本文選題：2型糖尿病 + 高血壓��； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：一、研究目的探討2型糖尿病合并高血壓病患者血管老化的臨床特征,研究其血管老化病變的臨床特點(diǎn)、中醫(yī)證候規(guī)律以及相關(guān)性,從而加深對于血管老化的全面理解,并將有助于豐富和完善中醫(yī)藥防治心血管疾病的途徑和靶點(diǎn)。二、研究方法本研究是一個(gè)橫斷面研究,通過專家問卷以及文獻(xiàn)調(diào)研編制2型糖尿病合并高血壓病的臨床調(diào)查量表,收集2016年5月-2017年4月于西苑醫(yī)院內(nèi)分泌科以及心血管內(nèi)科住院的107例2型糖尿病合并高血壓病患者的臨床資料,構(gòu)建臨床信息數(shù)據(jù)庫,并將患者按照年齡分為中年組(45-59歲)和老年組(60-80歲),對收集到的資料進(jìn)行統(tǒng)計(jì)分析,同時(shí)收集了 14例健康人作為對照組。對納入的107例患者的一般資料進(jìn)行頻數(shù)分析,運(yùn)用主成分分析-聚類分析等方法統(tǒng)計(jì)糖尿病合并高血壓病患者的中醫(yī)證素與中醫(yī)證型;使用t檢驗(yàn)、秩和檢驗(yàn)、線性回歸探討2型糖尿病合并高血壓病患者的臨床特征;使用單因素方差分析結(jié)合Logistic回歸分析中醫(yī)證素與血管老化指標(biāo)之間的相關(guān)性;使用獨(dú)立樣本t檢驗(yàn)以及秩和檢驗(yàn)分析糖尿病合并高血壓病患者與健康對照人群之間血管老化指標(biāo)的異同。三、研究結(jié)果:1基線資料107例2型糖尿病合并高血壓患者中,男性45例,女性62例;年齡最小45歲,最大80歲,平均年齡62.7±9.2歲;高血壓1級患者12人,高血壓2級患者38人,高血壓3級患者57人;血脂正常53人,血脂輕度升高25人,高脂血癥29人;糖尿病較輕患者17人,較重46人,嚴(yán)重44人;41人吸煙,占到患者組的38.32%,早發(fā)心血管疾病家族史的患者47人,占患者組的43.93%。對照組來自社會招募的非高血壓非糖尿病的健康志愿者,共計(jì)14人,最大年齡61歲,最小年齡45歲,平均年齡50.2±5.2歲,其中男性8人,女性6人。其中5人吸煙,占健康對照組的35.7%,3人有心血管病家族史,占健康對照組的21.4%。2不同年齡段、不同性別之間血管老化臨床特征的差異性分析中年組與老年組相比,胎球蛋白A(FetuinA)、脈搏波波速(Pulse Wave Velocity,PWV)的差異性明顯,中年組的PWV要低于老年組的PWV,中年組的FetuinA要高于老年組的FetuinA,中年組與老年組之間的血管性血友病因子(von Willebrand Factor,vWF)值并無明顯差異,提示隨著年齡的增加,血管老化程度逐漸加重,鈣質(zhì)沉積出現(xiàn)異常。不同性別之間的血管老化指標(biāo)差異并不明顯,提示隨著年齡的增加,不論男女,血管彈性逐漸變差,老化程度逐漸加重。3基礎(chǔ)疾病、年齡等因素對血管老化臨床特征的影響線性回歸分析中可以得出,PWV的回歸方程為:Y=1585.316+64.129X1,年齡水平(X1)是影響PWV的主要因素;FetuinA的回歸方程為:Y =1.577+0.235X3-0.122X1,高血壓水平(X3)、年齡水平(X1)是影響FetuinA的主要因素;vWF的回歸方程為:Y =0.233+0.03X4,血脂水平(X4)是影響vWF的主要因素。4糖尿病合并高血壓患者中醫(yī)證素的因子分析將通過臨床樣表收集到的患者的癥狀、舌苔、脈象進(jìn)行因子分析—主成分分析,得到15個(gè)公因子,選擇最大方差法對因子載荷矩陣中原始的15個(gè)公因子進(jìn)行旋轉(zhuǎn),旋轉(zhuǎn)在24次迭代后收斂,提取公因子負(fù)荷值≥0.5的變量,可以得出每個(gè)公因子對應(yīng)的中醫(yī)四診信息;根據(jù)因子中載荷系數(shù)的大小,決定每個(gè)因子中醫(yī)四診信息的主次順序,并結(jié)合該因子中其它中醫(yī)四診信息,分析每個(gè)因子可能提供的病性、病位信息,最終得到15個(gè)公因子分別代表氣虛、血瘀、熱盛、痰濕、陽亢、陽虛、陰虛,涉及的病變臟腑分別為肝、脾、肺、腎、胃。5糖尿病合并高血壓患者中醫(yī)證素的聚類分析將15個(gè)公因子作為變量進(jìn)行聚類,選擇最遠(yuǎn)臨元素—?dú)W氏距離的方法進(jìn)行聚類分析,從結(jié)果來看,聚為6類時(shí)從中醫(yī)理論解釋相對合理,據(jù)此可以初步判斷出糖尿病合并高血壓患者中醫(yī)的辨證分型,根據(jù)公因子下中醫(yī)癥狀的載荷系數(shù)的多少,結(jié)合中醫(yī)臨床相應(yīng)的辨證信息,可初步擬定各個(gè)證型的辨證依據(jù)。最終得到2型糖尿病合并高血壓有肝盛克脾、血瘀阻絡(luò)、陰虛陽亢、陽虛水泛、氣陰兩虛、肝郁脾虛等六種證型。6糖尿病合并高血壓患者病性證素分布情況本試驗(yàn)共收集了糖尿病合并高血壓患者39個(gè)臨床常見癥狀,舌診項(xiàng)目15項(xiàng),脈診項(xiàng)目9項(xiàng),107位病人出現(xiàn)該癥狀記為1,不出現(xiàn)該癥狀記為0,參照文獻(xiàn)中對于相關(guān)癥狀的描述,將患者的臨床癥狀依次錄入到EXCEL表格中,參照中醫(yī)證候辨證標(biāo)準(zhǔn),將患者滿足某項(xiàng)證素描述中50%的癥狀定義為患者具備該項(xiàng)病性證素。在107例2型糖尿病合并高血壓病的患者中,“陽虛”占到的比例最大,達(dá)到了 55.2%,“肝陽上亢”占的比例最小,僅為33.39%。7糖尿病合并高血壓患者病性證素組合分布情況統(tǒng)計(jì)分析得知,在患者中,兩類證素相兼的患者最多,有29人,占患者總數(shù)的27.6%,七種證素相兼的患者最少,只有2人,占患者總數(shù)的1.9%。8不同年齡組別、不同性別之間證素分布的差異中年男性最常見的證素為熱盛,病性證素的前三位分別是熱盛(77.3%)陽虛(68.2%)陰虛(45.5%);中年女性最常見的證素為痰濕,前三位的病性證素為痰濕(70.6%)陰虛(58.8%)=氣虛(58.8%)血瘀(52.9%);老年男性最常見的證素為陽虛和熱盛,病性證素前三位的是陽虛(56.5%)=熱盛(56.5%)痰濕(43.5%)氣虛(34.8%)=肝陽上亢(34.8%);老年女性最常見的證素為陽虛,病性證素的前三位分別是陽虛(51.2%)痰濕(48.8%)=陰虛(48.8%)=氣虛(48.8%)血瘀(46.5%)。9病性證素與血管老化之間的關(guān)系為探究相應(yīng)的病性證素與血管損傷指標(biāo)以及糖化血紅蛋白、血脂等生化指標(biāo)之間的相關(guān)性,對107例糖尿病合并高血壓的患者進(jìn)行統(tǒng)計(jì)分析。首先進(jìn)行正態(tài)分布檢驗(yàn),選取符合正態(tài)分布的項(xiàng)目進(jìn)行方差檢驗(yàn),不符合正態(tài)分布的項(xiàng)目進(jìn)行秩和檢驗(yàn),提取P≤0.1的項(xiàng)目做進(jìn)一步的分析。由單因素方差分可知,陽虛組與非陽虛組之間BMI、vWF有差異,陰虛組與非陰虛組之間HDL、TG有差異,熱盛組與非熱盛組之間年齡、TG、VLDL有差異。