本文關(guān)鍵詞： 2型糖尿病 肝經(jīng)郁熱證 焦慮 抑郁　出處：《北京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景：2型糖尿病(type 2 diabetes mellitus, T2DM)是因為胰島素分泌的絕對或相對不足而導(dǎo)致的代謝性疾病,同時又是一種身心疾病。國內(nèi)外諸多研究發(fā)現(xiàn)2型糖尿病與焦慮抑郁不良情緒之間關(guān)系密切。中醫(yī)認為“肝主疏泄,調(diào)暢情志”,情志不遂易引起肝氣郁滯,肝氣不舒會導(dǎo)致情志失調(diào)。糖尿病的基本病機是內(nèi)熱傷陰、壯火食氣、瘀血阻絡(luò)。肝郁化火而耗氣傷陰,加速糖尿病進程。臨床上2型糖尿病多見肝經(jīng)郁熱證,而對于2型糖尿病中肝經(jīng)郁熱證與焦慮抑郁情緒的具體關(guān)系卻缺乏相關(guān)研究。研究目的：通過2型糖尿病肝經(jīng)郁熱證與氣陰兩虛證的對比研究,以期能夠找到2型糖尿病肝經(jīng)郁熱證與焦慮抑郁情緒的相關(guān)性,肝經(jīng)郁熱證與糖尿病并發(fā)癥及伴發(fā)疾病的關(guān)系。從而為肝經(jīng)郁熱證的臨床辯證和糖尿病情緒障礙的臨床治療提供科學(xué)依據(jù)。研究方法：選取2015年至2016年東直門醫(yī)院門診及病房的2型糖尿病肝經(jīng)郁熱證、氣陰兩虛證患者,分為兩組進行對比研究。收集一般資料、證候積分資料,填寫Zung氏焦慮抑郁自評量表,用SPSS 17.0統(tǒng)計軟件進行數(shù)據(jù)分析。計量資料先進行正態(tài)檢驗：其中符合正態(tài)分布的數(shù)據(jù)采用獨立樣本t檢驗比較兩組間的差異；不符合正態(tài)分布的數(shù)據(jù)采用Mann-Whitney U檢驗比較兩組間的差異。計數(shù)資料采用卡方檢驗比較兩組間差異。兩組病例的年齡、BMI分層比較以及焦慮抑郁分級比較,均采用Kruskal-Wallis H檢驗。并采用Spearman相關(guān)分析證候積分與情緒評分之間的關(guān)系。所有數(shù)據(jù)均采用雙側(cè)檢驗,α取0.05,P0.05為差異有統(tǒng)計學(xué)意義。研究結(jié)果：①肝經(jīng)郁熱組抑郁評分(46±6)高于氣陰兩虛組(33±9),t=6.732,P=0.000。分層比較,肝經(jīng)郁熱組輕度、中度、重度抑郁患者的比例都高于氣陰兩虛組,X2=25.812,P=0.000。肝經(jīng)郁熱的證候積分與Zung氏抑郁自評量表的評分呈正向直線關(guān)系,Spearman相關(guān)系數(shù)r=0.591,P=0.000。②肝經(jīng)郁熱組焦慮評分(37±6)高于氣陰兩虛組(31±7),t=3.653,P=0.001。肝經(jīng)郁熱證的證候積分與Zung氏焦慮自評量表的評分呈正向直線關(guān)系,Spearman相關(guān)系數(shù)r=0.458,P=0.000。③肝經(jīng)郁熱組并發(fā)糖尿病視網(wǎng)膜病變的比例明顯高于氣陰兩虛組,X2=8.576,P=0.003。④肝經(jīng)郁熱證組伴發(fā)高血壓的比例明顯高于氣陰兩虛組,X2=4.993,P=0.025。⑤肝經(jīng)郁熱證組伴發(fā)高脂血癥的比例明顯高于氣陰兩虛組,X2=6.385,P=0.012。結(jié)論：①2型糖尿病肝經(jīng)郁熱證患者容易出現(xiàn)焦慮抑郁不良情緒,并且與氣陰兩虛證的患者相比,其焦慮抑郁的程度較重。②2型糖尿病肝經(jīng)郁熱證的嚴重程度與焦慮抑郁負性情緒的嚴重程度呈正向直線相關(guān)。③2型糖尿病肝經(jīng)郁熱證患者與氣陰兩虛證患者相比,更容易并發(fā)糖尿病視網(wǎng)膜病變。④2型糖尿病肝經(jīng)郁熱證患者與氣陰兩虛證患者相比,更容易伴發(fā)高血壓、高脂血癥等疾病。
[Abstract]:Background Type 2 diabetes mellitus type 2 diabetes mellitus (T2DM) is a metabolic disease caused by absolute or relative insufficiency of insulin secretion. At the same time, it is also a physical and mental disease. Many studies at home and abroad found that type 2 diabetes mellitus and anxiety and depression are closely related to bad mood. The basic pathogenesis of diabetes mellitus is internal heat injury of yin, strong fire and food qi, blood stasis blocking collaterals. Liver stagnation and fire dissipate Yin, accelerate the progress of diabetes mellitus. Type 2 diabetes mellitus is more common in liver meridian stagnation and heat syndrome. But for type 2 diabetes mellitus, the specific relationship between liver meridian stagnation heat syndrome and anxiety and depression is lack. Objective: through the type 2 diabetes mellitus liver meridian stagnation heat syndrome and qi and yin deficiency syndrome comparative study. In order to find out the relationship between type 2 diabetes mellitus liver meridian stagnation heat syndrome and anxiety and depression. The relationship between the syndrome of liver meridian and heat stagnation and the complications of diabetes mellitus and the associated diseases, thus providing the scientific basis for the clinical dialectical of liver meridian and heat stagnation syndrome and the clinical treatment of diabetic emotional disorder. The research methods are as follows:. From 2015 to 2016 in Dongzhimen