| Objective: To summarize the rules contained in the distribution of TCM syndrome types of insulin resistance patients with type 2 diabetes(T2DM);To analyze the risk factors affecting carotid intimal lesions in patients with this disease,study the effect of insulin resistance on carotid intima-media thickness(CIMT),enrich the content of integrated traditional Chinese and western medicine diagnosis and treatment of T2 DM insulin resistance,and early prevent and treat diabetes macroangiopathy.Method: 215 patients with T2 DM insulin resistance who met the standard were collected,recorded clinical symptoms,general data,glucose and lipid metabolism indicators,CIMT,etc.According to clinical symptoms,TCM syndrome differentiation and classification are carried out,TCM syndrome differentiation was performed according to clinical symptoms,and the clinical data database was established using SPSS software.Descriptive analysis,rank sum test,chi-square test and analysis of variance were used to analyze the differences and laws of clinical indicators in different syndrome groups;Logistic regression analysis and ROC curve were used to study the factors affecting carotid intimal lesions in T2 DM patients with insulin resistance.Results:1.TCM syndrome: The TCM symptoms of the patients included in this study are complex,and the symptoms of thirst(85.58%)are the most common;the main characteristics of tongue picture are red tongue(52.56%)and yellow tongue coating(27.44%);the rapid(62.79%)is the main characteristic in terms of pulse.2.Distribution of TCM syndrome types: 67 patients(31.2%)with phlegm(dampness)and heat accumulation syndrome>57 patients(26.5%)with Qi and Yin deficiency syndrome>52 patients(24.2%)with blood stasis and venation syndrome>22 patients(10.2%)with liver and stomach stagnation and heat syndrome>17 patients(7.9%)with Yin deficiency and heat excess syndrome.3.Correlation between TCM syndrome types and general data and clinical indicatorsGender and Age: There are 110 males and 105 females in this study.There is no significant difference between the gender of each syndrome type group.The average age was 58.51 years old.The age of patients in Qi and Yin deficiency syndrome group was significantly higher than that in the phlegm(dampness)and heat accumulation syndrome group and the liver and stomach stagnation and heat syndrome group(P<0.05).Smoking and drinking: There was no significant difference in the proportion of alcohol drinkers among all syndrome groups(P<0.05);The proportion of smoking in the phlegm(dampness)and heat accumulation syndrome group was significantly higher than that in the blood stasis vein group(P<0.05).The course of T2DM: The average course of disease was 6.82 years,and the course of disease in patients with Qi and Yin deficiency syndrome was significantly more than that in other syndrome groups(P<0.05),The course of disease in the liver and stomach stagnation and heat syndrome group was significantly less than that in the phlegm(dampness)and heat accumulation syndrome group(P<0.05).Body mass index(BMI): The average BMI of patients with phlegm(dampness)and heat accumulation syndrome is higher than that of the other four groups(P<0.05).The average BMI of the patients with liver and stomach stagnation and heat syndrome was lower than that of the other four groups(P<0.05).Glucose metabolism index: The levels of 2h PG,FINS,HOMA-IR and Hb A1 c in the phlegm(dampness)and heat accumulation syndrome group were significantly higher than those in the other 4 groups(P<0.05).The levels of FINS and HOMA-IR in Qi and Yin deficiency syndrome group were significantly higher than those in blood stasis and venation syndrome group,liver and stomach stagnation and heat syndrome,Yin deficiency and heat excess syndrome.The Hb A1 c level in the yin deficiency and heat excess syndrome group was significantly lower than that in the other 4 groups(P<0.05).Lipid metabolism index: The levels of TC and LDL-C in the phlegm(dampness)and heat accumulation syndrome group were significantly higher than those in the other 4 groups(P<0.05),The levels of TG in the phlegm(dampness)and heat accumulation syndrome group were significantly higher than those in the Qi and Yin deficiency syndrome group,liver and stomach stagnation and heat syndrome group,blood stasis and venation syndrome group(P<0.05).The level of TC in the group of liver and stomach stasis heat syndrome was significantly lower than that in the other 4 groups(P<0.05).CIMT:In this study,30.7%(66/215)of the patients with normal CIMT,38.1%(82/215)of the patients with thickening,and 31.2%(67/215)of the patients with carotid intimal plaque formation.The proportion of patients with normal CIMT in the phlegm(dampness)and heat accumulation syndrome group was significantly lower than that in the Qi and Yin deficiency syndrome group,the liver and stomach stagnation syndrome group and the yin deficiency and heat excess syndrome group(P<0.05).4.Analysis of related factors affecting carotid intimal lesions in T2 DM patients with insulin resistanceLogistic regression analysis showed that age(β=1.688),Smoking(β=1.614),Hb Alc(β=0.585),HOMA-IR(β=0.601),LDL-C(β=1.206)were risk factors for carotid intima lesion in T2 DM patients with insulin resistance.ROC curve showed that the HOMA-IR threshold for predicting carotid intimal lesions in T2 DM patients with insulin resistance was 7.04,the sensitivity was 0.718,and the specificity was 0.939.Conclusion:1.The TCM symptoms of the patients in this study are characterized by thirst,red tongue,yellow tongue coating and rapid pulse.The syndrome type of T2 DM insulin resistance accounts for the largest proportion of the phlegm(dampness)and heat accumulation syndrome group.Age,course of T2 DM,BMI、FPG、2h PG、FINS、Hb A1c、TC、TG、LDL-C are different in different TCM syndrome types,and clinical syndrome differentiation can be used for reference.2.The degree of insulin resistance of patients with phlegm(dampness)and heat accumulation syndrome group is significantly higher than that of other syndrome group.Different from the pathogenesis theory of traditional diabetes "Yin deficiency as the basis and dry heat as the symbol",the pathogenesis of "phlegm-dampness-heat" in T2 DM insulin resistance patients is more significant.Therefore,clinical treatment should grasp this difference,Using phlegm to eliminate turbidity,clearing heat and promoting blood.3.Age,Smoking,Hb Alc,HOMA-IR and LDL-C are risk factors for carotid intimal lesions in T2 DM patients with insulin resistance.HOMA-IR can be used to predict carotid intimal lesions in patients with 2DM insulin resistance,with a critical value of 7.04,sensitivity of 0.718,and specificity of 0.939.In clinical practice,we should actively control blood sugar,reduce blood fat,publicize smoking cessation and appropriate weight loss to prevent and treat cardiovascular complications of DM. |
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