再分別以熱盛、陰虛、陽虛為因變量,以年齡、FetuinA、vWF、TG、HDL、VLDL、PWV、BMI為協(xié)變量,進(jìn)行Logistic回歸分析。對因變量賦值如下:病性證素賦值為:0-否,1-是;協(xié)變量賦值為:性別:1-男性,2-女性,方法采用向后LR,結(jié)果發(fā)現(xiàn)熱盛的回歸方程中,年齡的OR值是0.941,回歸系數(shù)是-0.061,表示兩者負(fù)呈相關(guān),說明患者年齡越大,越不容易出現(xiàn)熱盛的癥候;在陽虛的回歸方程中,vWF的OR值是754.435,回歸系數(shù)是6.626,提示兩者呈正相關(guān),說明當(dāng)隨著vWF的增高,患者出現(xiàn)陽虛證的風(fēng)險(xiǎn)也跟著增大。10糖尿病、高血壓對血管老化的影響在糖尿病合并高血壓患者組與健康對照組之間,PWV、FetuinA的差異性明顯,糖尿病合并高血壓患者組的PWV要明顯高于健康對照組,說明糖尿病合并高血壓患者血管老化程度較為明顯;而患者組的FetuinA值要低于健康對照組,說明在糖尿病合并高血壓患者體內(nèi)可能出現(xiàn)了鈣質(zhì)沉積的異常。四、結(jié)論1隨著年齡的增加,血管彈性逐漸變差,老化程度逐漸加重;中年組血管內(nèi)鈣質(zhì)的異位沉積要低于老年組,高血脂可加重血管內(nèi)皮損傷,導(dǎo)致血管老化加重。2糖尿病合并高血壓病患者的中醫(yī)證素為氣虛、血瘀、熱盛、痰濕、陽亢、陽虛、陰虛;涉及的病變臟腑分別為肝、脾、肺、腎、胃;疾病的證型為:肝盛克脾、血瘀阻絡(luò)、陰虛陽亢、陽虛水泛、氣陰兩虛、肝郁脾虛。3中年男性最常見的證素為熱盛,中年女性最常見的證素為痰濕,老年男性最常見的證素為陽虛和熱盛,老年女性最常見的證素為陽虛。年齡越大,發(fā)生熱盛的可能性就越低;血管內(nèi)皮細(xì)胞損傷加重時(shí),患者更容易發(fā)生陽虛。4高血壓合并糖尿病患者的血管老化程度要重于健康對照人群。
[Abstract]:The purpose of this study is to investigate the clinical features of vascular aging in patients with type 2 diabetes and hypertension, to study the clinical characteristics of the vascular aging disease, the regularity of TCM syndrome and the correlation, so as to deepen the comprehensive understanding of the vascular aging, and to enrich and improve the ways and targets for the prevention and treatment of cardiovascular diseases in Chinese medicine. Two Methods a cross-sectional study was conducted in this study. The clinical data of type 2 diabetes combined with hypertension were compiled by the expert questionnaire and literature survey, and the clinical information of 107 patients with type 2 diabetes combined with high blood pressure in the Department of Endocrinology, Xiyuan Hospital, Xiyuan Hospital, and the cardiovascular medicine department in May 2016, -2017 years, was collected and the clinical information was constructed. The patients were divided into middle age group (45-59 years old) and aged group (60-80 years old) according to age. The collected data were statistically analyzed, and 14 healthy people were collected as control group. The general data of 107 patients were analyzed, and diabetes combined with hypertension was analyzed by principal component analysis cluster analysis. TCM syndromes and TCM syndrome types of patients with disease; using t test, rank sum test, linear regression to investigate the clinical characteristics of patients with type 2 diabetes combined with hypertension; use single factor analysis of variance and Logistic regression to analyze the correlation between TCM syndrome and blood vessel aging index, and use independent sample t test and rank sum test to analyze diabetes mellitus The differences and similarities between the blood vessel aging indexes between the patients with hypertension and the healthy controls. Three, the results of the study: 1 baseline data, 107 cases of type 2 diabetes combined with hypertension, 45 cases of male, 62 cases, the age of 45, the maximum 80 years, the average age of 62.7 + 9.2 years, 12 in the patients with high blood pressure 1, hypertensive 2 patients 38, high blood pressure grade There were 57 patients with normal blood lipids, 53 blood lipids, 25 hyperlipidemia, 29 hyperlipidemia, 17 diabetic patients, 46 heavier, 44 serious, 41 smoking, 38.32% in the patient group, 47 in the family history of early cardiovascular