非肥胖型糖尿病中医证型分布与相关因素的临床研究
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摘要
研究背景目前我国关于肥胖型糖尿病的证型临床研究较丰富,对于非肥胖型糖尿病证型分布及其体重减轻相关因素研究较少。
目的目前糖尿病发病率呈不断上升的趋势,本研究旨在探讨非肥胖型糖尿病中医证型分布特点及相关影响因素地关系,为今后进一步提高糖尿病中医临床疗效奠定基础。
资料与方法通过回顾性调查问卷形式,采集2007年4月至2008年3月我院内分泌科门诊及住院非肥胖型糖尿病患者的病程、年龄、身高、体重、体重变化情况、降糖药物应用情况、饮食及运动情况、实验室检查等资料,采集中医临床症状、舌脉,并参考相关标准形成证型诊断。应用SPSS(Statistical Package forSocial Science)15.0进行统计,讨论分析非肥胖型糖尿病患者的证型分布情况;分析非肥胖型糖尿病证型与病程、年龄、疾病本身、降糖药物、饮食控制、运动治疗等因素的相关性;分析非肥胖型糖尿病证型与实验室指标的相关性。
研究结果本研究非肥胖型糖尿病证型包括:肺胃热盛、郁热内蕴、湿浊阻滞、气阴两虚、瘀血阻络、阴阳两虚等6个证型;肺胃热盛证在年龄较轻或病程早期较多,但比例较少占5.5%,气阴两虚证贯穿整个病程占31.1%,随着年龄的增加、病程的延长,瘀血阻络证明显增多,占29.7%,但在疾病的早期中期,湿邪阻滞、郁热内蕴证在各自证型分布上较常见,分别占13.7%、16.0%,病情加重或病程延长则可出现阴阳两虚证,占总数的4.1%;疾病本身的发病机制,口服二甲双胍,良好的饮食控制及坚持长期运动对于患者体重减轻有临床意义,并且有利于血糖控制;疾病早期、实证,血糖相对容易控制,随着疾病的发展,虚证为主、伴发实证,则血糖较难控制。湿浊阻滞、瘀血阻络可能是非肥胖型糖尿病脂代谢紊乱的重要证型。
结论气阴两虚,瘀血阻络证是贯穿疾病的主要证型,而其他证型在病程及年龄等因素的影响下也有各自的分布特点。对于体重减轻的相关因素有:疾病本身因素,药物因素,饮食疗法及运动治疗。
Background:Our country currently concerning fat diabetes mellitus of type research is more abundant,but it is less study of the traditional Chinese medicine type and relative factors of normal weight diabetes mellitus.
Objective:The outbreak rate of diabetes mellitus continuously gets trend,the main idea is inquiry to analyze distributed characteristics of the Chinese medicine type of normal weight diabetes mellitus and relative factors,to improve the Chinese medicine clinical treatment effect of diabetes mellitus.
Materials an methods:Make use of inquisition form to observe patents in my hospital,collect normal weight diabetes mellitus and the relative main factors from 2007.4 to 2008.3,including course of illness,age,clinical medicine,the food control,sport therapy,the weight changes,chemistry relative factors,She condition and Mai condition.The application gets a type of the Chinese medicine type diagnosis, apply SPSS(the Social Science of the Statistical Package) 15.0 carry on covariance analysis a relation,analyzes normal weight diabetes mellitus of the Chinese medicine type distribution,analyzes normal weight diabetes mellitus of the Chinese medicine relate to course of illness,age,disease oneself,clinical medicine,the food control and sport therapy,analyzes normal weight diabetes mellitus of the Chinese medicine type relate to chemistry relative factors.
