2型糖尿病（消渴）证候规范与证素特征的研究
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摘要
目的：探讨糖尿病证素分布、演变、组合及证素的本质。
方法：1.文献研究：系统复习整理古今文献,了解糖尿病的证型分布特点与研究进展。2.临床调研及实验研究：采用临床调研与中医计量诊断、多元统计分析结合的方法,对长沙市区518例糖尿病患者常见证素与演变规律进行研究,同时对其中116例糖尿病患者选择与证素关系密切的指标,通过多指标与多证素的关系,进行证实质的研究。
结果：1.文献研究：系统复习整理古今文献,了解糖尿病的辨证方法突破了传统的三消辨证,发展为病性辨证(气血津液)、和病因辨证(痰湿、肝郁、热毒)的过程。辨证分型不一,据病套证,以证套症方法不符合临床辨证思维,亦不能满足临床需要,证素辨证符合系统论整体原理,能较近似的反映消渴病的特点。
2.临床调研：通过临床调研,运用中医计量诊断的方法,对糖尿病证素的分布、组合及证候的演变规律进行了初步的探讨。结果显示：
(1)症状、体征分布：典型的“三多一少”症占38.9%；形体消瘦占10.6%；形体肥胖占41.7%。
(2)变量聚类分析显示：糖尿病常见证素有：气虚、阴虚、阳虚、血瘀、痰湿、火热。并对每个证素进一步作主成分分析,找出每个证素的主症、次症。
(3)证素分布规律：气虚、阴虚贯穿各个阶段,阴虚更多见；血瘀在有并发症时出现；痰湿、火热在无并发症时出现的频率最高；阳虚多出现在并发证较重的晚期。
(4)证素组合规律：糖尿病证型分布广,证素组合复杂,糖尿病无并发症时,多为2项、3项、4项证素组合,存在并发症时多为3项、4项、5项证素组合。病情越重,证素组合越复杂。
(5)结合证素在糖尿病各阶段的分布与组合特点,认为脾虚是糖尿病发病的始动因素,肝郁是糖尿病发病的重要诱因。
3.临床实验研究：
(1)2型糖尿病痰湿证患者存在着高胰岛素血症(FINS、2PINS均升高)；高血脂(TG、TC、LDL-C、LP(a)均升高)；胰岛素抵抗(Hmoa-IR升高)；肥胖(BMI、WC值升高)等特点。与各组比,差异有显著性意义。提示上述综合指标可作为痰湿证分型的客观依据。
(2)心功能综合指标可作为气虚与阳虚的参考指标之一
(3) CAMP、CGMP与其比值可作为实证与虚证、阴虚与阳虚客观诊断指标之一
结论：1.根据聚类分析,糖尿病的常见证素有：气虚、阴虚、阳虚、血瘀、痰湿、火热。2.糖尿病证素分布组合复杂,多证素组合为主,气虚、阴虚贯穿糖尿病的各阶段。3.证候与指标之间为非单一的线性关系,多因素信息处理是证实质研究的新方法。
Objective:To explore the distribution, variation, combination and the essence of syndromes elements of Diabetes Mellitus (SEDM)
Methods:1. Literature research:To systems review literature existed in the past and recent years,to recognize distributions and the progression of SEDM 2.Clinical and experimental research:Combination with the investigation, diagnosis measurement of Traditional Chinese medicine (TCM) and multiple statistical analysis, to research 518 patients with common elements and following derivation of SEDM IN Changsha City. At the same time, the correlated indexes of 116 example of that sample were selected to discover the essence of SEDM by correlative research between multi-index and multi syndromes elements.
