糖尿病脑卒中与非糖尿病脑卒中的中医证候特点对照研究

目的探讨糖尿病脑卒中急性期至恢复早期的中医证候特点演变规律,为中风病辨证论治提供理论依据。方法以公认的糖尿病诊断标准,将156例发病7 d以内的脑卒中患者分为糖尿病组与非糖尿病组,均采用《中风病辨证诊断标准》(1994年)进行证候要素评分,探讨2组患者入院当天、发病第7天、第14天、第28天4个时点中医证候要素频数分布及分值演变规律。结果入院当天,风证、火热证、痰证占据较高频次,糖尿病组与非糖尿病组风证不同时点的证候要素分值变化均有显著差异(P<0.05)。发病第7天起,糖尿病组阴虚阳亢证频次增加,发病第28天2组阴虚阳亢证分值比较有显著性差异(P<0.01),2组阴虚阳亢证不同时点的频数分布比较有显著性差异(P<0.05)。结论糖尿病脑卒中患者发病早期中医证候特点受消渴病病机影响较小,以中风病疾病本病证候特点为主,后期消渴病病机特点显现,阴虚阳亢证候逐渐突出,出现以阴虚为本,痰、热为标的本虚标实证。

Control study on TCM syndrome characteristics between diabetic stroke and non-diabetic stroke

Objective To discuss the evolvement rule of TCM syndrome characteristics of diabetic stroke from acute stage to early recovery stage,and supply theoretical evidences for the syndrome differentiation and treatment of stoke.Methods The patients(n=156) with stroke attacked within 7 days were divided into diabetes group and non-diabetes group according to accepted diagnosis standard for diabetes.Standards of Syndrome-differentiated Diagnosis of Apoplexy(1994) was used for scoring syndrome factors.The frequency distribution and score evolvement rule of TCM syndrome factors were discussed in two groups in the day of hospitalization,and on the 7th day,14th day and 28th day after stroke attacking.Results In the day of hospitalization,wind syndrome,fire-heat syndrome and phlegm syndrome had a higher frequency.The score changes of syndrome factors of wind syndrome had significant difference between diabetes group and non-diabetes group at different time points(P<0.05).On the 7th day,the frequency of yin deficiency with yang hyperactivity syndrome increased in diabetes group.On the 28th day,the scores of yin deficiency with yang hyperactivity syndrome had significant difference between two groups(P<0.01),and the frequency distribution of yin deficiency with yang hyperactivity syndrome had significant difference between two groups at different time points(P<0.05).Conclusion At the early stage of diabetic stroke,the TCM syndrome characteristics are influenced much less by the pathogenesis of wasting-thirst and the characteristics are mainly confined in stroke itself.The characteristics of wasting-thirst become apparent at later stage along with the prominent yin deficiency with yang hyperactivity syndrome,and the syndrome of deficiency of the root and excess of the tip appears with yin deficiency as the root and phlegm and heat as the tip.