660例糖尿病周围神经病变患者中医证型及临床特点分析  

Syndrome Types of Chinese Medicine and Clinical Characteristics of 660 Patients with Diabetic Peripheral Neuropathy

作　　者：张倩[1] 梁晓春[1] 王超[1] 孙青[1] 吴群励[1] 尹德海[1] 王琼[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院中医科,北京100730 [2]中山大学公共卫生学院,广州510080

出　　处：《中国中西医结合杂志》2017年第1期62-67,共6页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：目的总结660例糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的中医证型分布和临床特点。方法收集660例2000年1月—2014年12月北京协和医院中医科病房以DPN为第一诊断患者的资料,观察患者中医证型分布,比较不同中医证型患者临床特点,同时以中医证型为四分类反应变量,对自变量行多分类Logistic回归分析。结果 660例DPN患者中医证型比例由大到小依次为阴虚血瘀(39.24%,259例)、阳虚血瘀证(29.39%,194例)、痰瘀滞络证(19.24%,127例)、阴虚风动证(12.12%,80例)。不同病程组证型构成差异无统计学意义(P>0.05),阳虚血瘀证比例随病程延长有升高趋势。不同证型患者糖化血红蛋白(Hb A1c)、空腹C肽(FCP)、收缩压(SBP)、血清总胆固醇(TC)、24小时尿蛋白总量(24 h UCP)、血肌酐(SCr)、血尿素氮(BUN)比较,差异具有统计学意义(P<0.05)。与阳虚血瘀证比较,阴虚血瘀证Hb A1c升高,SBP、SCr、BUN及24 h UCP降低,差异有统计学意义(P=0.006、0.002、0.001、0.001及0.007),阴虚风动证24 h UCP亦降低(P=0.34)。多分类Logistic回归示:以阴虚血瘀证作参照,Hb A1c是阳虚血瘀证的反向影响因素,8小时尿白蛋白排泄率(8 h UAE)是危险因素;阴虚风动证危险因素为TC、SCr;痰瘀滞络证危险因素为SCr。结论DPN患者血糖控制差与阴虚血瘀证有关,阳虚血瘀证患者病程可能更久并与SBP控制不佳及肾功能恶化有关,DPN合并糖尿病肾病者更易出现阳虚血瘀证。Objective To summarize the distribution and clinical characteristics of Chinese med- icine （CM） syndrome types in 660 patients with diabetic peripheral neuropathy （DPN）. Methods Totally 660 inpatients at Department of Traditional Chinese Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences were recruited from Jan 2000 to Dec 2014. Their first diagnoses were DNP. The distributions of their syndrome types were observed. Clinical characteristics in patients with different syndrome types were compared. Meanwhile, Logistic regression analysis was performed in independent variable by taking syndrome types of CM as quartering regression variables. Results The ratio of syndrome types was sequenced from high to low as yin deficiency blood stasis syndrome [39.24% （259/660）], yang deficiency blood stasis syndrome [29.39% （194/660）], phlegm stasis in collaterals syndrome [19.24% （127/660） ], yin deficiency induced wind stirring syndrome [12.12% （80/ 660）]. There was no significant difference in the constituent ratio of CM syndrome patterns among groups with different courses of diabetes （P 〉0.05）. The ratio of yang deficiency blood stasis syndrome had an increasing trend as the course increased. There was significant difference in HbAlc, fasting C pep-tide （FCP）, systolic blood pressure （SBP）, total cholesterol （TC）, 24 h total urinary protein （24 h UCP）, serum creatinine （SCr）, blood urea nitrogen （BUN） among patient groups with different CM syndrome types （P 〈0.05）. Compared with yang deficiency blood stasis syndrome, HbAlc increased, SBP,SCr,BUN and 24 hUCP decreased in yin deficiency blood stasis syndrome with statistical difference （P = 0.006, 0. 002,0.001,0. 001, and 0. 007; P 〈0.05） ; 24 h UCP also decreased in yin deficiency induced wind stirring syndrome （P =0.34, P 〈0.05）. Multi-classified Logistic regression showed that when taking yin deficiency blood stasis syndrome as reference, HbAlc was a protective factor

关 键 词：2型糖尿病周围神经病变 2型糖尿病 中医证型 

分 类 号：R259[医药卫生—中西医结合]