TCM Syndrome Classification Of Type2 Diabetic Mellitus With Coronary Heart Disease Study

Type2 Diabetic Mellitus(DM) and Coronary Heart Disease(CHD) both belonged to metabolic disease,they had lots of common risk factors,such as hypertension,dyslipidemia,blood hypercoagulative state,hyperinsulinemia(HINS),obesity etc,which were just the same risk factors of atheroslerosis.Numerous reasearches showed that HINS was the "common soil" that could lead to series of metabolic diseases,like DM and CHD.The product effect of DM with CHD accelerated the progression of atherosclerosis.Therefore,Natinonal Cholesterol Education Program(NCEP) adult treatment third report(ATPⅢ) ranked DM as the equivalent risk of CHD.The morbidity of DM was growing at an annual rate of 30～40 million per year.Besides,more and more young people were suffering from it.With the increasing mortality,DM with CHD had been a serious threaten to modern human,both in quality and safety of life.Traditional Chinese medicine(TCM) had not proposed the name of the disease,but seperately dicoused symptoms and treatments in the following categories,for example XiaoKe,Obestrcution of Qi in chest,Angina pectoris and Heart-throb etc.After that,combined with modern reseach methods and clinical experience summary,latter traditional chinese medicine doctors put forward some new disease names,such as TangXin disease,XiaoXin disease,XiaoKe-Obestrcution of Qi in chest etc.At the same time the further pathogenesis had been realized.They considered that the main reasons were natural endowment insufficioncy,post-natal improper diet,excessive comfort and lack of exercise,plus the invasion of exogenous pathogenic factors,so called"borned with innate deficiency","acquied lost support".Moreover phlegmand and blood stasis were the main pathogenic products,which accelerated the disease progression.In clinical treatment,combination of disease differentiation and syndrome differentiation was the most important method, the former was premise,the latter was core.The hackneyed syndromes were Qi-Yin deficiency,Fire excess from Yin deficincy,Qi stagnation and blood stasis,phlegm dampness and blood stagnation,accumulation of cold and blood stasis,cardic-splenic insufficiency of Yang etc.As result of the less of nichetargeting research,the disease syndrome-classification hadn't got an unified standard,therefore the research of differentiation of symptoms for classification in Type2 DM with CHD had important significance.PurposeThe subject plans to carry on an exploratory research towards the differentiation of symptoms for classification in Type2 DM with CHD.MethodThis study collected the information of four examination methods of TCM and laboratory paramaters of 204 cases of T2DM with CHD patients.Then input the collected data into EpiData3.10 and set up database,which would be imput into Spssll.5 and analyzed statistically.The classification of TCM syndromes used cluster analysis system(Hierarchical Cluster)in the variable clustering method(Variables Cluster),combined with《4 Ministry of Health of the People 's Republic of China.Guiding principle of clinical research on new drugs. Part 3》and the experts' opinions to determine the representative symptoms of each type,then used the principal component analysis to extract cardinal symptoms,finally summed up TCM types.ResultsAfter clusting syndromes,Qi asthenia and phlegm-blood stagnation has 106 cases,about 52.0%,Qi-Yin insufficiency with blood-stasis has 40 cases,about 19.6%,Yang asthenia and blood stasis has 58 cases,about 28.4%.Qi asthenia and phlegm-blood stagnation is the most common type of syndrome,blood stasis go through the entire course of T2DM with CHD.Sex,age,course of the disease,number of coronary vessel stenosis and diabetic complications are not statistically significant among 3 types(P＞0.05).Coronary triple-vessel stenosis is common in coronary stenosis,which in Qi asthenia and phlegm-blood stagnation type is most obvious,but it is not statistically significant among 3 syndrome types(P＞0.05),maybe relate to the small sample size and the special disease pathogenesis.Body mass index(BMI) is statistically significant among 3 syndrome types(P＜0.05),which of Qi asthenia and phlegm-blood stagnation type is highest,Qi-Yin insufficiency with blood-stasis is lowest.Fasting plasma glucose(FPG),post-pranddial glycaemia(PPG) and glycolated hemoglabin(HbA1c) are all statistically significant among 3 syndrome types(P＜0.05),which of Qi-Yin insufficiency with blood-stasis type is highest.ConclusionThe frequent clinical syndromes of Type2 DM with CHD were classified into 3 types:Qi asthenia and phlegm-blood stagnation,Qi-Yin insufficiency with blood-stasis,Yang asthenia and blood stasis,in which Qi asthenia and phlegm-blood stagnation was the most common type.Blood stasis syndrome may carry over through the whole course of disease.Obesity is an obvious charecter of Qi asthenia and phlegm-blood stagnation type.The glycaemia level of Qi-Yin insufficiency with blood-stasis type was highest.