冠心病合并2型糖尿病中医辨证分型与血管内皮功能相关性研究
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摘要
2型糖尿病和冠心病同属于代谢性疾病,具有共同的危险因子,如高血压、血脂异常、血液高凝状态、高胰岛素血症、肥胖等,而这些正是动脉粥样硬化的危险因素。大量的研究表明,高胰岛素血症是滋生糖尿病和心血管疾病等代谢相关疾病的“共同土壤”,而糖尿病合并冠心病后的乘积效应,加速动脉粥样硬化的进展。为此,美国胆固醇教育计划(NCEP)成人治疗第三次报告(ATPⅢ)中糖尿病被列为冠心病的等危症。其发病率以每年3000-4000万的速度速增并有年轻化的趋势,死亡率也逐年上升,成为严重威胁现代人类生活质量和生命安全的头号大敌。
祖国医学未提出冠心病合并2型糖尿病的病名,但对于糖尿病、冠心病分别有论述,分属于消渴、胸痹、真心痛、心悸等范畴讨论。在此基础上,现代医家结合现代研究方法及临床经验总结,提出诸如糖心病、消心病、消渴胸痹等病名,同时对本病的病因病机有了更深入的认识,认为先天察赋不足,后天饮食不节,贪逸少劳,加之外邪侵淫,即所谓“先天不足”、“后天失养”为其主要病因,痰瘀为主要的病理产物,进一步加速了疾病的进展。在临床治疗中需辨病与辨证相结合,辨病为前提,辨证为核心,其常见证型为气阴两虚、阴虚火旺、气滞血瘀、痰浊瘀阻、寒凝血瘀、心脾阳虚等。
现代医学证实冠心病发病与脂质浸润、血小板积聚与血栓形成、氧自由基产生、血管内皮功能受损、感染和炎性反应密切相关。尤其是近年来研究发现,冠脉急性缺血的发作与冠脉狭窄相关性差,而与内皮功能障碍关系密切。血管内皮功能损害已被确认为冠心病重要的独立危险因子。截至目前,冠心病合并2型糖尿病的中医辨证分型与血管内皮功能损害程度之间的相关性联系,尚缺乏针对性的研究证明,因此对于冠心病合并2型糖尿病(T2DM合并CHD)中医辨证分型与血管内皮功能的相关性关系进行研究具有十分重要的意义。
研究目的
本课题拟对冠心病合并2型糖尿病(T2DM合并CHD)中医辨证分型与血管内皮功能的相关性关系进行研究。
研究方法
本研究通过收集127例患者中医四诊信息及相关实验室指标,将所采集数据输入EpiData3.10建立数据库,将数据导入Spss 13.0进行统计分析,中医证候群的筛选采用系统聚类分析中的两步聚类法,再结合《中华人民共和国国家标准中医临床诊疗术语证候部分》判定每种分型的代表症状,归纳出中医证型,并对不同证型的客观数据加以分析比较。
研究结果
结论：1.冠心病合并2型糖尿病分为气虚痰瘀证、气阴两虚夹痰夹瘀证、气阳两虚血瘀证3型。
2.冠心病合并2型糖尿病三种证型瘀证始终贯穿其中
3.冠心病合并2型糖尿病组患者中,与气阳两虚血瘀证,气阴两虚夹痰夹瘀证相比,气虚痰瘀证ET水平显著增高(P均<0.01)；SOD水平在三种证型之间不存在显著差异；NO水平在三种证型之间不存在显著差异,提示在冠心病合并2型糖尿病患者中,气虚痰瘀证患者血管内皮功能受损程度大于气阳两虚血瘀证和气阴两虚夹瘀证。
Type2 Diabetic Mellitus(T2DM) and Coronary Heart Disease(CHD) both belonged to metabolic disease, they had lots of common risk factors, sueh as hypertension dysliPidemia、blood hyPereoagulativestate、hyperinsulinemia(HINS)、obesityet etc, which were just the same risk factors of atheroslerosis.Numerous reasearehes showed that HINS was the"common soil" that could lead to series of metabolic diseases, like DM and CHD.The Produet effete of DM with CHD accelerated the Progression of atheroselerosis.Therefore,Natinonal Cholesterol Edueation Program(NCEP) adult treatment third report(ATPⅢ)ranked DM as the equivalent risk of CHD.The morbidity of DM was growing at anannual rate of 30-40 million Per year.Besides, more and more young People were suffering from it.With the inereasing mortality, DM with CHD had been a serious threaten to modern human,both inquality and safety of life.
