糖尿病心脏自主神经病变患者中医证候学观察  

Cardiovascular Autonomic Neuropathy in Diabetes Patients TCM Syndromes

作　　者：王文锐[1] 王波[1] 陈洁[1] 孙平[1] 张琍萍[1] 毛小红[1] 朱亚梅[1] 黄燕[1] 

机构地区：[1]平湖市中医院,浙江平湖314200

出　　处：《中华中医药学刊》2016年第12期3021-3024,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：浙江省中医药科学研究项目(2014ZA109)

摘　　要：目的:观察分析不同阶段DCAN患者中医证候要素变化情况。方法:采用Holter分析系统检出纳入对象24 h全部窦性心搏并进行心率变异性(HRV)时域和频域分析,依据CAN评价标准分组观察非DCAN、DCAN临床前期及DCAN阳性患者中医证候积分、证候要素的病位及病性分布情况。结果:278例观察对象中筛查并分类出DCAN阳性组62例(22.30/%),DCAN临床前期组88例(31.65/%),DCAN阴性组128例(46.04/%);三组间中医证候积分值比较其差异均有统计学意义(P<0.05);三组间心、脾、肾系等病位频数间差异有统计学意义(P<0.05);DCAN阳性及阴性组间肺、肝、小肠、大肠、胃、胆及膀胱系等频数间差异有统计学意义(P<0.05);DCAN阳性及其临床前期组大肠及膀胱系频数间差异有统计学意义(P<0.05);三组间气虚、夹瘀、夹痰及夹湿等病性频数间差异均有统计学意义(P<0.05),DCAN阳性组血虚、阳虚、气滞、气逆、蕴热及寒凝等频数分别与DCAN临床前期及阴性组比较其差异均有统计学意义(P<0.05)。结论:约54%的住院糖尿病患者存在不同程度DCAN,尤以年龄偏大、诊断糖尿病时间长者居多;DCAN阳性患者中医证候积分明显增加,其病位要素以大肠、肾、膀胱、胃及心系多见,具有病位分布广泛、脏病及腑、腑病及脏的特点,病性要素则以由气及阳、由阴至血、虚实分化、从阳化热、从阴化寒及相关脏腑功能受损导致气机逆乱为特征。Objective： To observe and analyze patients TCM syndrome integral in different stages of DCAN.Methods：Use Holter analysis system into the included objects and detect sinus heart beat and heart rate variability（HRV） for 24 hours about time domain and frequency domain indexes.Observe the TCM syndrome integral and syndrome elements distribution of disease location and nature to the DCAN,preclinical DCAN and positive DCAN patients based on the CAN evaluation standard.Results：There were positive DCAN 62 cases（22.30/%）,preclinical DCAN 88 cases（31.65/%）and negative DCAN 128 cases（46.04/%） among the 278 objects.The difference of TCM syndrome integral had statistical significance in three groups（P〈0.05）.The frequency differences of disease location for heart,spleen and kidney were statistical significance in three groups（P〈0.05）.Between positive and negative DCAN groups,the frequency difference was statistical significance for lung,liver,small intestine,large intestine,stomach,bravery and bladder system（P〈0.05）.The frequency differences of large intestine and bladder system were statistically significant between positive and preclinical DCAN group（P〈0.05）.The frequency differences of disease nature had statistical significance for Qi deficiency,blood stasis,phlegm and dampness in the three groups（P〈0.05）.The frequency differences had statistical significance for the positive DCAN group respectively compared the preclinical and negative DCAN groups with blood deficiency,Yang deficiency,qi stagnation,qi reversal,accumulating heat and congealing cold（P〈0.05）.Conclusion：About54% of hospitalized diabetic patients have different degrees of DCAN,especially for those who are older or have longer of diagnosed diabetes time.TCM syndrome integrals were increased significantly in positive DCAN and the disease location was more in colon,kidney,bladder,stomach and heart.With the characteristics of wider range,Zang disease involving Fu and Fu disease involving Zang.The patholog

关 键 词：糖尿病 心脏自主神经 中医学 证候学 

分 类 号：R587.2[医药卫生—内分泌]