糖脂代谢病及其不同证型患者舌象特征的回顾性研究  

Retrospective Study on Tongue Image Characteristics of Patients with Glucolipid Metabolism Disorders with Different Traditional Chinese Medicine Syndromes

作　　者：刘实 高阳 江涛 陈展鸿 邓佳琳 许家佗[1] LIU Shi;GAO Yang;JIANG Tao;CHEN Zhanhong;Deng Jialin;XU Jiatuo('1.School of Traditional Chinese Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,201203;Shanghai Baoshan District Dachang Town Qilian Community Health Service Center)

机构地区：[1]上海中医药大学中医学院,上海市201203 [2]上海市宝山区大场镇祁连社区卫生服务中心

出　　处：《中医杂志》2025年第8期826-833,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82104738);国家中医药管理局高水平中医药重点学科建设项目(ZYYZDXK-2023069);中国博士后科学基金(2023M732337);上海市“超级博士后”资助项目(2022509);上海市宝山区科学技术委员会医学卫生项目(2023-E-57);上海市卫生健康委员会科研项目(20244Y0129)。

摘　　要：目的探讨糖脂代谢病患者及其主要证型的舌象图像特征分布规律。方法纳入841例糖脂代谢病患者(糖脂代谢病组)及380例非糖脂代谢病受试者(非糖脂代谢病组),其中糖脂代谢病组患者辨证分为肝郁脾虚证283例、痰湿阻滞证311例、气滞血瘀证247例。使用舌诊仪采集两组舌象图像数据,通过TDAS V3.0软件获取两组舌质舌苔颜色纹理及形质特征(TB,舌质;TC,舌苔;L,明度;a,红色-绿色轴;b,黄色-蓝色轴;Y,亮度;Cr,红色信号与亮度值之间的差异;Cb,蓝色信号与亮度值之间的差异;CON,对比度;ASM,角度方向二阶矩;ENT,熵值;MEAN,平均值;perAll,舌苔面积/全舌面积;perPart,舌苔面积/无舌苔面积);分析糖脂代谢病组不同证型患者舌象图像诊断特征,并采用Logistic回归分析糖脂代谢病不同证型的影响因素。结果糖脂代谢病组舌质指标中TB-L、TB-Y、TB-Cb大于非糖脂代谢病组,TB-a、TB-b、TB-Cr小于非糖脂代谢病组;糖脂代谢病组舌苔指标中TC-L、TC-Y、TC-Cb、perAll、perPart高于非糖脂代谢病组,TC-a、TC-b、TC-Cr低于非糖脂代谢病组(P<0.05)。糖脂代谢病组不同证型比较,肝郁脾虚证、痰湿阻滞证TB-L、TB-Y高于气滞血瘀证,痰湿阻滞证TB-a、TB-Cr低于气滞血瘀证,痰湿阻滞证perAll高于气滞血瘀证(P<0.05)。糖脂代谢病组点刺舌高于非糖脂代谢病组,肝郁脾虚证齿痕舌高于其他两证,痰湿阻滞证的腻苔、气滞血瘀证的瘀点舌分别高于其他两证(P<0.05)。Logistic回归分析得出,腻苔、点刺舌、瘀点舌、齿痕舌、perAll、TB-Cb是肝郁脾虚证的影响因素;腻苔、齿痕舌、TC-Cb、TC-Cr是痰湿阻滞证的影响因素;裂纹舌、瘀点舌、齿痕舌、TB-Y是气滞血瘀证的影响因素(P<0.05)。结论较非糖脂代谢病,糖脂代谢病患者舌质颜色偏暗,舌苔偏厚腻。肝郁脾虚证糖脂代谢病患者舌质偏红,在纹理表现上更为细腻,多见齿痕;痰湿阻滞证患者舌苔明亮度�Objective To explore the distribution pattern of tongue image characteristics in patients with glucolipid metabolic disorders and its main syndromes.Methods A total of 841 patients with glucolipid metabolic disorders(disease group),and 380 healthy subjects(control group)were included.The disease group was classified into three syndrome types:283 cases of liver depression and spleen deficiency syndrome,311 cases of phlegm-dampness obstruction syndrome,and 247 cases of qi stagnation and blood stasis syndrome.Tongue image data were collected using the TFDA-1 Tongue Diagnosis Instrument,and the TDAS V3.0 software was used to analyze the color,texture,and morphological features of the tongue body(TB)and tongue coating(TC)in patents with different syndromes of disease group(including lightness(L),red-green axis(a),yellow-blue axis(b),luminance(Y),difference between red signal and brightness(Cr),difference between blue signal and brightness(Cb),contrast(CON),angular second moment(ASM),entropy(ENT),mean value(MEAN),tongue coating area/tongue surface area(perAll),and tongue coating area/non-coated area(perPart)).Logistic regression analysis was conducted to identify influencing factors for different syndrome types of glucolipid metabolic disorders.Results The tongue body indicators TB-L,TB-Y,and TB-Cb in the disease group were significantly higher than those in the control group,while TB-a,TB-b,and TB-Cr were significantly lower.The tongue coating indicators TC-L,TC-Y,TC-Cb,perAll,and perPart in the disease group were significantly higher than those in the control group,while TC-a,TC-b,and TC-Cr were significantly lower(P<0.05).Comparing with the different syndromes in disease group,the TB-L and TB-Y of the liver depression and spleen deficiency syndrome,and the phlegm-damp obstruction syndrome were higher than those of the qi stagnation and blood stasis syndrome;the TB-a and TB-Cr of the phlegm-damp obstruction syndrome were lower than those of the qi stagnation and blood stasis syndrome;the perAll of the phlegm-damp obs

关 键 词：糖脂代谢病 舌诊 舌象 肝郁脾虚证 痰湿阻滞证 气滞血瘀证 

分 类 号：R259[医药卫生—中西医结合]