Results:The research includes six types are dual deficiency of both Qi and Yin,dual deficiency of both Yin and Yang,dominant of heat of both lung and stomach, stagnant blood obstruct vessel,obstruction by dampness,accumulative heat in body. dominant of heat of both lung and stomach occurrence at young and the course of illness was more in early days the comparison less had 5.5%,dual deficiency of both Qi and Yin through the whole course of illness to had 31.1%,along with the age and course of illness increasing,stagnant blood obstruct vessel showed to increase,had 29.7%,but the obstruction by dampness and accumulative heat in body were more familiar in this process had 13.7%,16.0%respectively,dual deficiency of both Yin and Yang had 4.1%,take food control and sport can reduce the weight of body.The obstruction by dampness and stagnant blood obstruct vessel may be the important types of the dyslipiemia.
Conclusions:Dual deficiency of both Qi and Yin and stagnant blood obstruct vessel through the disease,and other symptoms along with the course of illness and the age relation also have certain comparison.The cause of the diabetes mellitus weight to reduced include the diabetes mellitus disease factor,drug factor,food control,sports therapy.
目的目前糖尿病发病率呈不断上升的趋势,本研究旨在探讨非肥胖型糖尿病中医证型分布特点及相关影响因素地关系,为今后进一步提高糖尿病中医临床疗效奠定基础。
资料与方法通过回顾性调查问卷形式,采集2007年4月至2008年3月我院内分泌科门诊及住院非肥胖型糖尿病患者的病程、年龄、身高、体重、体重变化情况、降糖药物应用情况、饮食及运动情况、实验室检查等资料,采集中医临床症状、舌脉,并参考相关标准形成证型诊断。应用SPSS(Statistical Package forSocial Science)15.0进行统计,讨论分析非肥胖型糖尿病患者的证型分布情况;分析非肥胖型糖尿病证型与病程、年龄、疾病本身、降糖药物、饮食控制、运动治疗等因素的相关性;分析非肥胖型糖尿病证型与实验室指标的相关性。
研究结果本研究非肥胖型糖尿病证型包括:肺胃热盛、郁热内蕴、湿浊阻滞、气阴两虚、瘀血阻络、阴阳两虚等6个证型;肺胃热盛证在年龄较轻或病程早期较多,但比例较少占5.5%,气阴两虚证贯穿整个病程占31.1%,随着年龄的增加、病程的延长,瘀血阻络证明显增多,占29.7%,但在疾病的早期中期,湿邪阻滞、郁热内蕴证在各自证型分布上较常见,分别占13.7%、16.0%,病情加重或病程延长则可出现阴阳两虚证,占总数的4.1%;疾病本身的发病机制,口服二甲双胍,良好的饮食控制及坚持长期运动对于患者体重减轻有临床意义,并且有利于血糖控制;疾病早期、实证,血糖相对容易控制,随着疾病的发展,虚证为主、伴发实证,则血糖较难控制。湿浊阻滞、瘀血阻络可能是非肥胖型糖尿病脂代谢紊乱的重要证型。
结论气阴两虚,瘀血阻络证是贯穿疾病的主要证型,而其他证型在病程及年龄等因素的影响下也有各自的分布特点。对于体重减轻的相关因素有:疾病本身因素,药物因素,饮食疗法及运动治疗。
Background:Our country currently concerning fat diabetes mellitus of type research is more abundant,but it is less study of the traditional Chinese medicine type and relative factors of normal weight diabetes mellitus.
Objective:The outbreak rate of diabetes mellitus continuously gets trend,the main idea is inquiry to analyze distributed characteristics of the Chinese medicine type of normal weight diabetes mellitus and relative factors,to improve the Chinese medicine clinical treatment effect of diabetes mellitus.
Materials an methods:Make use of inquisition form to observe patents in my hospital,collect normal weight diabetes mellitus and the relative main factors from 2007.4 to 2008.3,including course of illness,age,clinical medicine,the food control,sport therapy,the weight changes,chemistry relative factors,She condition and Mai condition.The application gets a type of the Chinese medicine type diagnosis, apply SPSS(the Social Science of the Statistical Package) 15.0 carry on covariance analysis a relation,analyzes normal weight diabetes mellitus of the Chinese medicine type distribution,analyzes normal weight diabetes mellitus of the Chinese medicine relate to course of illness,age,disease oneself,clinical medicine,the food control and sport therapy,analyzes normal weight diabetes mellitus of the Chinese medicine type relate to chemistry relative factors.
