本文關(guān)鍵詞：視網(wǎng)膜血管血氧飽和度及管徑在病證結(jié)合辨證分析中的應(yīng)用研究　出處：《成都中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 糖尿病 慢性腎病 證素辨證 視網(wǎng)膜血管血氧飽和度 視網(wǎng)膜管徑

【摘要】：目的：通過(guò)對(duì)糖尿病、慢性腎病患者進(jìn)行證素辨證分型,以及視網(wǎng)膜血管管徑及血氧飽和度定量測(cè)量,探討糖尿病、慢性腎病的視網(wǎng)膜微血管血氧飽和度及管徑特征。方法：①通過(guò)建立慢性非傳染疾病中醫(yī)癥狀信息量表,采集2型糖尿病64例、慢性腎病83例患者中醫(yī)癥狀體征,參照嚴(yán)石林提出的病位、病因、病性、病勢(shì)證素辨證,利用頻次分析、積分分析,對(duì)糖尿病、慢性腎病患者進(jìn)行證素辨證分型,研究其證素辨證規(guī)律,得出可重復(fù)、相對(duì)客觀中醫(yī)證候。②基于證素辨證研究,納入2型糖尿病64例、慢性腎病83例及正常人103例,采集視網(wǎng)膜平均及各象限血管動(dòng)脈、靜脈血氧飽和度,動(dòng)靜脈血氧飽和度差異,動(dòng)脈、靜脈管徑值,動(dòng)靜脈比值指標(biāo),運(yùn)用統(tǒng)計(jì)分析,研究正常人、糖尿病、慢性腎病視網(wǎng)膜血氧飽和度及管徑,研究糖尿病、慢性腎病陰血虛、陽(yáng)氣虛的視網(wǎng)膜血管血氧飽和度及管徑特征,探索同證異病視網(wǎng)膜血氧飽和度及管徑的變化情況。結(jié)果：①證素辨證分析顯示,頻次法中所納入的2型糖尿病患者中醫(yī)證候中病位證素主要集中在肝(占35.9%),病性證素通過(guò)合并主要為陽(yáng)氣虛(占45.3%)、陰血虛(占32.8%)；頻次法中所納入慢性腎病患者中醫(yī)證候中病位證素主要集中在肝(占79.52%),脾(占54.22%)和腎(占51.81%),病性證素(含病因證素)通過(guò)合并主要為陽(yáng)氣虛(占54.21%)、痰濕(占45.78%)、陰血虛(占38.55%)。②對(duì)于糖尿病患者,視網(wǎng)膜平均動(dòng)脈血氧飽和度(102.76±9.79%)較正常人(95.91±4.88%)高,差異有統(tǒng)計(jì)學(xué)意義(p0.05);靜脈血氧飽和度(63.33±7.76%)與正常人(62.21±6.96%)相比差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)；血氧動(dòng)靜脈差異(39.44±8.80%)增大,與正常人(33.70±6.63%)相比差異有統(tǒng)計(jì)學(xué)意義(p0.05);視網(wǎng)膜靜脈管徑(169.29±17.85 u m)較正常組(158.97±16.33 u m)寬,動(dòng)靜脈比值(0.75±0.08)較正常人(0.80±0.10)小,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。③對(duì)于慢性腎病患者,視網(wǎng)膜平均動(dòng)脈血氧飽和度(98.20±7.88%)較正常人高,差異有統(tǒng)計(jì)學(xué)意義(p0.05),靜脈血氧飽和度(63.87±6.39%)與正常人相比,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),血氧動(dòng)靜脈差異(34.34±6.37%)與正常人比較無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)；視網(wǎng)膜動(dòng)脈管徑(116.18±16.26μ m)較正常組動(dòng)脈管徑(125.79±14.44μ m)窄,其動(dòng)靜脈比值(0.76±0.11)較正常人小,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。④單純糖尿病病程與視網(wǎng)膜血氧、管徑均值無(wú)明顯相關(guān)性(p0.05),慢性腎病疾病分期與視網(wǎng)膜動(dòng)脈、靜脈血氧飽和度均值成正相關(guān)(p0.05)。⑤陰血虛(101.41±10.1%)、陽(yáng)氣虛(98.28±6.01%)患者視網(wǎng)膜平均動(dòng)脈血氧飽和度較正常組(95.91±4.88%)高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),視網(wǎng)膜靜脈血氧飽和度均值與正常組比較無(wú)明顯差異(P0.05),陰血虛視網(wǎng)膜動(dòng)靜脈差異(39.16±7.85%)較正常組(33.70±6.63%)高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；陰血虛(118.36±17.76μm)、陽(yáng)氣虛(116.91±15.59μm)患者視網(wǎng)膜平均動(dòng)脈管徑較正常組(125.79±14.44μm)窄,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；靜脈管徑與正常組比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),陰血虛(0.744±0.12)、陽(yáng)氣虛(0.744±0.09)患者視網(wǎng)膜平均動(dòng)靜脈管徑比值較正常組(0.80±0.10)低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。⑥陰血虛與陽(yáng)氣虛比較：陰血虛患者視網(wǎng)膜動(dòng)脈、靜脈血氧飽和度與陽(yáng)氣虛比較無(wú)明顯差異(P0.05),陰血虛患者視網(wǎng)膜平均(39.16±7.85%)、顳上(40.78±13.85%)動(dòng)靜脈血氧差異較陽(yáng)氣虛平均(35.02±5.81%)、顳上(35.09±9.17%)血氧差異高,有統(tǒng)計(jì)學(xué)意義(P0.05)：陰血虛患者視網(wǎng)膜動(dòng)脈、靜脈管徑、動(dòng)靜脈管徑比值與陽(yáng)氣虛比較無(wú)明顯差異(P0.05)。結(jié)論：①單純2型糖尿病中醫(yī)病位證素主要在肝,病性證素為陽(yáng)氣虛、陰血虛；慢性腎病病位證素在肝、脾、腎,病性證素為陽(yáng)氣虛、痰濕、陰血虛。②與正常人相比,單純2型糖尿病患者視網(wǎng)膜平均動(dòng)脈血氧飽和度較高,血氧動(dòng)靜脈差異大,動(dòng)脈管徑較窄,動(dòng)靜脈管徑比值較小；慢性腎病患者視網(wǎng)膜平均動(dòng)脈血氧飽和度較高,靜脈管徑較寬,動(dòng)靜脈管徑比值較小。③陰血虛患者視網(wǎng)膜動(dòng)靜脈血氧飽和度差異較陽(yáng)氣虛患者大,提示陰血虛患者機(jī)體耗氧量較高。④視網(wǎng)膜血管血氧飽和度及管徑的客觀數(shù)據(jù)在中醫(yī)“證”上具有相通性,證明中醫(yī)證候的客觀性和科學(xué)性,為中醫(yī)的同證異病,異病同治理論提供了有力的客觀依據(jù)。
