摘要
【目的】观察糖尿病、糖尿病肾病患者的中医体质分布情况,并总结疾病进展过程中的中医证候变化规律。【方法】应用中医体质辨识四诊仪,收集健康人、超重肥胖、糖尿病前期、糖尿病及糖尿病肾病患者的中医体质数据,由专人指导受检者填写机器问卷,采集舌、面照片和脉诊数据,从而评估不同人群的中医体质分布情况和中医证候变化规律。【结果】(1)共纳入受检者355例,其中,健康人群35例,超重肥胖患者37例,糖尿病前期患者52例,糖尿病患者134例,糖尿病肾病患者97例。(2)除平和质外,在糖尿病患者中得分高的体质依次为气虚质、阴虚质、阳虚质、痰湿质;在糖尿病肾病患者中,Ⅰ期患者得分高的体质依次为气虚质、湿热质、痰湿质、阴虚质,Ⅱ期患者依次为气虚质、痰湿质、阴虚质、湿热质,Ⅲ期患者依次为痰湿质、气虚质、阴虚质、血瘀质。(3)气虚质评分在健康人群、超重肥胖、糖尿病前期、糖尿病人群中,呈梯度上升趋势,在不同肾病进展阶段大致呈持平趋势;痰湿质评分除超重肥胖人群呈明显增高趋势外,在健康人群、糖尿病前期、糖尿病及不同进展阶段糖尿病肾病人群,随病情严重程度的发展,痰湿质评分相应呈梯度上升趋势;阴虚质评分在健康人群、超重肥胖、糖尿病前期、糖尿病人群中,呈梯度上升趋势,在糖尿病肾病进展阶段阴虚质评分大致呈持平趋势;阳虚质评分分别在超重肥胖、糖尿病前期、糖尿病人群3个阶段以及糖尿病肾病不同进展阶段呈递增趋势;湿热质、血瘀质评分在各组人群中大致呈持平趋势。(4)在中医证型分布情况的调查中,对比健康组,超重肥胖组中脾虚湿盛证患者的占比明显增加;从糖尿病组到糖尿病肾病组,随着肾小球滤过率的降低,脾虚湿盛证的患者占比也越来越高。【结论】该研究发现,糖尿病、糖尿病肾病患者中得分较高的体质是气虚质、痰湿质、阴虚质和湿热质,这可能与患者所处地区的环境因素和饮食习惯等有关;同时还发现在疾病分期进展过程中,脾虚湿盛证型的占比逐步升高的中医证候变化规律,表明痰湿聚集可能在糖尿病、糖尿病肾病进展过程中起重要作用。
Objective To investigate the distribution of traditional Chinese medicine(TCM)constitution in patients with diabetes mellitus and diabetic kidney disease,and to explore the changes in TCM syndrome types during the disease progression.Methods The four-diagnostic instrument for identification of TCM constitution is applied to collect TCM constitution data from the healthy and the overweight and obese,pre-diabetic,diabetic and diabetic kidney disease patients.The subjects were instructed to fill in the machine questionnaire by the researcher,and the photos of tongue and face as well as the pulse condition data were collected.And then the distribution of TCM constitution and the changing pattern of TCM syndromes in different populations were assessed.Results(1)A total of 355 subjects were included,including 35 healthy subjects,37 overweight and obese patients,52 prediabetic patients,134 diabetic patients and 97 diabetic kidney disease patients.(2)Except for the balanced constitution,the constitution types of diabetic patients with high scores in descending order were qi deficiency,yin deficiency, yang deficiency and phlegm-damp. Among diabetic kidney disease patients, the high scoringconstitution types of stage Ⅰ patients were qi deficiency, damp-heat, phlegm-damp, and yin deficiency indescending order,the constitution types of stage Ⅱ patients were qi deficiency,phlegm-damp,yin deficiencyand damp- heat in descending order, and the constitution types of stage Ⅲ patients were phlegm- damp, qideficiency, yin deficiency and blood stasis in descending order.(3)The scores of qi deficiency constitutionshowed a gradient upward trend in the healthy, obese and overweight, pre-diabetic and diabetic groups, andpresented a flat trend at different stages of nephropathy. The scores of phlegm-damp constitution showed a gradientupward trend in the healthy,pre-diabetic,diabetic and diabetic groups and at different stages of diabetic kidneydisease with the exacerbations of the disease, while the phlegm- damp constitution scores of the obese andoverweight group presented a significant upward trend. The scores of yin deficiency constitution showed a gradientupward trend in the healthy,obese and overweight,pre-diabetic and diabetic groups,while the scores of yindeficiency constitution presented a flat trend at various progressive stages of diabetic kidney disease. The scores ofyang deficiency constitution showed an increasing trend in the obese and overweight,pre-diabetic and diabeticpopulations and at various progressive stages of diabetic kidney disease. The scores of damp-heat constitution andblood stasis constitution showed a flat trend in each group.(4)The survey of TCM syndrome types showed that theproportion of patients with predominant dampness due to spleen deficiency syndrome in the overweight and obesegroup was significantly increased compared to the healthy group,and the proportion of patients with predominantdampness due to spleen deficiency syndrome was increased with the decrease of the glomerular filtration rate in thediabetic group and the diabetic kidney disease group. Conclusion The study revealed that patients with diabetesmellitus and diabetic kidney disease have higher scores of qi deficiency constitution,phlegm-damp constitution,yin deficiency constitution and damp-heat constitution,which may be related to the living environmental factorsand dietary habits of the patients. It is also found that the proportion of predominant dampness due to spleendeficiency syndrome gradually increases with the progression of the disease stages,indicating that phlegm-dampaccumulation may play an important role in the progression of diabetes mellitus and diabetic kidney disease.
作者
吴瑕
古秀芬
黄静婷
戈娜
WU Xia;GU Xiu-Fen;HUANG Jing-Ting;GE Na(The Fourth Clinical Medical School of Guangzhou University of Chinese Medicine,Shenzhen 518033 Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2023年第8期1863-1869,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
国家自然科学基金项目(编号:81704012)。
关键词
糖尿病
糖尿病肾病
中医体质
气虚质
痰湿质
阴虚质
中医证型
脾虚湿盛
diabetes mellitus
diabetic kidney disease
traditional Chinese medicine(TCM)constitution
qi deficiency constitution
phlegm-damp constitution
yin deficiency constitution
traditional Chinese medicine(TCM)syndrome types
predominant dampness due to spleen deficiency
