本文選題：2型糖尿病 + 中醫(yī)辨證分型　； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察2型糖尿病不同中醫(yī)證型的分布規(guī)律和發(fā)展趨勢(shì),探討不同中醫(yī)證型與踝肱指數(shù)、血液流變學(xué)的相關(guān)性,為中醫(yī)證型規(guī)范化和系統(tǒng)化分類(lèi)提供實(shí)驗(yàn)室依據(jù),為臨床重點(diǎn)預(yù)防及治療2型糖尿病患者動(dòng)脈硬化等血管并發(fā)癥提供理論依據(jù)。方法:選取2016年4月至2016年8月于無(wú)錫市中西醫(yī)結(jié)合醫(yī)院內(nèi)分泌科病房2型糖尿病住院患者共120例作為研究組,入選患者均符合2013年中華醫(yī)學(xué)會(huì)糖尿病分會(huì)《中國(guó)2型糖尿病防治指南》提出的診斷標(biāo)準(zhǔn)、1999年WHO糖尿病專(zhuān)家委員會(huì)提出的分型標(biāo)準(zhǔn)以及排除標(biāo)準(zhǔn)。中醫(yī)辯證分型2002年參照衛(wèi)生部《中醫(yī)新藥臨床研究指導(dǎo)原則》及2007年中華醫(yī)藥學(xué)會(huì)《糖尿病中醫(yī)防治指南》,結(jié)合臨床觀察分為氣陰兩虛證、血瘀脈絡(luò)證、陰虛火旺證和陰陽(yáng)兩虛證。同時(shí)選取該院健康體檢者共50例作為對(duì)照組。收集兩組基本情況(姓名、性別、年齡、病史等),分別觀察分析各組的空腹血糖、糖化血紅蛋白、踝肱指數(shù)、血液流變學(xué)等指標(biāo)。結(jié)果:1.2型糖尿病各中醫(yī)證型所占比例由低到高依次為陰陽(yáng)兩虛證(17.5%)陰虛火旺證(23.3%)血瘀脈絡(luò)證(26.7%)氣陰兩虛證(32.5%)。2.T2DM各中醫(yī)證型組中,病程隨陰虛火旺組、氣陰兩虛組、血瘀脈絡(luò)組、陰陽(yáng)兩虛組遞增;其中陰虛火旺組病程最短,陰陽(yáng)兩虛組病程最長(zhǎng),與其余各組之間有統(tǒng)計(jì)學(xué)差異(P0.05、P0.01)�？崭寡撬诫S陰虛火旺組、氣陰兩虛組、血疲脈絡(luò)組、陰陽(yáng)兩虛組遞增;糖化血紅蛋白水平隨陰虛火旺組、氣陰兩虛組、血瘀脈絡(luò)組、陰陽(yáng)兩虛組遞增。3.右側(cè)踝肱指數(shù)及左側(cè)踝肱指數(shù)均隨血瘀脈絡(luò)組、陰陽(yáng)兩虛組、陰虛火旺組、正常對(duì)照組、氣陰兩虛組遞增;其中血瘀脈絡(luò)組及陰陽(yáng)兩虛組的雙側(cè)踝肱指數(shù)均較低,且陰陽(yáng)兩虛組與正常對(duì)照組以及其余各中醫(yī)證型組兩兩之間比較有統(tǒng)計(jì)學(xué)差異(P0.05),血瘀脈絡(luò)組與正常對(duì)照組以及其余各中醫(yī)證型組兩兩之間比較有明顯統(tǒng)計(jì)學(xué)差異(P0.01)。4.T2DM組與正常對(duì)照組比較,血液流變學(xué)指標(biāo)較高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),其中兩組在全血黏度(高切)、毛細(xì)管血漿黏度及血沉方面比較具有顯著的統(tǒng)計(jì)學(xué)意義(P0.01)。T2DM各中醫(yī)證型組中,全血黏度(低切)、全血黏度(高切)、毛細(xì)管血漿黏度、血沉、紅細(xì)胞壓積與紅細(xì)胞聚集指數(shù)均隨氣陰兩虛組、陰虛火旺組、陰陽(yáng)兩虛組、血瘀脈絡(luò)組遞增;兩兩相比,T2DM各中醫(yī)證型組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05、P0.01),其中血瘀脈絡(luò)組與陰虛火旺組,氣陰兩虛組與血瘀脈絡(luò)組、陰陽(yáng)兩虛組之間的差異有顯著統(tǒng)計(jì)學(xué)意義(p0.01)。結(jié)論:1.氣陰兩虛證為2型糖尿病臨床中最為常見(jiàn)的中醫(yī)證型,其次為血瘀脈絡(luò)證、陰虛火旺證,陰陽(yáng)兩虛證例數(shù)最少。2.2型糖尿病患者病程及空腹血糖水平由低到高依次為陰虛火旺證氣陰兩虛證血瘀脈絡(luò)證陰陽(yáng)兩虛證,陰虛火旺證糖化血紅蛋白水平最低,陰陽(yáng)兩虛證最高,2型糖尿病病程越長(zhǎng),病情逐漸加重。3.2型糖尿病患者右側(cè)踝肱指數(shù)及左側(cè)踝肱指數(shù)由低到高依次為血瘀脈絡(luò)證陰陽(yáng)兩虛證陰虛火旺證氣陰兩虛證;其中血瘀脈絡(luò)證組雙側(cè)踝肱指數(shù)最低,可將踩肱指數(shù)的測(cè)定作為預(yù)估糖尿病動(dòng)脈硬化等慢性血管并發(fā)癥的參考指標(biāo)之一。4.2型糖尿病患者較健康體檢者血液流變學(xué)指標(biāo)水平異常升高,由低到高依次為氣陰兩虛證陰虛火旺證陰陽(yáng)兩虛證血瘀脈絡(luò)證,其中血瘀脈絡(luò)證的血液流變學(xué)指標(biāo)最高,可將血液流變學(xué)指標(biāo)的測(cè)定作為防治糖尿病尤其是老年糖尿病的血管并發(fā)癥的量化指標(biāo)之一;血瘀貫穿于糖尿病的發(fā)展始終,臨床上適當(dāng)應(yīng)用活血化瘀療法對(duì)改善糖尿病并發(fā)癥及改善預(yù)后有重要意義。
[Abstract]:Objective: To observe the distribution and development trend of different TCM Syndrome Types in type 2 diabetes, explore the correlation between different TCM Syndrome Types and the ankle brachial index and hemorheology, provide laboratory basis for the standardization and systematic classification of TCM syndrome type, and provide the theory for prevention and treatment of vascular complications such as arteriosclerosis in patients with type 2 glycan disease. Methods: a total of 120 hospitalized patients with type 2 diabetes in the Department of endocrinology of the integrated traditional Chinese medicine and Western medicine hospital in Wuxi from April 2016 to August 2016 were selected as the research group. All the patients were in conformity with the standard of diagnosis and treatment of type 2 diabetes prevention and control of China in 2013, the Chinese Medical Association of China, in 1999, and the WHO diabetes expert committee in 1999 proposed In 2002, the dialectical classification of traditional Chinese medicine was divided into two deficiency syndrome of Qi Yin, blood stasis choroid syndrome, yin deficiency fire flourish syndrome and Yin Yang two deficiency syndrome, and 50 healthy persons in the hospital were selected. Two groups of basic conditions (name, sex, age, medical history, etc.) were collected to observe and analyze the fasting blood glucose, glycosylated hemoglobin, ankle brachial index and hemorheology, respectively. Results: the proportion of TCM syndrome types of type 1.2 diabetes from low to high was in the order of Yin Yang two deficiency syndrome (17.5%) yin deficiency and fire prosperity (23.3%) blood stasis vein Syndrome (26.7%) Qi Yin two deficiency syndrome (32.5%).2.T2DM syndrome type group, the course of disease with Yin deficiency fire