[Abstract]:Objective: Based on diabetic patients with chronic kidney disease, syndrome differentiation, and retinal vascular caliber and quantitative measurement of blood oxygen saturation, diabetes, chronic kidney disease, retinal microvascular diameter and saturation characteristics. Methods: 1. Through the establishment of chronic non communicable diseases in TCM symptom information acquisition scale, 64 cases of type 2 diabetes. 83 cases of patients with chronic kidney disease symptoms signs, according to Yan Shilin proposed a disease, etiology, disease, syndrome differentiation and disease syndrome, using frequency analysis, the integral analysis on diabetic patients with chronic kidney disease, syndrome differentiation, study the regularity of the syndrome element differentiation, it can be repeated, relatively objective TCM syndrome. 2 based on the research of syndrome differentiation syndrome, in 64 patients with type 2 diabetes, chronic kidney disease, 83 cases and 103 cases of normal control, and the average acquisition of retinal quadrant artery, venous oxygen saturation, arterial venous oxygen saturation The difference, artery, vein diameter, arteriovenous ratio index, using statistical analysis, the study of diabetes, normal people, chronic kidney disease, retinal oxygen saturation and the diameter of diabetes, chronic kidney yin deficiency, Yang deficiency of retinal vascular diameter and saturation characteristics, changes to explore syndrome with different oxygen saturation and the diameter of retinal disease results: 1. Differentiation of syndrome factor analysis showed that TCM syndrome in patients with type 2 diabetes included frequency method in the syndrome factor mainly in the liver (35.9%), disease syndrome is mainly through the merger of Yang Qi (45.3%), yin deficiency (32.8%); included patients with TCM syndrome chronic kidney disease syndrome of syndrome factor mainly in liver frequency method (79.52%), spleen (54.22%) and (51.81%), kidney disease syndrome (including etiological factors) by combining mainly for Yang deficiency (54.21%), phlegm (45.78%), yin deficiency (accounted for 38 .55%). For the patients with diabetes, the average retinal arterial oxygen saturation (102.76 + 9.79%) than normal (95.91 + 4.88%), the difference was statistically significant (P0.05); venous oxygen saturation (63.33 + 7.76%) and normal people (62.21 + 6.96%) compared to the difference was not statistically significant (P0.05); oxygen dynamic vein (39.44 + 8.80%) difference increases, and normal people (33.70 + 6.63%) compared to the difference was statistically significant (P0.05); retinal vein diameter (169.29 + 17.85 u m) compared with the normal group (158.97 + 16.33 u m wide), arteriovenous ratio (0.75 + 0.08) than normal (0.80 + 0.10) small, the difference was statistically significant (P0.05). For patients with chronic kidney disease, retinal mean arterial oxygen saturation (98.20 + 7.88%) is higher than that of normal people, the difference was statistically significant (P0.05), blood oxygen saturation (63.87 + 6.39%) compared with the normal, the difference was not statistically significant (P0.05), arteriovenous oxygen difference (34 .34 + 6.37%) there was no significant difference with normal people (P0.05); retinal artery diameter (116.18 + 16.26 m) compared with