A Study On The Rule Of Syndrome Differentiation Of Type 2 Diabetes Combined With Hyperlipidaemia Based On The Objectified Tongue Manifestation

Objective: To study the objective diagnosis and rules of syndrome differentiation of type 2 diabetes combined with hyperlipidaemia,so as to provide objective diagnostic reference for the identification and treatment of type 2 diabetes combined with hyperlipidaemia.Methods: ⑴ Study of the syndrome elements of type 2 diabetes combined with hyperlipidaemia.In accordance with the inclusion and exclusion criteria of the literature,the patterns,the common symptoms,the common tongue manifestation and pulse of type 2diabetes combined with hyperlipidaemia were extracted and summarized from the literature,with reference to the principle of syndrome elements.⑵ Study of the objective characteristics of the tongue manifestation in type 2 diabetes combined with hyperlipidaemia.Patients with type 2 diabetes combined with hyperlipidaemia,hyperlipidaemia,type 2 diabetes,and healthy people were included and divided into four groups according to the corresponding diagnostic criteria.The patients’ digital tongue images were captured by the TFDA1 tongue image acquisition device,and the tongue parameters were extracted by the TDAS version 2.0 system to compare the differences in tongue objectification parameters between the groups.⑶ Study of the diagnostic parameters for the objectification of the tongue manifestation.The parameters of the Lab colour space were selected with reference to the characteristics of each colour space.Combining the results of the group’s previous Lab diagnostic criteria for common tongue manifestation,the Lab’s AUC(area under the curve)and the ratio of the number of negative and positive individuals were imported into the Empower Stats and the required sample size for the diagnostic test was calculated.Qualified digital tongue images were screened according to the sample size requirement,and by consensus of three experts,the tongue image was determined and compared with the results of tongue diagnosis objectification,and finally the tongue image parameters with diagnostic accuracy greater than80% were included as the tongue image objectification diagnostic parameters.⑷ To study the rules of syndrome differentiation of type 2 diabetes combined with hyperlipidaemia based on the objective diagnostic parameters of tongue manifestation.Patients with type 2 diabetes combined with hyperlipidaemia were included,and information on the four diagnoses was collected,as well as the results of the objective diagnosis of the tongue,which were combined with the previous study of the pattern elements to determine the content of the observed symptom entries.After processing the raw data,cluster analysis and Bayesian network analysis,combined with expert experience,were applied to derive the classification of type 2 diabetes combined with hyperlipidaemia.The differences in tongue texture parameters and glucolipid metabolic parameters were compared between the types,and the correlation between glucolipid metabolic parameters and tongue objectification parameters was analyzed.Result:⑴ The main disease locations of type 2 diabetes combined with hyperlipidaemia include the spleen,kidney,liver and stomach,and the syndrome elements are yin deficiency,qi deficiency,yang deficiency,blood stasis,phlegm,dampness,and heat.⑵ The objectified features of tongue manifestation of Type 2 diabetes combined with hyperlipidaemia: among the tongue colour parameters,the type 2 diabetes combined with hyperlipidaemia group was statistically different from the hyperlipidaemia group in R,G,B,g,I,S,L,a,Y,and Cb values;and from the healthy group in R,G,B,I,S,a,Y,Cr,and Cb values.The difference between the type 2 diabetic group and the healthy group was statistically significant only in g values.Among the tongue texture colour parameters,there were statistically significant differences in R,G,B,I,b,Y,Cb,and Cr values between the type 2 diabetes combined with hyperlipidaemia group and the hyperlipidaemia group;and in R,G,B,I,Y,a,and Cb values between the healthy group.Among the tongue coating parameters,there were statistical differences between the type 2 diabetes combined with hyperlipidaemia group and the hyperlipidaemia group,as well as between the healthy group in TC-CON,TC-ASM,TC-ENT,and TC-MEAN values;and between the healthy group only in per All values.⑶ According to the results of the diagnostic tests,the tongue objectified diagnostic parameters of type 2 diabetes combined with hyperlipidaemia were g-value,b-value and Cb-value.⑷ The patterns of the type 2 diabetes combined with hyperlipidaemia: Yin deficiency with phlegm-heat,Qi deficiency with phlegm-dampness,Yin deficiency with phlegm-dampness,Yin deficiency with phlegm-stasis,and Yin and Yang deficiency with phlegm-dampness.Among them,patients with Yin deficiency with phlegm-stasis were the majority.Comparison of the thickness of the tongue coating by patterns: Yin and Yang deficiency with phlegm-dampness < Yin deficiency with phlegm-heat <Yin deficiency with phlegm-stasis <Qi deficiency with phlegm-dampness <Yin deficiency with phlegm-dampness,with Yin deficiency with phlegm-dampness having the thickest tongue coating and the heaviest degree of phlegm-dampness.⑸ The correlation between glucolipid metabolism indicators and tongue manifestation objectification parameters: HDL cholesterol showed a positive correlation with tongue texture g and b values,and tongue coating b value(P < 0.01);a negative correlation with the tongue texture and coating Cb value value(P < 0.01).Triglycerides were negatively correlated with tongue texture and coating b value(P < 0.01);positively correlated with tongue texture and coating Cb value(P < 0.01);Cholesterol showed a negative correlation with the R value of the tongue(P < 0.05).Conclusion:⑴ The main disease locations of type 2 diabetes combined with hyperlipidaemia include the spleen,kidney,liver and stomach,and the syndrome elements are yin deficiency,qi deficiency,yang deficiency,blood stasis,phlegm,dampness,and heat.⑵ Type 2 diabetes combined with hyperlipidaemia is characterized with a greater incidence of red,cyanotic,and Pale white and more yellow,greasier thicker tongue coating.⑶ The patterns of type 2 diabetes combined with hyperlipidaemia: Yin deficiency with phlegm-heat,Qi deficiency with phlegm-dampness,Yin deficiency with phlegm-dampness,Yin deficiency with phlegm-stasis,and Yin and Yang deficiency with phlegm-dampness.The patterns are characterized by yin deficiency as the root combined with phlegm-dampness and blood stasis.⑷ The greater the thickness index of the tongue,the thicker the tongue,the greater the degree of phlegm and dampness,which is in accordance with the clinical practice and suggests that the method of objective tongue diagnosis is feasible.⑸ Glucose and lipid metabolism indicators correlate with tongue manifestation objectification parameters,which is of reference value for the prevention and treatment of hyperlipidaemia in combination with type 2 diabetes.