Hospital, type 2 diabetes mellitus with liver stagnation and heat syndrome was selected from outpatient and ward of Dongzhimen Hospital. The patients with deficiency of qi and yin were divided into two groups for comparative study. The general data and syndromes integral data were collected and Zung's anxiety and depression self-rating scale was filled out. The statistical software SPSS 17.0 was used to analyze the data. The measurement data were tested by normal test. The difference between the two groups was compared by independent sample t test for the data in accordance with normal distribution. Mann-Whitney U test was used to compare the difference between the two groups. The counting data were compared by chi-square test. The age of the two groups was compared. BMI stratification and anxiety and depression grades were compared. Kruskal-Wallis H test was used, and Spearman correlation analysis was used to analyze the relationship between syndrome score and emotion score. All data were tested by bilateral test. Results the depression score of 1% 1 liver meridian and heat stagnation group (46 鹵6) was higher than that of Qi and Yin deficiency group (33 鹵9). The proportion of mild, moderate and severe depression in liver meridian stagnation group was higher than that in Qi Yin deficiency group. There was a positive linear relationship between the syndrome score of liver meridian stagnation and the score of Zung's self rating Depression scale. The Spearman correlation coefficient was 0. 591. The anxiety score was 37 鹵6 in liver meridian stagnation group (P 0.000.2) and 3.653 in Qi and Yin deficiency group (31 鹵7). P0. 001.The syndromes score of liver meridian stagnation heat syndrome and the score of Zung's self rating anxiety scale were positively correlated with the Spearman correlation coefficient r0. 458. The rate of diabetic retinopathy in liver meridian stagnation group was significantly higher than that in Qi Yin deficiency group (8.576). The incidence of hypertension in the group of liver meridian stagnation and heat stagnation was significantly higher than that in the group of deficiency of qi and yin. The proportion of hyperlipidemia in liver meridian stagnation syndrome group was significantly higher than that in Qi and Yin deficiency group. Conclusion the patients with liver meridian and heat stagnation syndrome of type 12 diabetes are prone to anxiety and depression, and compared with the patients with deficiency of qi and yin. The degree of anxiety and depression in type 22 diabetes mellitus is more serious. The severity of liver meridian and heat stagnation syndrome is positively related to the severity of negative emotion of anxiety and depression. There is a positive linear correlation between type 32 diabetes mellitus patients with liver meridian heat stagnation syndrome and patients with deficiency of qi and yin. Compared to. The patients with type 42 diabetic liver meridian and heat stagnation syndrome were more easily complicated with hypertension and hyperlipidemia than those with deficiency of qi and yin.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259;R277.7

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