Results:The research includes six types are dual deficiency of both Qi and Yin,dual deficiency of both Yin and Yang,dominant of heat of both lung and stomach, stagnant blood obstruct vessel,obstruction by dampness,accumulative heat in body. dominant of heat of both lung and stomach occurrence at young and the course of illness was more in early days the comparison less had 5.5%,dual deficiency of both Qi and Yin through the whole course of illness to had 31.1%,along with the age and course of illness increasing,stagnant blood obstruct vessel showed to increase,had 29.7%,but the obstruction by dampness and accumulative heat in body were more familiar in this process had 13.7%,16.0%respectively,dual deficiency of both Yin and Yang had 4.1%,take food control and sport can reduce the weight of body.The obstruction by dampness and stagnant blood obstruct vessel may be the important types of the dyslipiemia.
Conclusions:Dual deficiency of both Qi and Yin and stagnant blood obstruct vessel through the disease,and other symptoms along with the course of illness and the age relation also have certain comparison.The cause of the diabetes mellitus weight to reduced include the diabetes mellitus disease factor,drug factor,food control,sports therapy.
引文
[1]陈道明.推动糖尿病研究向前发展.中国医学论坛报,2007,33(28):1。
[2]陈慧玲,郭丽娟,廖岚,雷闽湘.非肥胖2型糖尿病胰岛素抵抗的病机研究.中国医师杂志 2002.2.6.(、2):183-184。
[3]洪杰,顾卫琼,张翼飞,陈宇宏等.肥胖与非肥胖的2型糖尿病患者胰岛素敏感性和B细胞功能研究.中国糖尿病杂志 2003,11,2:96-99。
[4]李红,张曼云.非肥胖的2型糖尿病血脂异常与胰岛素抵抗的关系.中国基层医药 2001,8,(8),4:315-316。
[5]王露,张丹,刘国良.肥胖与非肥胖2型糖尿病患者外周血CRP、TNF-α、IL-1β水平的比较研究.中国误诊学杂志,2006,10,(6),19:3689-3690。
[6]毛培军,李桂玲,孙劲风,吴大方.非肥胖2型糖尿病中LADA的发病状况.西北国防医学杂志,2002,23(2)。
[7]单书健,陈子华.古今名医证治金鉴·消渴卷.北京:中国中医药出版社,1999:108-113。
[8]上海中医药杂志.1982;(6):5。
[9]吕仁和.糖尿病及其并发症中西医诊治学.北京:人民卫生出版社,1997:241-242。
[10]任继学.任继学治疗消渴病拾遗.长春中医学院学报,1994.9(2):14。
[11]晁梁.周仲瑛辨证论治糖尿病的经验特色.辽宁中医杂志,2006,33(12).34-35。
[12]王岩.程益春教授治疗糖尿病临床辨证论治经验.福建中医药,2006,4(37):42-43。
