A Clinical Study On The Characteristics Of Vascular Aging In Patients With Type 2 Diabetes Mellitus Complicated With Hypertension

1.ObjectivesThis study aims to investigate the clinical characteristics of vascular aging in patients with type 2 diabetes mellitus complicated with hypertension,and to study the clinical characteristics of vascular aging disease,TCM syndromes and correlation,so as to deepen the comprehensive understanding of vascular aging.This study will help enrich and improve the pathways and targets of Chinese medicine to prevent cardiovascular disease.2.MethodsThis study is a cross-sectional study.Through the expert questionnaire and literature research the preparation of type 2 diabetes with hypertension clinical survey scale,we collected in May 2016-April 2017 in Xiyuan Hospital endocrinology and cardiovascular hospitalization 107 cases of type 2 diabetes with hypertension in patients with clinical data,and built the clinical information database.The patients were divided into middle age group(45-59 years old)and elderly group(60-80 years old)according to their age,and 14 healthy people were collected as the control group.The general data of 107 patients were analyzed by frequency analysis,and the TCM syndromes and syndromes of diabetic patients with hypertension were analyzed by cluster analysis in order to discuss the clinical characteristics of TCM.Clinical analysis of western medicine in patients with type 2 diabetes mellitus complicated with hypertension by t-test,rank sum test and linear regression.Analysis of the correlation between TCM syndromes and vascular aging markers using one-way ANOVA and Logistic regression.3.Results:3.1 General analysis of subjectsAmong the 107 patients with type 2 diabetes mellitus complicated with hypertension,there were 45 males and 62 females;the youngest 45 years old,the largest 80 years old,the average age was 62.7 ± 9.2 years.There are 12 people ranked at hypertension Level 1,38 people ranked at hypertension Level 2,57 people ranked at hypertension Level 3.On blood lipid level,53 person at a normal level,25 person have a slight increase,and 29 people with hyperlipidemia.Among all 107 patients,there are 17 people with mild diabetes,46 were heavier and 44 were serious.41 people smoking,accounting for the total number of 38.32%,and 47 patients with early family history of cardiovascular disease,accounting for 43.93%of the total number of patients.The control group from the social recruitment of non-hypertensive non-diabetic healthy volunteers,a total of 14 people.The maximum age is 61 years and the minimum age is 45 years,with an average age of 50.2 ± 5.2 years.There are 8 males and 6 females.3.2 Clinical characteristics of vascular aging in patients with diabetes mellitus complicated with hypertension3.2.1 Differential analysis of clinical characteristics of vascular aging between different age groups and different genderCompared with the elderly group,the differences of FetuinA and PWV were obvious.The PWV of the middle-aged group was lower than that of the elderly group,and the FetuinA in the middle-aged group was higher than that in elderly group.There was no significant difference in vWF value between the middle age group and the elderly group,and there was no significant difference in vascular aging between different gender.3.2.2 Effects of underlying diseases and age on the clinical characteristics of vascular agingThough linear regression analysis ww can find out that PWV's regression equation is:Y = 1585.316 +64.129X1,and age(X1)is the main factor affecting PWV.The regression equation of FetuinA is:Y = 0.683 + 0.24X2 + 0.197X3,BMI(X2),hypertension classification(X3)is the main factor affecting FetuinA.The regression equation of vWF is:Y = 0.156 + 0.029X2 + 0.029X4,BMI(X2),hyperlipidemia grade(X4)is the main factor affecting vWF.3.3 Factor Analysis and Cluster Analysis of TCM Syndromes in Diabetic Patients with Hypertension3.3.1 Factor analysisWe collected through the clinical sample of the patient's symptoms,tongue,pulse as factors and ran factor analysis-principal component analysis to get 15 common factors.We chose the maximum variance method to rotate the original 15 common factors in the factor load matrix,and the rotation converges after 24 iterations.And then extracted the common factor load value>0.5 of the variables,so that each common factor can be obtained corresponding to the four Chinese medicine diagnosis information.According to the size of the load factor in the factor,we decided of each factor Chinese medicine four diagnostic information in the order.And combined with the other four Chinese medicine in this factor information,analysed of each factor may provide the disease information.Finally,we got 15 common factors which were represented Qi deficiency,blood stasis,excessive heat,phlegm,Yang hyperactivity,Yang deficiency,Yin deficiency,and the involved in the lesion were Liver,spleen,lung,kidney,stomach.3.3.2 Cluster analysisThe variables were clustered by the 15 common factors obtained in the previous text.And the method was the farthest element-Euclidean distance.The number of clusters is 6 relatively reasonable,we can initially determine the diabetes with hypertension in TCM syndrome differentiation.According to the size of the traditional Chinese medicine symptoms of the load factor and combined with traditional Chinese medicine clinical corresponding dialectical information,the basis of the syndrome differentiation can be determined initially.Eventually we got types of diabetes with hypertension syndromes of Chinese medicine are Inharmony of liver and spleen,Blood stasis,Yin deficiency and Yang hyperfunction,Diarrhea due to Yang Asthenia,Qi Yin deficiency,Liver spleen deficiency,six TCM Syndromes in total.3.4 Correlation analysis of TCM Syndrome Distribution Characteristics and vascular aging index in diabetic