青岛地区2型糖尿病患者中医证型分型研究
摘要
目的:研究青岛地区2型糖尿病的中医分型及特点,并阐述糖尿病各证型与各种客观指标的联系,从而为该病的中医规范化诊疗提供依据。方法:对青岛市海慈医疗集团2010年5月至2010年12月住院及门诊收治的613例T2DM患者进行临床分析。结果:1.筛选出五种中医证型:湿热困脾证14.5%、阴虚燥热证14.5%、气阴两虚证32.5%、气阴两虚兼血瘀27.4%、阴阳两虚证11.4%。发病特点:市区高于郊区,发病年龄集中于50-70岁。2.⑴从各组病程比较可以看出湿热困脾证<阴虚燥热证<气阴两虚证<阴阳两虚<气阴两虚兼血瘀。⑵各并发症例数按阴虚燥热组、气阴两虚证、气阴两虚兼血瘀证方向增多。糖尿病肾病、眼病等慢性并发症发生率随病程、年龄延长而增高。⑶T2DM中医各证型的BMI、HbAlc、血脂、与健康对照组比,均有统计学差异。湿热困脾的BMI、FPG、HbAlc、TC最高,其它三组之间的差别无统计学意义。结论:青岛地区最常见的2型糖尿病证型为5类:湿热困脾证、阴虚燥热证、气阴两虚证、气阴两虚兼血瘀、阴阳两虚证,以气阴两虚、气阴两虚兼血瘀最为多见。发病过程中易于夹瘀、夹痰湿、湿热,病位与肺脾肾联系密切。各T2DM中医证型与年龄、病程、慢性并发症等有统计学意义。
Objective: To classify and analyze TCM syndrome types of type 2 diabetes mellitus in Qingdao, study the relations between each classification and the objective index,provide a basis and standard for judging the condition of patient. Method: There were 613 cases surveyed that came from the department of Endocrine ward and Clinic of Qingdao Haici Hospital. Results:1.There are 5 TCM syndrome types of T2DM selected: syndrome of Humid heat distressing spleen (14.5%), syndrome of pathogenic dryness-heat combined with deficiency of yin(14.5%), syndrome of deficiency on both qi and yin(32.5%),syndromes of deficiency on both qi and yin combined with blood stasis(27.4%),syndromes of deficiency on both yin and yang(11.4%) The incidence of T2DM in city is higher than outskirts and Village. The age range of onset for T2DM was between ages 50 and 70. 2.?⑴The comparison of course of disease in 5 TCM syndrome types: syndrome of Humid heat distressing spleen
Objective: To classify and analyze TCM syndrome types of type 2 diabetes mellitus in Qingdao, study the relations between each classification and the objective index,provide a basis and standard for judging the condition of patient. Method: There were 613 cases surveyed that came from the department of Endocrine ward and Clinic of Qingdao Haici Hospital. Results:1.There are 5 TCM syndrome types of T2DM selected: syndrome of Humid heat distressing spleen (14.5%), syndrome of pathogenic dryness-heat combined with deficiency of yin(14.5%), syndrome of deficiency on both qi and yin(32.5%),syndromes of deficiency on both qi and yin combined with blood stasis(27.4%),syndromes of deficiency on both yin and yang(11.4%) The incidence of T2DM in city is higher than outskirts and Village. The age range of onset for T2DM was between ages 50 and 70. 2.?⑴The comparison of course of disease in 5 TCM syndrome types: syndrome of Humid heat distressing spleen
引文
[1]胡仁明,朱禧星.糖尿病.陈灏珠,主编.实用内科学.第12版[M].北京:人民卫生出版社,2005;1015～1062.
[2]杜娟,张绍维,李鹏飞等.2型糖尿病患者203例危险因素的病例对照研究[J].中国冶金工业医学杂志,2007;24(2):210～211. [3 30 31]闫胜利,王颜刚,赵世华等,青岛地区型糖尿病的流行特点[J].青岛大学医学院学报报, 2001;37(2): 106-107.
[4]祝堪予,郭赛珊,梁晓春.对糖尿病中医辨证指标及施治方药的探讨[J].上海中医药杂志,1952;(6):5
[5]林兰.糖尿病的中西医结合论治.第1版[M].北京:北京科学技术出版社,1992;
[6]吕仁和,张洁荣,高彦彬.消渴病(糖尿病)中医分期辨证与疗效评定标准[J].中国医药学报,993,s(3):54一56社,1992;143-151.
[7]淦家荣,刘红英,普丽.2型糖尿病证型客观性研究.云南中医药杂志[J].2004;25(5):23.