[13]陈良,仝小林.辛开苦降法治疗糖尿病的理论探讨.第八届全国中医糖尿病学术会议论文汇编。
[14]仝小林.糖尿病中医诊疗中的关键问题与对策.第八届全国中医糖尿病学术会议论文汇编。
[15]郑庆瑞.糖尿病患者的证候特征.中医杂志,2000,41(1):44-45。
[16]巩如伦,王集贤.论糖尿病与脾.中医药信息,1991,8(5):5-7。
[17]高彦彬.糖尿病中医治则概述.吉林中医药,1991,(4):40-42。
[18]程汉桥.糖尿病患者中医证型与血液流变学的相关性研究.中国中西医结合杂志,1998,18(1):11。
[19]李雯,邓尚平.糖尿病中医辨证分型与胰岛功能关系的探讨.四川医学,1999,20(4):350-352。
[20]薛洁,申立章,葛朝伦等.糖尿病的中医辨证分型及中药治疗.新疆中医药,2004,2(6):62-64。
[21]余学庆,李建生.2型糖尿病患者中医证候分布规律研究.上海中医药大学学报,2004,18(3):9-13。
[22]李秋萍.糖尿病不同证型与并发症发生率的关系341例分析.湖南中医杂志,2003,19(5):31。
[23]International Diabetes Federation Diabetes Atlas[R]Brussels;[s.n],2003。
[24]马学毅.现代糖尿病治疗学.北京:人民军医出版社,2007,253。
[25]中国糖尿病防治指南组.中国糖尿病防治指南.北京:2004,23。
[26]胡绍文.实用糖尿病学.第1版.北京:人民军医出版社,2002.86-87。
[27]薛洁,申立章,葛朝伦等.糖尿病的中医辨证分型及中药治疗.新疆中医药,2004,2(6):62-64。
[28]于青云,张德宪,杨浚宪等.糖尿病证群调查及证型研究.山东中医药大学学报,2001,25(3):185-188。
[29]陈灏殊.实用内科学.第12版.北京:人民卫生出版社,2005.1015-1024。
[30]赵林双,戚本岭,向光大等.二甲双胍治疗高血压并发2型糖尿病98例.医药导报,2004,23(10):739-740。
[31]Nielsen JV E,Nilsson AK.Lasting improvements of hyperglycemia and bodyweight:Low-carbohydrate in type 2 diabetes mellitus-a brief report.Ups J Med,2005,11(1):69。
[32]杨晓峰,戴坷.运动对糖尿病患者胰岛素敏感排的影响团.中国民间疗法,2007,1(51):35-63。
[33]Pavlou KN,Kerns,Steffen WP.Exercise as an adjust to weight loss and maintenance in moderately obese object.Am J Clim Nut1989 49(5) 1115-1123。
[34]张延群,韩清,和贵章.2080例糖尿病患者证型与血糖关系分析.中医杂志 1996,37(10):167-168。
[35]孙丰雷.2型糖尿病患者血瘀证患者脂代谢变化相关性研究.山东中医杂志,2004,23(1):13-15。
[36]宋家瑛.2型糖尿病患者血脂变化与中医辨证分型的关系.天津中医,2001,18(4):27-28。
[37]罗若茵,吴友忠.试析2型糖尿病证型分布.浙江中医学院学报,2003,27(3):15--19。
[38]李江慧,周果宏.糖尿病证型统计分析.中国医药学报,1999,14(6):70-72。
[39]于青云,张德宪,杨浚宪等.糖尿病证侯群调查及证型研究.山东中医药大学学报,2001,25(3):185-188。
[2]陈慧玲,郭丽娟,廖岚,雷闽湘.非肥胖2型糖尿病胰岛素抵抗的病机研究.中国医师杂志 2002.2.6.(、2):183-184。
[3]洪杰,顾卫琼,张翼飞,陈宇宏等.肥胖与非肥胖的2型糖尿病患者胰岛素敏感性和B细胞功能研究.中国糖尿病杂志 2003,11,2:96-99。
[4]李红,张曼云.非肥胖的2型糖尿病血脂异常与胰岛素抵抗的关系.中国基层医药 2001,8,(8),4:315-316。
[5]王露,张丹,刘国良.肥胖与非肥胖2型糖尿病患者外周血CRP、TNF-α、IL-1β水平的比较研究.中国误诊学杂志,2006,10,(6),19:3689-3690。
