehensive evaluation in Chinese medicine[J].China Journal of Traditional Chinese Medicine and Pharmacy,2012,27(1):37-39.
[15]战文翔,申芳芳,沈伟,等.36486例中老年人中医体质分类研究[J].中国临床研究,2014,27(9):1150-1152.DOI:10.13429/j.cnki.cjcr.2014.09.046.ZHAN W X,SHEN F F,SHEN W,et al.Study on the classification of TCM constitution in 36486 cases of middle-aged and old people[J].Chinese Journal of Clinical Research,2014,27(9):1150-1152.DOI:10.13429/j.cnki.cjcr.2014.09.046.
[16]郑碧桃.老年人体质辨识分析及临床指导[J].亚太传统医药,2015,11(9):73-74.ZHENG B T.Analysis on the syndrome differentiation of the constitution in the elderly and clinical guidance[J].Asia-Pacific Traditional Medicine,2015,11(9):73-74.
[2]郑姜钦,马坤,吕绍光.2型糖尿病中医辨证与胰岛素抵抗的关系[J].中华中医药杂志,2010,25(8):1318-1320.ZHENG J Q,MA K,LYU S G.Relationship between TCM syndrome differentiation and insulin resistance of type 2 diabetes[J].China Journal of Traditional Chinese Medicine and Pharmacy,2010,25(8):1318-1320.
[3]邓小敏,唐爱华,周卫惠,等.2型糖尿病中医体质的调查研究[J].中国中医药现代远程教育,2014,12(10):148-150.DOI:10.3969/j.issn.1672-2779.2014.10.091.DENG X M,TANG A H,ZHOU W H,et al.Investigation and study of TCM constitution of type 2 diabetes[J].Chinese Medicine Modern Distance Education of China,2014,12(10):148-150.DOI:10.3969/j.issn.1672-2779.2014.10.091.
[4]夏君,谢晓娜,刚晓坤,等.老年糖尿病患者个体化治疗的研究进展[J].吉林大学学报(医学版),2016,42(1):191-194.DOI:10.3969/j.issn.1671-6450.2017.02.027.XIA J,XIE X N,GANG X K,et al.Progress research on individualized treatment of senile patients with diabetes[J].Journal of Jilin University(Medicine Edition),2016,42(1):191-194.DOI:10.3969/j.issn.1671-6450.2017.02.027.
[5]王琦.中医体质学说的研究现状与展望[J].山东中医学院学报,1994(2):74-82,144.WANG Q.The present situation and prospect for the research on TCM constitution theory[J].Journal of Shandong University of Traditional Chinese Medicine,1994(2):74-82,144.
[6]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.DOI:10.3321/j.issn:1006-2157.2005.04.001.WANG Q.Classification and diagnosis basis of nine basic constitutions in Chinese medicine[J].Journal of Beijing University of Traditional Chinese Medicine,2005,28(4):1-8.DOI:10.3321/j.issn:1006-2157.2005.04.001.
[7]蔡海荣,黄永莲,郭永宁,等.广州地区中老年人群瘀血质、湿热质、平和质与心血管病危险因素关系分析[J].中国中医基础医学杂志,2017,23(6):810-812.CAI H R,HUANG Y L,GUO Y N,et al.Relationship between blood stasis type,dampness heat type,harmony type and cardiovascular risk factors in middle aged and elderly people in Guangzhou[J].Chinese Journal of Basic Medicine in Traditional Chinese Medicine,2017,23(6):810-812.
[8]石劢,刘兆兰,许美艳,等.北京城区老年人中医体质与慢性病的关系研究[J].山东中医杂志,2016,35(1):28-30.DOI:10.16295/j.cnki.0257-358x.2016.01.010.SHI M,LIU Z L,XU M Y,et al.Study on the relationship between traditional Chinese medicine body constitution and chronic diseases in the older population in the downtown area of Beijing[J].Shandong Journal of Traditional Chinese Medicine,2016,35(1):28-30.DOI:10.16295/j.cnki.0257-358x.2016.01.010.
[9]李红金,赵敏,綦雯雯,等.2010美国糖尿病协会糖尿病治疗指南[J].中国卒中杂志,2011,6(4):316-324.DOI:10.3969/j.issn.1673-5765.2011.04.013.LI H J,ZHAO M,QI W W,et al.Standards of medical care in diabetes-2010[J].Chinese Journal of Stroke,2011,6(4):316-324.DOI:10.3969/j.issn.1673-5765.2011.04.013.
[10]周仲芳,王庆稳,罗家红,等.中医体质辨识研究进展综述[J].内蒙古中医药,2016,35(9):138-139.DOI:10.16040/j.cnki.cn15-1101.2016.09.131.ZHOU Z F,WANG Q W,LUO J H,et al.Review of research progress on constitution identification of traditional Chinese medicine[J].Nei Mongol Journal of Traditional Chinese Medicine,2016,35(9):138-139.DOI:10.16040/j.cnki.cn15-1101.2016.09.131.
[11]袁尚华,富斌,陈斐斐,等.老年人中医体质特征及干预对策[J].中华中医药杂志,2015,30(10):3450-3452.YUAN S H,FU B,CHEN F F,et al.Traditional Chinese medicine constitution features in the aged and intervention strategy[J].China Journal of Traditional Chinese Medicine and Pharmacy,2015,30(10):3450-3452.
[12]井延杰,李军.中医体质与2型糖尿病的临床研究进展[J].国医论坛,2017,32(3):68-70.DOI:10.13913/j.cnki.41-1110/r.2017.03.038.JIN Y J,LI J.Clinical research progress of TCM constitution and type2 diabetes[J].Forum on Traditional Chinese Medicine,2017,32(3):68-70.DOI:10.13913/j.cnki.41-1110/r.2017.03.038.
[13]邸洁,朱燕波,王琦,等.不同年龄人群中医体质特点对应分析[J].中国中西医结合杂志,2014,34(5):627-630.DOI:10.7661/CJIM.2014.05.0627.DI J,ZHU Y B,WANG Q,et al.Correspondence analysis of Chinese medical constitution features in different ages population[J].Chinese Journal of Integrated Traditional and Western Medicine,2014,34(5):627-630.DOI:10.7661/CJIM.2014.05.0627.
[14]朱燕波.中医体质分类判定与兼夹体质的综合评价[J].中华中医药杂志,2012,27(1):37-39.ZHU Y B.Constitutional classification and comprehensive evaluation in Chinese medicine[J].China Journal of Traditional Chinese Medicine and Pharmacy,2012,27(1):37-39.
[15]战文翔,申芳芳,沈伟,等.36486例中老年人中医体质分类研究[J].中国临床研究,2014,27(9):1150-1152.DOI:10.13429/j.cnki.cjcr.2014.09.046.ZHAN W X,SHEN F F,SHEN W,et al.Study on the classification of TCM constitution in 36486 cases of middle-aged and old people[J].Chinese Journal of Clinical Research,2014,27(9):1150-1152.DOI:10.13429/j.cnki.cjcr.2014.09.046.
[16]郑碧桃.老年人体质辨识分析及临床指导[J].亚太传统医药,2015,11(9):73-74.ZHENG B T.Analysis on the syndrome differentiation of the constitution in the elderly and clinical guidance[J].Asia-Pacific Traditional Medicine,2015,11(9):73-74.