Traditional Chinese medieine(TCM)had not proposed the name of the disease,but separately dicoused symptoms and treatments in the following categories, for example Xiao Ke、obestrcution of Qi in chest,Angina Pectoris and Heart- throb etc. After that, combined with modern research methods and clinieal experience summary,Latter traditional Chinese medicine doctors put forward some new disease names, such as TangXin disease、Xiao Xin disease XiaoKe-obestrcution of Qi in the chest.AT the same time the further Pathogenesis had been realized.They considered that the main reasons were naturalendowment insuffieioney、Post-natal improper diet、excessive comfort and lack of exereise, Plus the invasion of exogenous pathogenic factors, So called with inate deficieney aequied los tsupport.Moreover Phlegmand and blood stasis were the main Pathogenie Produets, which accelerated the disease Progression. In clinieal treatment, combination of disease differentiation and syndrome differentiation was the most important method, the former was Premise, the latter was core.The haekneyed syndromes were Qi-Yin defieiene、Fire excess from Yin defieiney, Qi stagnation and blood stasis, Phlegm dampness and blood stagnation, accumulation of cold and blood stasis, cardic-splenic insuffieieney of Yang etc.
Modern medicine demonstrates coronary heart disease morbidity and the lipid are soaked, the blood platelet is accumulated with thrombopoiesis, the oxygen free radical is come into being, the blood vessel bast function is derided, infection and scorching reaction go hand in hand. Dysfunction relation is close especially the narrow pulse correlativity studying the paroxysm and crown discovering, crowning impatient incomplete pulse blood with in recent years dispatches, but with bast. Blood vessel bast function damage is already affirmed for independent important dangerous coronary heart disease factor. So far, coronary heart disease combines Type 2 diabetes mellitus of TCM discriminating mark of type and the correlativity between blood vessel bast function extent of damage gets in touch with, the go into still being short of a pertinency proves that, therefore, the coronary heart disease combines Type 2 diabetes mellitus of traditional Chinese medicine discriminates mark of type and functional correlativity of blood vessel bast relation is in progress to coronary heart disease to study to have very important significance. Purpose
To research whether coronary heart disease combines Type 2 diabetes mellitus of TCM discriminating mark of type have relationship whith the correlativity between blood vessel bast function extent of damage.
Research method
Index studying four examine information and the relevance laboratory of TCM of 127 patients, with collected data entry EpiData3.10 building a data base, statistic analysis data leading-in Spss 13.0 is carried out, syndrome groups of TCM preparation by screening adopt system clustering two step clustering law in analysing, again be tied in wedlock "the PRC national standard of TCM diagnoses the technical term syndrome part clinically" decides each the representative symptom being allotted a type kind, sum up in TCM certificate type, and analysing the objective data being unlike the certificate type compared.
Research result
1.2-DM combins CHD can be Divided to 3 types symptoms of TCM:Qi-Yin defieiene、Qi defieiene and Phlegm stasis、Yang defieiene and blood stasis.
2.Stssis is the main factors of the 3 types symptoms of TCM.
3.In groups suffering 2-DM combins CHD, the level of ET of Qi defieiene and Phlegm stasis is higher than it of other 2 types。The level of NO has no differentence in the 3 types, neither SOD。
祖国医学未提出冠心病合并2型糖尿病的病名,但对于糖尿病、冠心病分别有论述,分属于消渴、胸痹、真心痛、心悸等范畴讨论。在此基础上,现代医家结合现代研究方法及临床经验总结,提出诸如糖心病、消心病、消渴胸痹等病名,同时对本病的病因病机有了更深入的认识,认为先天察赋不足,后天饮食不节,贪逸少劳,加之外邪侵淫,即所谓“先天不足”、“后天失养”为其主要病因,痰瘀为主要的病理产物,进一步加速了疾病的进展。在临床治疗中需辨病与辨证相结合,辨病为前提,辨证为核心,其常见证型为气阴两虚、阴虚火旺、气滞血瘀、痰浊瘀阻、寒凝血瘀、心脾阳虚等。
现代医学证实冠心病发病与脂质浸润、血小板积聚与血栓形成、氧自由基产生、血管内皮功能受损、感染和炎性反应密切相关。尤其是近年来研究发现,冠脉急性缺血的发作与冠脉狭窄相关性差,而与内皮功能障碍关系密切。血管内皮功能损害已被确认为冠心病重要的独立危险因子。截至目前,冠心病合并2型糖尿病的中医辨证分型与血管内皮功能损害程度之间的相关性联系,尚缺乏针对性的研究证明,因此对于冠心病合并2型糖尿病(T2DM合并CHD)中医辨证分型与血管内皮功能的相关性关系进行研究具有十分重要的意义。
研究目的
本课题拟对冠心病合并2型糖尿病(T2DM合并CHD)中医辨证分型与血管内皮功能的相关性关系进行研究。
研究方法
本研究通过收集127例患者中医四诊信息及相关实验室指标,将所采集数据输入EpiData3.10建立数据库,将数据导入Spss 13.0进行统计分析,中医证候群的筛选采用系统聚类分析中的两步聚类法,再结合《中华人民共和国国家标准中医临床诊疗术语证候部分》判定每种分型的代表症状,归纳出中医证型,并对不同证型的客观数据加以分析比较。
研究结果
结论：1.冠心病合并2型糖尿病分为气虚痰瘀证、气阴两虚夹痰夹瘀证、气阳两虚血瘀证3型。
2.冠心病合并2型糖尿病三种证型瘀证始终贯穿其中
3.冠心病合并2型糖尿病组患者中,与气阳两虚血瘀证,气阴两虚夹痰夹瘀证相比,气虚痰瘀证ET水平显著增高(P均<0.01)；SOD水平在三种证型之间不存在显著差异；NO水平在三种证型之间不存在显著差异,提示在冠心病合并2型糖尿病患者中,气虚痰瘀证患者血管内皮功能受损程度大于气阳两虚血瘀证和气阴两虚夹瘀证。