[6]毛培军,李桂玲,孙劲风,吴大方.非肥胖2型糖尿病中LADA的发病状况.西北国防医学杂志,2002,23(2)。
[7]单书健,陈子华.古今名医证治金鉴·消渴卷.北京:中国中医药出版社,1999:108-113。
[8]上海中医药杂志.1982;(6):5。
[9]吕仁和.糖尿病及其并发症中西医诊治学.北京:人民卫生出版社,1997:241-242。
[10]任继学.任继学治疗消渴病拾遗.长春中医学院学报,1994.9(2):14。
[11]晁梁.周仲瑛辨证论治糖尿病的经验特色.辽宁中医杂志,2006,33(12).34-35。
[12]王岩.程益春教授治疗糖尿病临床辨证论治经验.福建中医药,2006,4(37):42-43。
[13]陈良,仝小林.辛开苦降法治疗糖尿病的理论探讨.第八届全国中医糖尿病学术会议论文汇编。
[14]仝小林.糖尿病中医诊疗中的关键问题与对策.第八届全国中医糖尿病学术会议论文汇编。
[15]郑庆瑞.糖尿病患者的证候特征.中医杂志,2000,41(1):44-45。
[16]巩如伦,王集贤.论糖尿病与脾.中医药信息,1991,8(5):5-7。
[17]高彦彬.糖尿病中医治则概述.吉林中医药,1991,(4):40-42。
[18]程汉桥.糖尿病患者中医证型与血液流变学的相关性研究.中国中西医结合杂志,1998,18(1):11。
[19]李雯,邓尚平.糖尿病中医辨证分型与胰岛功能关系的探讨.四川医学,1999,20(4):350-352。
[20]薛洁,申立章,葛朝伦等.糖尿病的中医辨证分型及中药治疗.新疆中医药,2004,2(6):62-64。
[21]余学庆,李建生.2型糖尿病患者中医证候分布规律研究.上海中医药大学学报,2004,18(3):9-13。
[22]李秋萍.糖尿病不同证型与并发症发生率的关系341例分析.湖南中医杂志,2003,19(5):31。
[23]International Diabetes Federation Diabetes Atlas[R]Brussels;[s.n],2003。
[24]马学毅.现代糖尿病治疗学.北京:人民军医出版社,2007,253。
[25]中国糖尿病防治指南组.中国糖尿病防治指南.北京:2004,23。
[26]胡绍文.实用糖尿病学.第1版.北京:人民军医出版社,2002.86-87。
[27]薛洁,申立章,葛朝伦等.糖尿病的中医辨证分型及中药治疗.新疆中医药,2004,2(6):62-64。
[28]于青云,张德宪,杨浚宪等.糖尿病证群调查及证型研究.山东中医药大学学报,2001,25(3):185-188。
[29]陈灏殊.实用内科学.第12版.北京:人民卫生出版社,2005.1015-1024。
[30]赵林双,戚本岭,向光大等.二甲双胍治疗高血压并发2型糖尿病98例.医药导报,2004,23(10):739-740。
[31]Nielsen JV E,Nilsson AK.Lasting improvements of hyperglycemia and bodyweight:Low-carbohydrate in type 2 diabetes mellitus-a brief report.Ups J Med,2005,11(1):69。
[32]杨晓峰,戴坷.运动对糖尿病患者胰岛素敏感排的影响团.中国民间疗法,2007,1(51):35-63。
[33]Pavlou KN,Kerns,Steffen WP.Exercise as an adjust to weight loss and maintenance in moderately obese object.Am J Clim Nut1989 49(5) 1115-1123。
[34]张延群,韩清,和贵章.2080例糖尿病患者证型与血糖关系分析.中医杂志 1996,37(10):167-168。
[35]孙丰雷.2型糖尿病患者血瘀证患者脂代谢变化相关性研究.山东中医杂志,2004,23(1):13-15。
[36]宋家瑛.2型糖尿病患者血脂变化与中医辨证分型的关系.天津中医,2001,18(4):27-28。
[37]罗若茵,吴友忠.试析2型糖尿病证型分布.浙江中医学院学报,2003,27(3):15--19。
[38]李江慧,周果宏.糖尿病证型统计分析.中国医药学报,1999,14(6):70-72。
[39]于青云,张德宪,杨浚宪等.糖尿病证侯群调查及证型研究.山东中医药大学学报,2001,25(3):185-188。