Study On The Law Of Traditional Chinese Medicine Syndrome Elements In Different Stages Of Type 2 Diabetic Retinopathy

Objective: To analyze the law of TCM syndrome elements in different stages of Type 2 Diabetic Retinopathy and to discuss the related risk factors of DR progression,so as to provide some references for the treatment and prevention of DR based on TCM syndrome differentiation.Methods: Using cross-sectional survey method into Ⅰ ~ Ⅵ period,a total of 283 patients with type 2 diabetic retinopathy.The general data,syndrome and syndrome element data,biochemical indexes and complications of each stage were compared.Results: 1.Comparison of general data: the course of diabetes mellitus,BMI,SBP and DBP of the NPDR group were lower than those of the PDR group(P < 0.01 or P < 0.05).2.Comparison of complications: the prevalence of hypertension,coronary heart disease and peripheral neuropathy in the NPDR group was significantly lower than that in the PDR group(P < 0.01),and the prevalence of diabetic foot was lower than that in the PDR group(P < 0.05).3.Comparison of biochemical indexes: the levels of HbA1 c,LDL-C,TC,SCr,SUA and positive rate of urinary protein(PRO)in the NPDR group were all lower than those in the PDR group(P < 0.01 or P < 0.05).4.DR correlation factor analysis: the stage of DR was positively correlated with the course of diabetic disease,HbA1 c,LDL-C,TC,SUA,SCr,SBP and DBP(r=0.817,0.811,0.329,0.224,0.364,0.274,0.594,0.384,P < 0.01).5.Comparison of syndrome elements of disease position in DR: the main syndrome elements of disease position in NPDR group were liver,spleen and stomach,while those in PDR group were liver,kidney and spleen.Compared with the PDR group,the frequency of liver,kidney and heart in NPDR group decreased significantly,while the frequency of stomach was higher(P < 0.05).The frequency of liver in Ⅱ~Ⅵ stage was the highest.With the development of DR,the frequency of liver,kidney and heart presented an increasing trend.The frequency of liver in Ⅴ~Ⅵ stage was higher than that in Ⅰ stage(P < 0.005).The frequency of kidney was obviously higher than that in Ⅰ and Ⅱ stages(P < 0.005).The frequency of heart in Ⅴ~Ⅵ stage was obviously higher than that in Ⅰ~Ⅳ stage(P < 0.005).6.Comparison of syndrome elements of disease nature in DR: The main deficiency syndrome elements in NPDR group were Yin deficiency and qi deficiency,while the main positivism syndrome elements were heat and dampness.The main deficiency syndrome elements in PDR group were qi deficiency,blood deficiency and Yang deficiency,while the main positivism syndrome elements were phlegm and blood stasis.With the progress of DR,the frequency of deficiency syndrome elements such as qi deficiency,Yang deficiency,blood deficiency,essence deficiency,and qi instability gradually increased,while Yin deficiency and heat gradually decreased.The frequency of Yin deficiency and heat in the NPDR group was higher than that in the PDR group(P < 0.01),while that of qi deficiency,blood deficiency,Yang deficiency,essence deficiency,qi deficiency,phlegm,blood stasis,qi stagnation and cold syndrome elements in the NPDR group was lower than that in the NPDR group(P < 0.01 or P < 0.05).The frequency of yang deficiency,phlegm and blood stasis in Ⅲ~Ⅵ stage of DR increased significantly than that in Ⅰ stage,however the frequency of Yin deficiency significantly decreased(P < 0.005).Compared with the I and II stages,the frequency of blood deficiency in Ⅳ~Ⅵ stage was significantly higher(P < 0.005)and heat frequency was significantly lower(P < 0.005).Compared with Ⅱ stage,the frequency of Yang deficiency in stage Ⅲ,Qi instability in stage Ⅲ,hemopenia in stage Ⅳ and phlegm in Ⅲ~Ⅵ stage was significantly increased(P < 0.005).The frequency of blood deficiency in Ⅴ~Ⅵ stage was significantly higher than that in Ⅲ stage.Conclusion: 1.The course of disease,blood pressure,HbA1 c,SCr,SUA,TC and LDL-C of type 2 diabetes mellitus are in parallel correlation with DR staging and are risk factors for DR progression.2.The main syndrome elements of disease position in NPDR were liver,spleen and stomach,while those in PDR was liver,kidney and spleen.With the progression of NPDR to PDR,the frequency of liver,kidney and cardiomycin increased gradually,and the late stage increased obviously.3.Qi deficiency and Yin deficiency are the main deficiency syndrome elements of NPDR,while heat and humidity are the main positivism syndrome elements.Qi deficiency and Yin deficiency are the main deficiency syndrome elements in NPDR,while in PDR,they are qi deficiency,blood deficiency and Yang deficiency.Heat and dampness are the main positivism syndrome elements of NPDR,as phlegm and blood stasis as in PDR.The early deficiency syndrome elementsin DR are dominated by qi and Yin deficiency,while the positivism syndrome elements are dominated by dampness and heat.The Ⅲ stage is the transition phase of the development for DR syndrome elements.In this stage,Yang deficiency,phlegm and blood stasis become the main syndrome elements,and the frequency of qi stagnation and cold increases significantly,while that of Yin deficiency and heat decreases.In the late stage of DR,the disease is characterized by pathological state of mixed qi-blood-Yang deficiency,phlegmblood-stasis and dampness.