patients with hypertension3.4.1 Distribution of disease syndrome elements in diabetic patients with hypertension This study collected patients with diabetes mellitus complicated with hypertension a total of 39 common clinical symptoms,14 kind of tongue pictures,and 10 different kind of pulse condition.The patient's clinical symptoms are then entered into the excel form refer to the literature for descriptions of related symptoms.Referring to the standard of TCM syndrome differentiation,one possesses over 50%symptom of any syndrome elements is defined as "Positive".Statistical shows that in patients with type 2 diabetes mellitus and hypertension,"deficiency of yang" accounts for the largest proportion,reaching 55.2%.While "hyperactivity of liver-YANG" accounts for the smallest proportion,only reaching 33.3%.3.4.1.1 Distribution of syndrome elements in patients with diabetes mellitus and hypertensionStatistical analysis shows that in the patients group,the combination of two types of syndromes cover the most patients,a total of 29 people.While only 2 persons belong to the group of seven kinds of syndrome elements.3.4.1.2 Distribution of TCM syndrome elements in different age groups and different genderAs the age increases,the composition of the syndrome of the disease is also changing.The physiological characteristics of men and women are different,and there may also be differences in the distribution of disease syndromes.The main TCM syndrome elements of the middle-aged male group is "excessive heat",which accounts for 77.3%.The top three factors of the syndrome in middle-aged male group are:excessive heat(77.3%)>deficiency of Yang(68.2%)>deficiency of Yin(45.5%).The main symptom of the middle-aged female group is "phlegmatic",and the tops factors of the syndrome in middle-aged female group are:Phlegmatic(70.6%)>deficiency of Yin(58.8%)=deficiency of Qi(58.8%)>Blood stasis(52.9%).The main TCM syndrome elements of the elder male is "deficiency of Yang" and "excessive heat".The top three TCM syndrome elements in elder male group are:deficiency of Yang(56.5%)= excessive heat(56.5%)>phlegmatic(43.5%)>deficiency of Qi(34.8%)= excessive rising of liver-YANG(34.8%),and in the elder female group the arrangements are following:deficiency of Yang(51.2%)>phlegmatic(48.8%)=deficiency of Yin(48.8%)=deficiency of Qi(48.8%)>Blood stasis(46.5%).3.4.2 Relationship between syndrome elements and vascular agingIn order to explore the correlation between the corresponding syndrome elements and the vascular injury indexes and biochemical indexes,we analyzed 107 patients with diabetes and hypertension.First,a normal distribution test was carried out to find out the items that fit the normal distribution and then carried out the variance test.Items that do not conform to the normal distribution were tested by rank sum,and chose P which is less than or equal to 0.1 projects for further analysis.Significant difference was found between vWF and "Deficiency of Yang",triglyceride and "Deficiency of Yin";Very low density lipoprotein and "excessive heat".Then the Logistic regression analysis was carried out with age,FetuinA,vWF,TG,HDL,VLDL and PWV as covariates while heat,yin deficiency and yang deficiency as dependent variables.The dependent variables are assigned as follows:The syndrome element is assigned as:0-No,1-Yes;gender:1-Male,2-Female.The method is backward LR.It was found that in the regression equation of excessive heat,the OR value of the age is 0.941,the regression coefficient is 0.061,which Indicates a negative correlation between the age and the syndrome element "excessive heat".It means that older the patient is,the less likely it is to develop a syndrome of "excessive heat".In the regression equation of"Deficiency of Yang",the OR value of the age is 754.435,the regression coefficient is 6.626,which Indicates a positive correlation between the vWF value and the syndrome element "Deficiency of Yang".It means that with the increase of vWF,the risk of "Deficiency of Yang" is increased.3.5 Effects of diabetes mellitus and hypertension on vascular agingThe difference of PWV and FetuinA between the patients group and the healthy control group was obvious.Table 16 shows that the PWV in diabetic patients with hypertension is significantly higher than that in healthy controls,which shows that the degree of vascular aging is more obvious in diabetic patients with hypertension.While the FetuinA value of the healthy control group was higher than that of the patients group,which suggests that there may be abnormal calcium deposits in patients with diabetes and hypertension.4.Conclusion4.1 With the increase of age,the elasticity of vascular gradually get deteriorated,and the degree of aging gradually increased.The ectopic deposition of intravascular calcium in middle age group was lower than that in elderly group.High blood lipids can increase vascular endothelial injury,which leads to vascular aging increased.4.2 The TCM syndromes of diabetic patients with hypertension are following:Qi deficiency,Blood stasis,excessive heat,phlegmatic,YANG hyperactivity,Yang deficiency,Yin deficiency,and the involved in the lesion were Liver,spleen,lung,kidney,stomach.We got types of diabetes with hypertension syndromes of Chinese medicine are Inharmony of liver and spleen,Blood stasis,Yin deficiency and Yang hyperfunction,Diarrhea due to Yang Asthenia,Qi Yin deficiency,Liver spleen deficiency,six TCM Syndromes in total.4.3 The main TCM syndrome elements of the middle-aged male group is "excessive heat",and the main symptom of the middle-aged female group is "phlegmatic",The main TCM syndrome elements of the elder male is "deficiency of Yang" and "excessive heat",and for the the elder female,the main TCM syndrome elements is "deficiency of Yang".4.4 Hypertension with diabetes mellitus has a greater degree of vascular aging than healthy controls.