Results:1.Literature research:the methods of differentiation of syndrome was known by complete revisewing all the past literatures, to know that of nowadays have developed to differentiate syndromes in accordance with the nature of diseases (Qi, blood, Jinye,) and the cause of diseases (phlegm-dampness、stagnancy of live-qi、hotness) out of traditional triple diadetes differentiation of syndrome.The types of syndrome are different. To differentiation syndrome according to the disease and differentiation symptoms according to syndrome it is not accorded with the clinical thinking of differentiation of syndrome,and also couldn't satisfied with the clinic need. Differentiation of syndrome accords with the Gestalt Principle of System Theory, and could reflect proximately the characters of diabetes Mellitus(DM).2. Clinical research:Through clinical research, using the method of counting-diagnosis of TCM. To research the distribution, combination of the elements of syndrome and the variation regular of syndrome of DM. The result:
(1) Symptoms and physical signs:the typical symptoms of polydipsia, polyuria, polyphagie and maciationa,are 38.9percentage; ones of emaciation body are 10.6 percentage; ones of corpulent body are 41.7 percentage. (2) Variable clustering analysis:the common elements of syndrome of Dmare:deficiencyof Qi, deficiency of Yin, insufficiency of yang, biood stasis,phlegm-dampness and hotness. To every elements of syndrome has the principal component analysis to find the cardinal symptoms,subcardinal ones. (3) Distribution regular of elements of syndrome:deficiency of Qi and Yin are in every phase, especially; blood stasis is present following with other complications; phlegm-dampness and hotness are present most frequently without complications; deficiency of Yang is present usually in later stage of serious complications. (4) Combination regular of elements of syndrome:the syndrome DM distribute widely the combination of elements are complicated, DM without complications usually is the complication of two,three or four syndrome,when with complications, usually is the complication of three, four or five syndrome,the more serious, the more complicate of the complication of elements. (5) According to the character of distribution and combination of the SEDM in every phase:to think Insufficiency of spleen is primitive factor of DM.
1.Clinical experiment research:(1) The phlegm-dampness syndrome of DM type 2 patients has the character of Hyperinsulinism (FINS,2PINS are all hing); hyper-lipoproteinemia(TG, TC, LDL-C, LP(a)are all high);Insulin resistance(Homa-IR are high);obesity (BMI,WC are both high).To compare with other groups, the difference is significant.It shows that the combination of the indexes mentioned above can be used as the objective evidence for the differentiation of phlegm-dampness syndrome. (2)The index of heart function can be used as one of reference indexes to different deficiency of Qi and deficiency of Yang. (3) CAMP CGMP and their proportionalit can be used as one of objective indexes to different excess syndrome and deficiency syndrome, deficiencof Yin and Yang.
Conclusions:1. according to variable ciustering analysis,the common syndrome's elements of DM are:Deficiency of Qi, Deficiency of Yin, insufficiency of yang,Blood stasis, phlegm-dampness and hotness.2. The distribute and combination of syndrome's elements are very complicated,the combination of several syndrome's elements is major, Deficiency of Qi and Deficiency of Yin are present in every phase of DM.3. The relationship between indexes and syndrome is not linear relation,several-factors treating is the new method for the research of syndrome's elements.
方法：1.文献研究：系统复习整理古今文献,了解糖尿病的证型分布特点与研究进展。2.临床调研及实验研究：采用临床调研与中医计量诊断、多元统计分析结合的方法,对长沙市区518例糖尿病患者常见证素与演变规律进行研究,同时对其中116例糖尿病患者选择与证素关系密切的指标,通过多指标与多证素的关系,进行证实质的研究。
结果：1.文献研究：系统复习整理古今文献,了解糖尿病的辨证方法突破了传统的三消辨证,发展为病性辨证(气血津液)、和病因辨证(痰湿、肝郁、热毒)的过程。辨证分型不一,据病套证,以证套症方法不符合临床辨证思维,亦不能满足临床需要,证素辨证符合系统论整体原理,能较近似的反映消渴病的特点。
2.临床调研：通过临床调研,运用中医计量诊断的方法,对糖尿病证素的分布、组合及证候的演变规律进行了初步的探讨。结果显示：
(1)症状、体征分布：典型的“三多一少”症占38.9%；形体消瘦占10.6%；形体肥胖占41.7%。
(2)变量聚类分析显示：糖尿病常见证素有：气虚、阴虚、阳虚、血瘀、痰湿、火热。并对每个证素进一步作主成分分析,找出每个证素的主症、次症。
(3)证素分布规律：气虚、阴虚贯穿各个阶段,阴虚更多见；血瘀在有并发症时出现；痰湿、火热在无并发症时出现的频率最高；阳虚多出现在并发证较重的晚期。
(4)证素组合规律：糖尿病证型分布广,证素组合复杂,糖尿病无并发症时,多为2项、3项、4项证素组合,存在并发症时多为3项、4项、5项证素组合。病情越重,证素组合越复杂。
(5)结合证素在糖尿病各阶段的分布与组合特点,认为脾虚是糖尿病发病的始动因素,肝郁是糖尿病发病的重要诱因。
3.临床实验研究：
(1)2型糖尿病痰湿证患者存在着高胰岛素血症(FINS、2PINS均升高)；高血脂(TG、TC、LDL-C、LP(a)均升高)；胰岛素抵抗(Hmoa-IR升高)；肥胖(BMI、WC值升高)等特点。与各组比,差异有显著性意义。提示上述综合指标可作为痰湿证分型的客观依据。
(2)心功能综合指标可作为气虚与阳虚的参考指标之一
(3) CAMP、CGMP与其比值可作为实证与虚证、阴虚与阳虚客观诊断指标之一
结论：1.根据聚类分析,糖尿病的常见证素有：气虚、阴虚、阳虚、血瘀、痰湿、火热。2.糖尿病证素分布组合复杂,多证素组合为主,气虚、阴虚贯穿糖尿病的各阶段。3.证候与指标之间为非单一的线性关系,多因素信息处理是证实质研究的新方法。
Objective:To explore the distribution, variation, combination and the essence of syndromes elements of Diabetes Mellitus (SEDM)
Methods:1. Literature research:To systems review literature existed in the past and recent years,to recognize distributions and the progression of SEDM 2.Clinical and experimental research:Combination with the investigation, diagnosis measurement of Traditional Chinese medicine (TCM) and multiple statistical analysis, to research 518 patients with common elements and following derivation of SEDM IN Changsha City. At the same time, the correlated indexes of 116 example of that sample were selected to discover the essence of SEDM by correlative research between multi-index and multi syndromes elements.