disease, and a group of 43.93%. control group from non hypertensive and non diabetic healthy volunteers recruited from the society. A total of 14 people, the maximum age of 61 years, the minimum age of 45 years, the average age of 50.2 + 5.2 years, including 8 men and 6 women, 5 of them smoking, accounting for 35.7% in the healthy control group, 3 people with the family history of cardiovascular disease, accounting for the different age groups of 21.4%.2 in the healthy control group and the difference analysis of the clinical characteristics of blood vessel aging between the different sexes and the aged group and the elderly Compared with the group, the difference of fetal globulin A (FetuinA) and pulse wave velocity (Pulse Wave Velocity, PWV) was obvious. The PWV in the middle age group was lower than the PWV in the elderly group, and the FetuinA in the middle age group was higher than the FetuinA in the elderly group. There was no significant difference between the middle-aged group and the elderly group. With the increase of age, the degree of vascular aging is increasing and the calcareous deposition is abnormal. The difference of blood vessel aging indices between different sex is not obvious. It is suggested that with the increase of age, the vascular elasticity gradually becomes worse, the degree of aging gradually aggravates the basic.3 disease, and the factors of age and other factors affect the clinical characteristics of blood vessel aging. It can be concluded that the regression equation of PWV is Y=1585.316+64.129X1, age level (X1) is the main factor affecting PWV; the regression equation of FetuinA is Y =1.577+0.235X3-0.122X1, the level of hypertension (X3), and the age level (X1) is the main factor affecting FetuinA; vWF regression equation is the main factor of Y, and the blood lipid level is the main influence Factor analysis of factors of TCM syndrome in patients with.4 diabetes combined with hypertension, the symptoms, tongue coating, pulse condition, factor analysis, principal component analysis, 15 common factors are obtained, and the maximum variance method is selected to rotate the original 15 common factors in the factor load matrix, and the rotation is convergent after 24 iterations. Taking the variables of the public factor load value more than 0.5, we can get the four diagnosis information of each public factor, and determine the order of the four diagnosis information of each factor according to the load coefficient in the factor, and combine the four diagnosis information of the other Chinese medicine in the factor, and analyze the possible disease, the disease location information which each factor may provide, and finally get 15 The public factors represent Qi deficiency, blood stasis, heat, phlegm, phlegm, yang hyperactivity, Yang deficiency and yin deficiency. The cluster analysis of the syndrome elements of the liver, spleen, lung, kidney, and gastric.5 diabetes combined with hypertension, cluster analysis of 15 common factors as variables, and select the farthest element Euclidean distance to cluster analysis, from the results. In the 6 class, the interpretation of TCM theory is relatively reasonable. According to this, the syndrome differentiation of diabetic patients with hypertension can be