group, Qi Yin deficiency group, blood stasis choroid group, yin and yang two deficiency group increasing; among them, yin deficiency group with the shortest course of disease, yin and yang two virtual group course is the longest, and the other groups between the statistical difference (P0.05, P0.01). Fasting blood glucose level with Yin deficiency flourishing group, Qi Yin Two deficiency group, blood exhaustion choroid group, Yin Yang two deficiency group increased progressively; the level of glycosylated hemoglobin with Yin deficiency fire group, Qi Yin deficiency group, blood stasis choroid group, Yin Yang two deficiency group increased.3. right ankle brachial index and left ankle brachial index in the group of blood stasis vein group, Yin yang two deficiency group, yin deficiency fire flourish group, normal control group, Qi Yin deficiency group increasing; among them blood stasis choroid group Both yin and yang two deficiency group had lower bilateral ankle brachial index, and there was a statistical difference between the group of Yin Yang two deficiency and the normal control group and the other TCM syndrome type group (P0.05). There was significant difference between the blood stasis choroid group and the normal control group and the other TCM Syndrome group 22 (P0.01).4.T2DM group and the normal control group. The blood rheology index was higher and the difference was statistically significant (P0.05). The two groups had significant statistical significance (P0.01) in the whole blood viscosity (Gao Qie), capillary plasma viscosity and erythrocyte sedimentation rate (P0.01), the whole blood viscosity (low shear), whole blood viscosity (Gao Qie), capillary plasma viscosity, erythrocyte sedimentation, and hematocrit And the index of red blood cell aggregation with Qi and yin deficiency group, yin deficiency fire group, yin and yang two deficiency group, blood stasis choroid group increased progressively; compared with 22, T2DM each of the TCM syndrome types were statistically significant (P0.05, P0.01), among which blood stasis choroid group and yin deficiency group, Qi Yin deficiency group and blood stasis group, Yin Yang two deficiency group have significant statistics P0.01. Conclusion: 1. Qi Yin two deficiency syndrome is the most common type of TCM syndrome in type 2 diabetes, followed by blood stasis choroid syndrome, yin deficiency and fire prosperity syndrome, Yin Yang two deficiency syndrome, the course of the least.2.2 type diabetes and the level of fasting blood glucose from low to high in turn are yin deficiency, Qi Yin, Qi Yin, Qi Yin, two deficiency syndrome, blood stasis, Yin Yang two deficiency syndrome and yin deficiency. The level of glycosylated hemoglobin is the lowest, the deficiency of yin and yang two is the highest, the course of type 2 diabetes is longer, the disease progressively aggravates the right ankle brachial index and the left ankle brachial index from low to high in order for the patients with type.3.2 diabetes, which is the blood stasis vein syndrome Yin Yang two deficiency syndrome Yin deficiency and the Qi Yin two deficiency syndrome, and the bilateral ankle brachial index in the blood stasis choroid group is the lowest. The measurement of the brachial index can be used as one of the reference indexes for predicting the chronic vascular complications such as diabetes arteriosclerosis, the abnormal elevation of hemorheological indexes in the patients with type.4.2 diabetes mellitus, from low to high is the blood stasis syndrome of yin and yang two deficiency syndrome of yin deficiency of yin deficiency of two of Qi Yin and the blood stasis of blood stasis. The hemorrheology index is the highest, which can be used to measure the hemorrheology index as one of the quantitative indexes for the prevention and treatment of diabetic vascular complications, especially in the elderly diabetes. The blood stasis is throughout the development of diabetes. The clinical application of blood circulation and stasis therapy is of great significance in improving the complications of diabetes and improving the prognosis.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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