Type2 Diabetic Mellitus(T2DM) and Coronary Heart Disease(CHD) both belonged to metabolic disease, they had lots of common risk factors, sueh as hypertension dysliPidemia、blood hyPereoagulativestate、hyperinsulinemia(HINS)、obesityet etc, which were just the same risk factors of atheroslerosis.Numerous reasearehes showed that HINS was the"common soil" that could lead to series of metabolic diseases, like DM and CHD.The Produet effete of DM with CHD accelerated the Progression of atheroselerosis.Therefore,Natinonal Cholesterol Edueation Program(NCEP) adult treatment third report(ATPⅢ)ranked DM as the equivalent risk of CHD.The morbidity of DM was growing at anannual rate of 30-40 million Per year.Besides, more and more young People were suffering from it.With the inereasing mortality, DM with CHD had been a serious threaten to modern human,both inquality and safety of life.
Traditional Chinese medieine(TCM)had not proposed the name of the disease,but separately dicoused symptoms and treatments in the following categories, for example Xiao Ke、obestrcution of Qi in chest,Angina Pectoris and Heart- throb etc. After that, combined with modern research methods and clinieal experience summary,Latter traditional Chinese medicine doctors put forward some new disease names, such as TangXin disease、Xiao Xin disease XiaoKe-obestrcution of Qi in the chest.AT the same time the further Pathogenesis had been realized.They considered that the main reasons were naturalendowment insuffieioney、Post-natal improper diet、excessive comfort and lack of exereise, Plus the invasion of exogenous pathogenic factors, So called with inate deficieney aequied los tsupport.Moreover Phlegmand and blood stasis were the main Pathogenie Produets, which accelerated the disease Progression. In clinieal treatment, combination of disease differentiation and syndrome differentiation was the most important method, the former was Premise, the latter was core.The haekneyed syndromes were Qi-Yin defieiene、Fire excess from Yin defieiney, Qi stagnation and blood stasis, Phlegm dampness and blood stagnation, accumulation of cold and blood stasis, cardic-splenic insuffieieney of Yang etc.
Modern medicine demonstrates coronary heart disease morbidity and the lipid are soaked, the blood platelet is accumulated with thrombopoiesis, the oxygen free radical is come into being, the blood vessel bast function is derided, infection and scorching reaction go hand in hand. Dysfunction relation is close especially the narrow pulse correlativity studying the paroxysm and crown discovering, crowning impatient incomplete pulse blood with in recent years dispatches, but with bast. Blood vessel bast function damage is already affirmed for independent important dangerous coronary heart disease factor. So far, coronary heart disease combines Type 2 diabetes mellitus of TCM discriminating mark of type and the correlativity between blood vessel bast function extent of damage gets in touch with, the go into still being short of a pertinency proves that, therefore, the coronary heart disease combines Type 2 diabetes mellitus of traditional Chinese medicine discriminates mark of type and functional correlativity of blood vessel bast relation is in progress to coronary heart disease to study to have very important significance. Purpose
To research whether coronary heart disease combines Type 2 diabetes mellitus of TCM discriminating mark of type have relationship whith the correlativity between blood vessel bast function extent of damage.
Research method
Index studying four examine information and the relevance laboratory of TCM of 127 patients, with collected data entry EpiData3.10 building a data base, statistic analysis data leading-in Spss 13.0 is carried out, syndrome groups of TCM preparation by screening adopt system clustering two step clustering law in analysing, again be tied in wedlock "the PRC national standard of TCM diagnoses the technical term syndrome part clinically" decides each the representative symptom being allotted a type kind, sum up in TCM certificate type, and analysing the objective data being unlike the certificate type compared.
Research result
1.2-DM combins CHD can be Divided to 3 types symptoms of TCM:Qi-Yin defieiene、Qi defieiene and Phlegm stasis、Yang defieiene and blood stasis.
2.Stssis is the main factors of the 3 types symptoms of TCM.
3.In groups suffering 2-DM combins CHD, the level of ET of Qi defieiene and Phlegm stasis is higher than it of other 2 types。The level of NO has no differentence in the 3 types, neither SOD。
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