judged preliminarily. According to the load coefficient of the symptoms of traditional Chinese medicine under the common factor, according to the corresponding clinical syndrome differentiation information of traditional Chinese medicine, the syndrome differentiation basis of each type of syndrome can be preliminarily drawn up. Finally, the combination of type 2 diabetes is higher. The blood pressure has the liver Sheng Ke spleen, blood stasis obstructing the collaterals, yin deficiency and yang hyperactivity, Yang deficiency water flooding, Qi Yin deficiency, liver depression and spleen deficiency and other six types of.6 diabetes combined with hypertension, the distribution of the disease syndrome in the patients with diabetes combined hypertension, 39 common symptoms, 15 items of tongue diagnosis, 9 items of pulse diagnosis, and 107 patients with this symptom For 1, the symptoms were not recorded as 0. According to the description of the related symptoms in the literature, the patients' clinical symptoms were entered into the EXCEL form in turn. Referring to the syndrome differentiation standard of TCM syndrome, the patients were satisfied with the symptoms of a certain syndrome, which were defined as the patient with the disease, in 107 patients with type 2 diabetes combined with hypertension. The proportion of "Yang Deficiency" accounted for the largest proportion, reaching 55.2%. The proportion of "liver yang hyperactivity" accounted for the smallest proportion. Only the statistical analysis of the combination distribution of 33.39%.7 diabetes combined with hypertension showed that in the patients, the number of two types of syndrome elements was the most, with 29, accounting for 27.6% of the total number of patients, and the least of the seven types of syndrome elements, only the least, only the patients with the least. There were 2 people, accounting for the 1.9%.8 age group of the total number of patients. The most common syndromes in middle-aged men were hot and hot (77.3%) Yang deficiency (77.3%) Yang deficiency (68.2%) yin deficiency (45.5%), and the most common syndromes in middle-aged women were phlegm dampness and the first three were phlegm dampness (70.6%) yin deficiency (58.8%) = three. Qi deficiency (58.8%) blood stasis (52.9%); the most common syndromes in old men were Yang deficiency and heat flourishing, and the first three were Yang deficiency (56.5%) = hot (56.5%) phlegm dampness (43.5%) Qi deficiency (34.8%) = liver yang hyperactivity (34.8%); the most common syndromes in old women were Yang deficiency, and the first three of the disease syndrome elements were Yang deficiency (51.2%) phlegm dampness (48.8%) = Yin deficiency (48.8%) = Qi deficiency (4) 8.8%) the relationship between blood stasis (46.5%).9 disease and vascular aging is to explore the correlation between the corresponding syndromes and blood vessel damage indexes, glycated hemoglobin, blood lipid and other biochemical indexes, and to make a statistical analysis on 107 patients with diabetes combined with hypertension. First, normal distribution test is carried out to select normal distribution. The project carries on the variance test, does not conform to the normal distribution of the project to carry on the rank sum test, extracts P less than 