【作者】 王岚；

【导师】 陈秋；

【作者基本信息】 成都中医药大学 ， 中西医结合临床， 2019， 硕士

【摘要】 目的:观察老年2型糖尿病患者在不同肾功能分期的中医证候分布特点,探寻疾病证候的演变规律以及各证型与相关实验室指标的关系。方法:收集2018.01——2019.01期间成都中医药大学附属医院内分泌科及肾病科300例60岁及以上老年2型糖尿病住院患者的临床资料及中医证候等信息,进行统计分析。结果:1、300例老年2型糖尿病患者中男性149例,女性151例,男女之比为0.98:1;95.3%的患者为汉族人;64.7%的糖尿病病程在10年以上。2、中医证型以气血两虚夹瘀证(27.7%)最为常见。3、不同年龄组人群、吸烟史、G分期的中医证型构成比差异具有统计学意义(P<0.05),性别、饮酒史、糖尿病病程的中医证型构成比差异不具有统计学意义(P>0.05)。4、G1期以痰(湿)热互结证最常见(28.0%),G2期以气阴两虚夹瘀证最常见(38.0%),G3a期以气阴两虚夹瘀证最常见(46.0%),G3b期以气阴两虚夹瘀证最常见(44.0%),G4期以阴阳两虚夹瘀证最常见(22.0%),G5期以阴阳两虚证最常见(32.0%)。5、数据服从正态分布,具有方差齐性,对不同中医证型人群组的身高、体重、BMI、腰围、收缩压、舒张压、P、eGFR、FPG、2hPG、HbA1c、ACR、Scr、UA、HDLC、LDLC、TG、TC差异进行单因素方差分析,不同中医证型人群组在收缩压、eGFR、FPG、2hPG、HbA1c、ACR、Scr、UA方面,差异均具有统计学意义(P<0.05)。6、以中医证型为因变量,以差异分析中有统计学意义的因素年龄分组、吸烟史、收缩压、EGFR、FPG、2hPG、HbA1c、ACR、Scr、UA作为自变量,参考类别为阴阳两虚夹瘀证,进行中医证型的多项logistic回归分析显示:痰(湿)热互结证无主要影响因素;与81-92岁年龄组相比,60-70岁年龄组是热盛伤津证的概率为4.754,71-80岁年龄组是热盛伤津证的概率为2.612;收缩压、UA是气阴两虚证的主要影响因素;UA是肝肾阴虚证的主要影响因素;FPG是阴阳两虚证的主要影响因素。eGFR是气阴两虚夹痰证的主要影响因素。Scr是气阴两虚夹瘀证的主要影响因素;与有吸烟史的人群相比,无吸烟史的人群是气阴两虚,痰瘀互结证的概率是7.958;eGFR、Scr是肝肾阴虚夹瘀证的主要影响因素(P<0.05)。结论:1、年龄、吸烟史、肾功能分期是影响中医证型的因素。2、老年2型糖尿病患者各肾功能分期临床症候表现复杂多样,证型以气血两虚夹瘀证最为常见,证型的演变规律为:痰(湿)热互结证-气阴两虚夹瘀证-阴阳两虚夹瘀证-阴阳两虚证。3、60-70岁年龄组是热盛伤津证的概率是81-92岁年龄组的4.754倍,71-80岁年龄组是热盛伤津证的概率是81-92岁年龄组的2.612倍;无吸烟史人群是气阴两虚,痰瘀互结证的概率是有吸烟史人群的7.958倍;气阴两虚证容易出现收缩压、血尿酸异常;肝肾阴虚证容易出现血尿酸异常;阴阳两虚证容易出现空腹血糖异常;气阴两虚夹痰证容易出现肾小球滤过率的异常;气阴两虚夹瘀证容易出现血肌酐异常;肝肾阴虚夹瘀证容易出现肾小球滤过率、血肌酐的异常。4、老年2型糖尿病各肾功能分期中医证型与常规实验室指标有密切的相关性,对中医辨证分型具有一定的辅助参考价值。更多还原