[8]肖燕倩,杨志新,郭美珠2型糖尿病胰岛素抵抗(IR)与中医辨证分型的相关性研究.中华中医药学刊[J].2007;25(4):743-745.
[9]魏军平,周丽波,刘芳等2型糖尿病患者体型与证候特点研究中华中医药学刊[J].2007; 25(12):2653-2655.
[10]毛竹君董颖等,180例2型糖尿病患者中医证候调查及证型研究[J].中华中医药杂志(原中国医药学报)2009;(24)8 :1064-1067. [11 26 36]于青云张德宪等,糖尿病证群调查及证型研究[J].山东中医药大学学报,2001;(25)3:185-188.
[12]高妍.糖尿病与心血管疾病[J].中华内分泌代谢杂志,2005;21(1):18～20.
[13]张扬,冉建民,徐刚.2型糖尿病患者高密度脂蛋白水平变化分析[J].中国基层医药,2007,14(7):1196-1197.
[14]陈营,贾伟平,陆俊茜,等.上海市成人代谢综合征流行调查[J].中华心血管杂志,2003;31(12):909—912.
[15]范洪.老年人型糖尿病高脂血症发生率的临床分析[J].河北中西医结合杂志,1998;7(4):529.
[16]程汉桥.糖尿病患者中医证型与血液流变学的相关性研究[J].中国中西医结合杂志,1998; 1:112.
[17]张延群韩清和贵章等.2080例糖尿病患者证候与血糖关系分析[J].中医杂志,1996;37(l)617-619.
[18]陈超罗楚云郑瑞璋等2型糖尿病人血瘀症与胰岛素抵抗的关系[J].中华实用中西医杂志2004(17)15: 2301-2302.
[19]王东姜良铎李敬林等,胰岛素抵抗的中医药研究进展[J].中国中医基础医学杂志, 2003(9)06:76-79.
[20] Rajala MW,Scherer PE. Minireview:the adipocyte—at the crossroads of energy homeostasis,inflammation,and atherosclerosis. Endocrinology,2003;144(9):3765-3773.
[21] Lazar MA. How obesity causes diabetes:not a tall tale. Science[J].2005;307(5708):373-375.
[22] Thorand B,Kolb H,Baumert J,et al. Elevated levels of interleukin-18 predict the development of type 2 diabetes:results from the MONICA/KORA Augsburg Study,1984-2002[J].Diabetes,2005;54(10):2932-2938.
[23] Bluher M,Fasshauer M,Tonjes A,et al. Association of interleukin-6,C-reactive protein,interleukin-10 and adiponectin plasma concentrations with measures of obesity,insulin sensitivity and glucose metabolism. Exp Clin Endocrinol Diabetes[J].2005;113(9):534-537.
[24]Pick JC.Crook MA.Is type 2 diabetes mellitus a disease of the innate immune system Diahetologia[J].1998;41:1241-1248.
[25] Grau AJ.Buggle F, Becher H, et a1.The association of leukodytecount,fibririogen and C—reactive protein with vascular risk and ischemic vascular diseases[J].Thrombosis research 1996;82(3):245～255.
[27]余学庆,李建生.2型糖尿病患者中医证候分布规律研究[J].2003,18 (3)9-13.
[28]黄梅芳,李显梅肥胖及高血压与中老年人糖尿病患病率的关系《实用预防医学》[J].2000 7(6): 406-407.
[29]张延群,李瑛,孔祥梅等.2080例糖尿病患者证候与并发症相关性流行病学调查报告[J].上海中医药杂志2000;1: 24-25.
[32]祝堪予,郭赛珊,梁晓春.对糖尿病中医辨证指标及施治方药的探讨[J].上海中医药杂志,1952;(6):5.
[33]刘志龙,李锡杰,丁萍等2型糖尿病中医证型的筛选研究[J].世界中医药2009;3(4):74-75.
[34]殷百万.消渴病机说.陕西中医,2002;23 (6):527-529.
[35]王静芳. 96例老年糖尿病中医证候分析[J].上海中医药杂志,1999;(7)21-22.
[37]余学庆,李建生.2型糖尿病患者中医证候分布规律研究[J].上海中医药大学学报2004;18(3)9-13.
[2]杜娟,张绍维,李鹏飞等.2型糖尿病患者203例危险因素的病例对照研究[J].中国冶金工业医学杂志,2007;24(2):210～211. [3 30 31]闫胜利,王颜刚,赵世华等,青岛地区型糖尿病的流行特点[J].青岛大学医学院学报报, 2001;37(2): 106-107.