0.1 of the project to do further analysis. By the single factor variance, the difference between the Yang deficiency group and the non Yang deficiency group BMI, the vWF is different. The difference between the yin deficiency group and the non Yin deficiency group is HDL, the TG is different, the age between the hot and non hot groups, the TG, and the VLDL are different. Do not take heat, yin deficiency and yang deficiency as the dependent variable, take age, FetuinA, vWF, TG, HDL, VLDL, PWV, BMI as co variables to carry out Logistic regression analysis. The values of the dependent variables are as follows: the value of the syndrome factor is 0- no, 1- is: 1- male, 2- female, and method adopts backward regression equation, and the result finds the age value of 0 .941, the regression coefficient is -0.061, indicating the negative correlation between the two, indicating that the older the patient is, the less prone to hot syndrome; in the regression equation of Yang deficiency, the OR value of vWF is 754.435 and the regression coefficient is 6.626, suggesting that the risk of Yang deficiency syndrome with the increase of vWF also increases.10 diabetes and higher blood. The effect of pressure on the aging of blood vessels was significantly different between the diabetic group and the healthy control group. The difference of PWV and FetuinA was obvious. The PWV of the patients with diabetes combined with hypertension was significantly higher than that in the healthy control group, indicating that the blood vessel aging degree of the patients with diabetes combined with hypertension was more obvious; the FetuinA value of the patient group was lower than that of the healthy one. According to the group, the abnormal calcium deposits may appear in the patients with diabetes combined with hypertension. Four, conclusion 1 with the increase of age, the vascular elasticity gradually deteriorated and the aging degree gradually aggravated, and the ectopic deposition of intravascular calcium in the middle age group was lower than that in the elderly group. Hyperlipidemia could aggravate the vascular endothelial damage, and the aging of blood vessels aggravated.2 diabetes. The TCM Syndromes of the patients with hypertension are Qi deficiency, blood stasis, heat, phlegm, yang hyperactivity, Yang deficiency and yin deficiency, the liver, spleen, lung, kidney and stomach are respectively the liver, spleen, lung, kidney and stomach. The syndrome of the disease is liver, blood stasis, yin deficiency and yang hyperactivity, Yang deficiency water flooding, two deficiency of Qi Yin, the most common syndrome of middle aged male.3 men with liver depression and spleen deficiency, the most common middle age female female The common syndromes are phlegm dampness. The most common syndromes in old men are Yang deficiency and heat, and the most common syndrome in old women is Yang deficiency. The older the age is, the lower the possibility of thermal prosperity. When the vascular endothelial cell damage is aggravated, the patient is more likely to have the degree of blood vessel aging in patients with Yang deficiency.4 hypertension and diabetes. Group.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1;R544.1

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