Study On The Relationship Between Tcm Syndrome Differentiation And Cytokines(TNF-α、IL-10) In Type 2 Diabetes Mellitus With Anxiety And Depression

Objective: Based on TCM syndrome differentiation,this study studied the correlation between different TCM syndrome differentiation types of type 2 diabetes mellitus(T2DM)with anxiety and depression and cytokines(TNF-α,IL-10),analyzed and discussed the pathological nature and micro state of type 2 diabetes mellitus with anxiety and depression,so as to provide objective reference for clinical TCM syndrome differentiation.Methods:In this study,a case-control study was used to analyze the clinical data of 171T2 DM patients with anxiety and depression in the Department of Endocrinology,Henan Hospital of traditional Chinese Medicine from January 2019 to January 2020,and 50 healthy subjects from Henan Hospital of traditional Chinese Medicine in the same period were selected as the control group.The levels of serum TNF-α and IL-10 in the two groups were detected and compared by enzyme linked immunosorbent assay(Elisa).The study group finally included 16 cases of liver depression and qi stagnation syndrome,51 cases of liver-stomach heat syndrome,14 cases of yin deficiency syndrome,47 cases of qi-yin deficiency syndrome and 43 cases of phlegm and blood stasis syndrome.The basic conditions of patients of each syndrome type were recorded and analyzed:age,sex,course of disease,body mass index(BMI);laboratory index:fasting blood glucose(FBG),glycosylated hemoglobin(Hb A1c).Finally,multiple disordered Logistic regression was used to analyze the correlation between syndrome types and cytokines(TNF-α,IL-10).Results:1.The levels of TNF-α,HAMD and HAMA in T2 DM patients with anxiety and depression were higher than those in healthy subjects,while the level of IL-10 in patients with anxiety and depression was lower than that in healthy subjects.2.The distribution characteristics of syndrome types of T2 DM patients with anxiety and depression are as follows: stagnation of liver and stomach>deficiency of both qi and yin>combination of phlegm and blood stasis>stagnation of liver qi>heat of yin deficiency.The univariate analysis of each syndrome type was as follows:there were significant differences in sex,age,course of disease,BMI,FBG,diabetic peripheral angiopathy and diabetic peripheral neuropathy among syndrome types,and there were significant differences in HAMA and HAMD scores among different syndrome types.HAMA score was the highest in liver-stomach stagnation heat group and HAMD score in qi-yin deficiency group.The levels of TNF-α,IL-10 and the ratio of TNF-α/IL-10 were statistically significant among different syndrome types.TNF-α was the highest in the group of stagnant heat of liver and stomach,the lowest in the group of deficiency of both qi and yin,and the highest ratio of TNF-α/IL-10 in the group of deficiency of both qi and yin.The average value of TNF-α/IL-10 ratio was from high to low:deficiency of both qi and yin>stagnation of liver and stomach>heat of yin deficiency>stagnation of liver qi>phlegm and blood stasis.3.Multiple disordered Logistic regression analysis showed that the syndrome of stagnation of heat in liver and stomach was positively correlated with TNF-α and HAMA,and the syndrome of deficiency of both qi and yin was positively correlated with TNF-α and HAMD,but negatively correlated with IL-10.4.In T2 DM patients with anxiety and depression,TNF-α was positively correlated with FBG and Hb A1 c,IL-10 was positively correlated with HAMA score,negatively correlated with HAMD score,TNF-α/IL-10 ratio was positively correlated with Hb A1 c,negatively correlated with HAMA score,TNF-α was positively correlated with FBG and Hb A1 c in liver and stomach stagnation heat syndrome.In the syndrome of deficiency of both qi and yin,TNF-α was positively correlated with Hb A1 c and HAMD scores,IL-10 was positively correlated with HAMA scores,TNF-α/IL-10 ratio was positively correlated with Hb A1 c,and negatively correlated with HAMA scores.Conclusion:1.The most common TCM syndromes of T2 DM with anxiety and depression were stagnation of heat in liver and stomach and deficiency of both qi and yin.There was correlation between syndrome of stagnation of heat in liver and stomach and TNF-αand HAMA scores,and correlation between syndrome of deficiency of both qi and yin and scores of TNF-α,IL-10 and HAMD.In the syndrome of stagnation of heat in liver and stomach and deficiency of both qi and yin,there is a serious imbalance of TNF-α/IL-10,and the degree of anxiety and depression is more serious than that of other syndromes.In clinical treatment,we can strengthen opening depression and clearing heat,replenishing qi and nourishing yin to improve the disorder of cytokines and anxiety and depression.2.There are abnormal expressions of TNF-α and IL-10 in T2 DM patients with anxiety and depression,and the imbalance of TNF-α/IL-10 increases with the aggravation of anxiety and depression.Anxiety and depression may participate in the occurrence and development of type 2 diabetes by aggravating the imbalance of cytokines.