2型糖尿病合并冠心病患者中医证候特征的回顾性多中心横断面调查  

The Characteristics of Traditional Chinese Medicine Syndromes in Patients with Type 2 Diabetes Mellitus Complicated with Coronary Heart Disease:A Retrospective Multicenter Cross-sectional Survey

作　　者：郭艺蕾 杨洁红 郭姣[2] 赵明君 杨文明 张艳 侯群[6] 黄抒伟 窦丽萍 姚迎节 王丹妮 雷烨 曹依兰 徐玉涵 万海同[1] GUO Yilei;YANG Jiehong;GUO Jiao;ZHAO Mingjun;YANG Wenming;ZHANG Yan;HOU Qun;HUANG Shuwei;DOU Liping;YAO Yingjie;WANG Danni;LEI Ye;CAO Yilan;XU Yuhan;WANHaitong(Institute of Cardiovascular and Cerebrovascular Diseases,Zhejiang Chinese Medical University,Hangzhou,310053;Guangdong Pharmaceutical University;Affiliated Hospital of Shaanxi University of Chinese Medicine;The First Affiliated Hospital of Anhui University of Chinese Medicine;The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine;The First Affiliated Hospital of Zhejiang Chinese Medical University;The Second Affiliated Hospital of Zhejiang Chinese Medi-cal University;Wenzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University;The First Affiliated Hospital of Henan University of Chinese Medicine;The Second Affiliated Hospital of Shaanxi University of Chinese Medicine)

机构地区：[1]浙江中医药大学中医心脑血管病研究院,浙江省杭州市310053 [2]广东药科大学 [3]陕西中医药大学附属医院 [4]安徽中医药大学第一附属医院 [5]辽宁中医药大学附属医院 [6]浙江中医药大学附属第一医院 [7]浙江中医药大学附属第二医院 [8]浙江中医药大学附属温州中医院 [9]河南中医药大学第一附属医院 [10]陕西中医药大学第二附属医院

出　　处：《中医杂志》2023年第15期1556-1564,共9页Journal of Traditional Chinese Medicine

基　　金：国家重点研发计划(2018YFC1704204);浙江省“万人计划”科技创新领军人才计划(2019R52020)。

摘　　要：目的 探讨2型糖尿病合并冠心病患者的中医证候特征。方法 回顾性收集2015年1月1日至2019年12月31日5个省市的7家三级甲等医院就诊的2型糖尿病合并冠心病患者临床资料,设计中医证候调查表(包括患者的性别、年龄、烟酒史、家族史、发病诱因、生命体征、中医四诊信息、血常规、生化检查等),运用证候辨证素权值计量法探讨症状、证素、证型的分布规律,采用无序多分类Logistic回归分析探讨中医证型与入院基本情况的相关性。结果 共纳入2556例患者,症状或体征出现频率前3位依次为胸闷(69.87%)、神疲(48.90%)、倦怠乏力(47.61%);舌象多见舌色(黯)红(45.58%)、淡红(29.38%)、淡白(15.30%),舌苔多为白(78.09%)、薄(58.26%)、腻(28.52%);脉象多见细(43.94%)、弦(34.98%)、滑(24.14%)。归纳出7种虚性病性证素、11种实性病性证素和10个病位证素,其中虚性证素以气虚(51.80%)、阳虚(37.72%)、阴虚(35.13%)为主,实性证素以痰(38.97%)、血瘀(37.87%)、湿(24.84%)居多,脏腑病位证素主要为心(49.37%),其次是肺(42.29%)、胸膈(12.25%)、脾(12.09%)、肾(9.66%)。占比在3%以上的证型共有12个,分别为痰湿内蕴证(11.07%)、痰瘀阻滞证(9.55%)、气虚血瘀证(8.96%)、气虚痰阻证(8.69%)、阴虚证(6.57%)、阴阳气虚证(6.18%)、血瘀证(5.71%)、气阴两虚证(5.52%)、气血亏虚证(5.44%)、阳气虚证(4.97%)、阳气虚兼痰瘀证(4.03%)、气阴两虚兼痰瘀证(3.29%)。12种证型患者在不同收缩压分层中分布差异有统计学意义(P<0.05),以痰湿内蕴证、痰瘀阻滞证、气虚血瘀证、气虚痰阻证为主。女性是阴阳气虚证、气血亏虚证的危险因素;年龄(≤60岁)是痰瘀阻滞证、血瘀证的危险因素;收缩压(<140 mmHg)与痰瘀阻滞证、气虚血瘀证、气虚痰阻证、阴阳气虚证、血瘀证、气阴两虚证、气血亏虚证、阳气虚证、阳气虚兼痰瘀证呈正相关(P≤0.05)。结论 2型糖尿病合�Objective To investigate the characteristics of traditional Chinese medicine(TCM)syndromes in patients with type 2 diabetes mellitus complicated with coronary heart disease(T2DM-CHD).Methods Clinical data of T2DM-CHD patients who were admitted to seven tertiary grade-A Chinese medicine hospitals in five provinces and cities from January 1st,2015 to December 31st,2019 were retrospectively collected.A TCM syndrome questionnaire was designed,collecting data on patients'gender,age,smoking and drinking history,family history,pathogenic fac⁃tors,vital signs,four examinations,blood routine examination,and biochemical examination.The distribution pat⁃terns of symptoms,syndrome elements,and TCM syndrome types were explored using the method of syndrome ele⁃ment weight measurement.Unordered multinomial logistic regression analysis was conducted to investigate the correla⁃tion between TCM syndrome types and baseline characteristics upon admission.Results A total of 2556 patients were included.The top three symptoms or signs were chest tightness(69.87%),fatigue(48.90%),and lassitude(47.61%).Tongue manifestations were mainly dark red(45.58%),pale red(29.38%),and pale(15.30%),with white coating(78.09%),thin coating(58.26%),and greasy coating(28.52%).Pulse conditions were mostly thin(43.94%),stringy(34.98%),and slippery(24.14%).A total of 7,11 and 10 syndrome elements related to defi⁃ciency nature,excess nature,and location of disease were summarized.Deficiency syndrome elements were mainly qi deficiency(51.80%),yang deficiency(37.72%),and yin deficiency(35.13%),while excess syndrome elements were primarily phlegm(38.97%),blood stasis(37.87%),and dampness(24.84%).The main affected organs included the heart(49.37%),lungs(42.29%),chest and diaphragm(12.25%),spleen(12.09%),and kidneys(9.66%).There were 12 TCM syndrome types each accounting for more than 3%,including phlegm-dampness inter⁃nal obstruction syndrome(11.07%),phlegm-stasis obstruction syndrome(9.55%),qi deficiency and blood stasis syndrome(8.96%),qi deficienc

关 键 词：2型糖尿病 冠心病 证素 中医证型 回顾性研究 

分 类 号：R259[医药卫生—中西医结合]