糖尿病周围神经病变的中医证候特点研究

目的:探讨糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的中医证候特点和相关因素。方法:450例DPN患者的病历资料经整理后统一辨证分为气虚证、阴虚证、阳虚证、血瘀证、痰湿证、气滞证6个单证。结果:单证频率前3位依次为:血瘀证(70.89%)、阴虚证(64.89%)、气虚证(57.33%);以复合证型为主(89.11%),其中以虚实夹杂为主(89.78%),阴阳两虚血瘀最多见(23.44%);本虚角度上来讲,不同病程组证型构成比有显著性差异(P0.05),病程大于10年组中阴阳两虚、或兼痰瘀证最多(34.16%);不同病程组痰瘀互结证出现率较高(17.77%-28.00%),但组间无显著性差异。Logistic回归分析提示年龄、周围神经症状、针刺痛觉、糖尿病病程、舒张压水平是阴阳两虚证的危险因素。结论:血瘀是DPN的关键病机;DPN后期出现阴阳两虚为本的病机演变。

Study on the characteristics of syndrome of traditional Chinese medicine for diabetic peripheral neuropathy

Objective: To investigate the characteristics and the correlative factors of traditonal Chinese medicine(TCM) syndrome in diabetic peripheral neuropathy(DPN).Methods: Casebooks of 450 patients with DPN were recorded and arranged,then classified by unified criteria of traditional Chinese medicine as syndromes of Qi-deficiency,Yin-deficiency,Yang-deficiency,blood-stasis,phlegm-dampness,Qi-depression.Results:Frequency of the first three single syndrome were Blood-stasis syndrome(70.89%),Yin-deficiency syndrome(64.89%),Qi-deficiency syndrome(57.33%).The principal syndrome were compounded TCM syndrome patterns(89.11%),the main type of which was mixture of asthenia and sthenia(89.78%).Deficiency of both Yin and Yang combined with blood stasis(23.44%) was the most common syndrome.On the side of deficiency syndrome,there was a significant difference in constituent ratio of TCM syndrome patterns(P<0.05).The incidence of blood-stasis combined with phlegm-dampness pattern was relatively high(17.77%-28.00%) in each group,but there was no significant difference between them.In the group of more than 10 years course,the most common syndrome was Yin and Yang deficiency combined with blood-stasis and/or phlegm-dampness(34.16%).Analysis of Logistic regression indicated that age,symptoms of peripheral neuropathy,needling pain,course of disease,level of diastolic blood pressure were risk factors of Yin and Yang deficiency syndrome.Conclusion: The vital TCM pathogenesis in DPN is blood stasis.As later stage of DPN,deficiency of both Yin and Yang began to play an important role.