糖尿病患者周围神经电生理改变与中医证型的关系探讨

目的探讨2型糖尿病患者周围神经电生理改变与中医证型之间的关系.方法将1 28例DM患者辨证分型为:气阴两虚、脾虚痰湿、阴阳两虚、阴虚燥热、湿热痹阻、气滞血瘀.并检测肌电图、运动神经传导速度(MCV)以及运动传导潜伏期(ML)等.结果 128例EMG异常肌肉382块(77.0%),其中气阴两虚型57例159块;脾虚痰湿型26例81块;阴阳两虚型1 4例38块;阴虚燥热型13例37块;湿热痹阻型10例36块;气滞血瘀型8例31块.MCV异常者823条(83.6%).其中阴虚燥热型MCV正常者最多,四种神经发生MCV异常的比率较其他证型明显减低(P＜0.01),以气滞血瘀型MCV异常率最高,其次为湿热痹阻型.在6种不同证型中,以气滞血瘀型的ML最长,湿热痹阻型其次,气阴两虚型最短.结论2型糖尿病患者周围神经电生理改变,以气滞血瘀型最为显著,其次为脾虚痰湿型和湿热闭阻型,说明实证较虚证发生周围神经病变的机会增加,病情相对较重.

Relationship between the Electrophysiological Changes in the Peripheral Nerves of Diabetic Patients and the Differentiation of TCM Syndromes

Objective To explore the relationship between the electrophysiological changes in peripheral nerves of type 2 diabetic patients and the differentiation of TCM syndromes. Methods 128 cases of type 2 diabetic patients were observed. According to syndrome differentiation, they are classified as Qi and Yin deficiency, spleen deficiency with retention of phlegm and damp, Yin and Yang deficiency, Yin deficiency with heat and dryness, stagnation of heat and damp with bi-stagnation, Qi and blood stagnation. The examination of EMG, MCV, and ML were performed. Results 128 patients had 382 abnormal muscles (77%) under EMG exam , in which there were 57 cases of Qi and Yin deficiency with 159 abnormal muscles, 26 cases of spleen deficiency and phlegm-damp with 81, 14 cases of Yin and Yang deficiency with 38, 13 cases of Yin deficiency and heat-dryness with 37, 10 cases of damp-heat and Bi stagnation with 36, 8 cases of Qi and blood stagnation with 31. The patients with abnormal results from MCV had 823 (83.6%). Most of the patients with Yin deficiency and heat-dryness are normal in MCV, the abnormal rates in MCV of 4 nerves were significantly lower than the other syndromes (P<0.01), the MCV abnormal rates of the Qi and blood stagnation patients were the highest, and those of the damp-heat and Bi-stagnation patients were the second.In the 6 kinds of different syndromes, ML of the Qi and blood stagnation patients was the longest, that of the damp-heat and Bi stagnation patients was the second, and that of the Qi and Yin deficiency patients was the shortest. Conclusion The electrophysiological changes in the peripheral nerves of 2 type diabetic patients changed mostly in those with the syndrome of Qi and blood stagnation, and secondly in the cases of spleen deficiency with retention of phlegm and damp, and damp-heat Bi-stagnation. It proves that the patients with excessive syndromes are more prone to have electrophysiological changes in peripheral nerves than those with deficiency syndromes and their condition are more serious.