【Abstract】 Objective: To observe the distribution characteristics of TCM syndromes in elderly patients with type 2 diabetes mellitus in different stages of renal function and explore the rules of syndrome evolution.Methods: from January 2018 to January 2019 the clinical data and TCM syndromes of 300 inpatients with type 2 diabetes aged 60 years or above in the department of endocrinology and nephrology of the Hospital of Chengdu University of Traditional Chinese Medicine were collected for statistical analysis.Results: 1.Among the 300 elderly patients with type 2 diabetes,149 were males and 151 were females,and the ratio of males to females was0.98:1;95.3% of the patients were han Chinese.64.7% of patients had diabetes for more than 10 years.2.TCM syndromes include qi and blood deficiency with blood stasis syndrome(27.7%)were the most common.3.There were statistically significant differences in the composition ratio of TCM syndromes in different age groups,smoking history and G stage(P < 0.05),while there were no statistically significant differences in the composition ratio of TCM syndromes in gender,drinking history and diabetes course(P > 0.05).4.Phlegm(wet)heat intermingled syndrome was the most common in G1(28.0%),qi and Yin deficiency and blood stasis syndrome was the most common in G2(38.0%),qi and Yin deficiency and blood stasis syndrome was the most common in G3a(46.0%),qi and Yin deficiency and blood stasis syndrome was the most common in G3b(44.0%),Yin and Yang deficiency with blood stasis syndrome was the most common in G4(22.0%),and Yin and Yang deficiency syndrome was the most common in G5(32.0%).5.The data is normally distributed with homogeneity of variance,the different TCM syndrome types population groups of height,weight,BMI,waist circumference,systolic blood pressure,diastolic pressure,Pulse,eGFR,FPG,2hPG,HbA1 c,ACR,Scr,UA,differences in HDLC,LDLC,TG,TC,single factor variance analysis to different TCM syndrome types population groups in systolic blood pressure,eGFR,FPG,2 HPG,HbA1 c,ACR,Scr,UA,the differences were statistically significant(P < 0.05).6.With TCM syndrome type as the dependent variable,the difference was statistically significant in the analysis of the factors of age group,smoking history,systolic blood pressure,EGFR,FPG,2 HPG,HbA1 c,ACR,Scr,UA as independent variables,the reference category for two virtual folder stasis syndrome of Yin and Yang,TCM syndrome type of multinomial logistic regression analysis showed that phlegm(wet)heat each other by the main influencing factors;Compared with the 81-92 age group,the probability of the 60-70 age group being the syndrome of severe heat injury is 4.754,and the probability of the 71-80 age group being the syndrome of severe heat injury is 2.612.Systolic blood pressure and UA were the main influencing factors of qi and Yin deficiency syndrome.UA is the main influencing factor of liver-kidney Yin deficiency syndrome.FPG is the main influencing factor of Yin-Yang deficiency syndrome.EGFR is the main influencing factor of qi and Yin deficiency with phlegm syndrome.Scr is the main influencing factor of qi-Yin deficiency with blood stasis syndrome.Compared with those with a history of smoking,those without a history of smoking are deficient in both qi and Yin,and the probability of mutual syndrome of phlegm and blood stasis is 7.958.EGFR and Scr were the main influencing factors of the syndrome of liver-kidney Yin deficiency with blood stasis(P < 0.05).Conclusions: 1.Age,smoking history and renal stage are the factors affecting TCM syndrome type.2.In the elderly patients with type 2 diabetes,the clinical manifestations of various stages of renal function are complex and diverse.The most common syndrome type is the syndrome of deficiency of qi and blood combined with blood stasis.The evolution of syndrome types is as follows:Phlegm(dampness)and heat syndrome-qi and Yin deficiency and blood stasis syndrome-Yin and Yang deficiency and blood stasis syndrome-Yin and Yang deficiency.3.The probability of 60-70 years old group with syndrome of severe heat injury is 4.754 times that of 81-92 years old group,and the probability of 71-80 years old group with syndrome of severe heat injury is 2.612 times that of 81-92 years old group.Those with no smoking history had qi and Yin deficiency,and the probability of phlegm and blood stasis syndrome was 7.958 times of those with smoking history.Systolic blood pressure and abnormal blood uric acid are easy to occur in the deficiency of qi and Yin.Liver and kidney Yin deficiency syndrome is prone to abnormal blood uric acid;The deficiency of Yin and Yang is prone to abnormal fasting blood glucose.The abnormality of glomerular filtration rate is easy to appear in the syndrome of qi and Yin deficiency with phlegm.The syndrome of qi and Yin deficiency with blood stasis is prone to abnormal blood creatinine.Kidney Yin deficiency with blood stasis is prone to the glomerular filtration rate,blood creatinine abnormalities.4.There is a close correlation between TCM syndrome types of renal function stages of type 2 diabetes in the elderly and conventional laboratory indicators,which has certain auxiliary reference value for TCM syndrome differentiation.更多还原