the normal group, the arterial diameter (125.79 + 14.44 m) is narrow, the arteriovenous ratio (0.76 + 0.11) than normal, the difference was statistically significant (P0.05). The simple diabetes the course of disease and retinal oxygen has no obvious correlation, mean diameter (P0.05), chronic kidney disease staging and retinal arterial venous oxygen saturation, mean positive correlation (P0.05). The Yin blood deficiency (101.41 + 10.1%), Yang Qi (98.28 + 6.01%) in patients with retinal mean arterial oxygen saturation compared with the normal group (95.91 + 4.88%) high, the difference was statistically significant (P0.05), no significant difference between the mean retinal venous oxygen saturation and the normal group (P0.05), Yin hemopenia retinal arteriovenous difference (39.16 + 7.85%) compared with the normal group (33.70 + 6.63%), the difference was statistically significant (P0.05); Yin blood Virtual (118.36 + 17.76 u m), Yang Qi (116.91 + 15.59 m) with average retinal artery diameter than the normal group (125.79 + 14.44 m) is narrow, the difference was statistically significant (P0.05); vein diameter compared with the normal group had no statistical significance (P0.05), Yin hemopenia (0.744 + 0.12). Yang Qi (0.744 + 0.09) with the average retinal arteriovenous diameter ratio than the normal group (0.80 + 0.10), the difference was statistically significant (P0.05). The blood deficiency and Yin Yang Qi, Yin blood deficiency in patients with retinal arterial and venous oxygen saturation and yang deficiency compared with no significant difference (P0.05), female patients with retinal the average blood (39.16 + 7.85%), temporal (40.78 + 13.85%) arteriovenous oxygen difference is the Yang Qi average (35.02 + 5.81%), temporal (35.09 + 9.17%) oxygen difference high, with statistical significance (P0.05): Yin hemopenia patients of retinal artery, vein diameter, arteriovenous diameter ratio and yang deficiency than There are no significant difference (P0.05). Conclusion: the simple type 2 diabetes mellitus TCM syndrome factor mainly in liver disease syndrome of Yang Qi deficiency, yin deficiency; chronic kidney disease syndrome factor in the liver, spleen, kidney, disease syndrome of Yang Qi deficiency, phlegm, yin deficiency compared. With normal people, simple retinal in patients with type 2 diabetes mellitus mean arterial oxygen saturation is higher, arteriovenous oxygen difference, arterial diameter is narrow, arteriovenous diameter ratio is small; the retina in patients with chronic nephropathy mean arterial oxygen saturation is high, wide vein diameter, arteriovenous diameter ratio is small. The Yin blood deficiency in patients with retinal arterial venous oxygen saturation difference compared with the patients with Yang Qi, Yin blood deficiency in patients with prompt higher oxygen consumption. The diameter of the objective data saturation and retinal vessel oxygen have similarities in traditional Chinese medicine, to prove the objectivity and scientificity of syndromes of TCM. It provides a strong objective basis for the theory of the same syndrome and the theory of the same treatment.

【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.5;R259;R276.7

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