Results:1.Literature research:the methods of differentiation of syndrome was known by complete revisewing all the past literatures, to know that of nowadays have developed to differentiate syndromes in accordance with the nature of diseases (Qi, blood, Jinye,) and the cause of diseases (phlegm-dampness、stagnancy of live-qi、hotness) out of traditional triple diadetes differentiation of syndrome.The types of syndrome are different. To differentiation syndrome according to the disease and differentiation symptoms according to syndrome it is not accorded with the clinical thinking of differentiation of syndrome,and also couldn't satisfied with the clinic need. Differentiation of syndrome accords with the Gestalt Principle of System Theory, and could reflect proximately the characters of diabetes Mellitus(DM).2. Clinical research:Through clinical research, using the method of counting-diagnosis of TCM. To research the distribution, combination of the elements of syndrome and the variation regular of syndrome of DM. The result:
(1) Symptoms and physical signs:the typical symptoms of polydipsia, polyuria, polyphagie and maciationa,are 38.9percentage; ones of emaciation body are 10.6 percentage; ones of corpulent body are 41.7 percentage. (2) Variable clustering analysis:the common elements of syndrome of Dmare:deficiencyof Qi, deficiency of Yin, insufficiency of yang, biood stasis,phlegm-dampness and hotness. To every elements of syndrome has the principal component analysis to find the cardinal symptoms,subcardinal ones. (3) Distribution regular of elements of syndrome:deficiency of Qi and Yin are in every phase, especially; blood stasis is present following with other complications; phlegm-dampness and hotness are present most frequently without complications; deficiency of Yang is present usually in later stage of serious complications. (4) Combination regular of elements of syndrome:the syndrome DM distribute widely the combination of elements are complicated, DM without complications usually is the complication of two,three or four syndrome,when with complications, usually is the complication of three, four or five syndrome,the more serious, the more complicate of the complication of elements. (5) According to the character of distribution and combination of the SEDM in every phase:to think Insufficiency of spleen is primitive factor of DM.
1.Clinical experiment research:(1) The phlegm-dampness syndrome of DM type 2 patients has the character of Hyperinsulinism (FINS,2PINS are all hing); hyper-lipoproteinemia(TG, TC, LDL-C, LP(a)are all high);Insulin resistance(Homa-IR are high);obesity (BMI,WC are both high).To compare with other groups, the difference is significant.It shows that the combination of the indexes mentioned above can be used as the objective evidence for the differentiation of phlegm-dampness syndrome. (2)The index of heart function can be used as one of reference indexes to different deficiency of Qi and deficiency of Yang. (3) CAMP CGMP and their proportionalit can be used as one of objective indexes to different excess syndrome and deficiency syndrome, deficiencof Yin and Yang.
Conclusions:1. according to variable ciustering analysis,the common syndrome's elements of DM are:Deficiency of Qi, Deficiency of Yin, insufficiency of yang,Blood stasis, phlegm-dampness and hotness.2. The distribute and combination of syndrome's elements are very complicated,the combination of several syndrome's elements is major, Deficiency of Qi and Deficiency of Yin are present in every phase of DM.3. The relationship between indexes and syndrome is not linear relation,several-factors treating is the new method for the research of syndrome's elements.
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