[4]祝堪予,郭赛珊,梁晓春.对糖尿病中医辨证指标及施治方药的探讨[J].上海中医药杂志,1952;(6):5
[5]林兰.糖尿病的中西医结合论治.第1版[M].北京:北京科学技术出版社,1992;
[6]吕仁和,张洁荣,高彦彬.消渴病(糖尿病)中医分期辨证与疗效评定标准[J].中国医药学报,993,s(3):54一56社,1992;143-151.
[7]淦家荣,刘红英,普丽.2型糖尿病证型客观性研究.云南中医药杂志[J].2004;25(5):23.
[8]肖燕倩,杨志新,郭美珠2型糖尿病胰岛素抵抗(IR)与中医辨证分型的相关性研究.中华中医药学刊[J].2007;25(4):743-745.
[9]魏军平,周丽波,刘芳等2型糖尿病患者体型与证候特点研究中华中医药学刊[J].2007; 25(12):2653-2655.
[10]毛竹君董颖等,180例2型糖尿病患者中医证候调查及证型研究[J].中华中医药杂志(原中国医药学报)2009;(24)8 :1064-1067. [11 26 36]于青云张德宪等,糖尿病证群调查及证型研究[J].山东中医药大学学报,2001;(25)3:185-188.
[12]高妍.糖尿病与心血管疾病[J].中华内分泌代谢杂志,2005;21(1):18～20.
[13]张扬,冉建民,徐刚.2型糖尿病患者高密度脂蛋白水平变化分析[J].中国基层医药,2007,14(7):1196-1197.
[14]陈营,贾伟平,陆俊茜,等.上海市成人代谢综合征流行调查[J].中华心血管杂志,2003;31(12):909—912.
[15]范洪.老年人型糖尿病高脂血症发生率的临床分析[J].河北中西医结合杂志,1998;7(4):529.
[16]程汉桥.糖尿病患者中医证型与血液流变学的相关性研究[J].中国中西医结合杂志,1998; 1:112.
[17]张延群韩清和贵章等.2080例糖尿病患者证候与血糖关系分析[J].中医杂志,1996;37(l)617-619.
[18]陈超罗楚云郑瑞璋等2型糖尿病人血瘀症与胰岛素抵抗的关系[J].中华实用中西医杂志2004(17)15: 2301-2302.
[19]王东姜良铎李敬林等,胰岛素抵抗的中医药研究进展[J].中国中医基础医学杂志, 2003(9)06:76-79.
[20] Rajala MW,Scherer PE. Minireview:the adipocyte—at the crossroads of energy homeostasis,inflammation,and atherosclerosis. Endocrinology,2003;144(9):3765-3773.
[21] Lazar MA. How obesity causes diabetes:not a tall tale. Science[J].2005;307(5708):373-375.
[22] Thorand B,Kolb H,Baumert J,et al. Elevated levels of interleukin-18 predict the development of type 2 diabetes:results from the MONICA/KORA Augsburg Study,1984-2002[J].Diabetes,2005;54(10):2932-2938.
[23] Bluher M,Fasshauer M,Tonjes A,et al. Association of interleukin-6,C-reactive protein,interleukin-10 and adiponectin plasma concentrations with measures of obesity,insulin sensitivity and glucose metabolism. Exp Clin Endocrinol Diabetes[J].2005;113(9):534-537.
[24]Pick JC.Crook MA.Is type 2 diabetes mellitus a disease of the innate immune system Diahetologia[J].1998;41:1241-1248.
[25] Grau AJ.Buggle F, Becher H, et a1.The association of leukodytecount,fibririogen and C—reactive protein with vascular risk and ischemic vascular diseases[J].Thrombosis research 1996;82(3):245～255.
[27]余学庆,李建生.2型糖尿病患者中医证候分布规律研究[J].2003,18 (3)9-13.
[28]黄梅芳,李显梅肥胖及高血压与中老年人糖尿病患病率的关系《实用预防医学》[J].2000 7(6): 406-407.
[29]张延群,李瑛,孔祥梅等.2080例糖尿病患者证候与并发症相关性流行病学调查报告[J].上海中医药杂志2000;1: 24-25.
[32]祝堪予,郭赛珊,梁晓春.对糖尿病中医辨证指标及施治方药的探讨[J].上海中医药杂志,1952;(6):5.
[33]刘志龙,李锡杰,丁萍等2型糖尿病中医证型的筛选研究[J].世界中医药2009;3(4):74-75.
[34]殷百万.消渴病机说.陕西中医,2002;23 (6):527-529.
[35]王静芳. 96例老年糖尿病中医证候分析[J].上海中医药杂志,1999;(7)21-22.
[37]余学庆,李建生.2型糖尿病患者中医证候分布规律研究[J].上海中医药大学学报2004;18(3)9-13.