| ObjectiveDiabetic Peripheral Neuropathy(DPN)was a common complication of diabetes,it can happen at any stage in diabetes,its pathogenesis was not clear with no specific treatment,and complex condition,repeated and protracted.A number of studies had shown that DPN combined with traditional Chinese and western medicine can effectively improve patients ’ symptoms and improve the quality,of life.The department of endocrinology,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,had formally formed a clinical pathway to cure DPN based on the differentiation and treatment of yin-yang and six-channels,and had achieved good efficacy.Therefore,the purpose of this study was to collect clinical data of type 2 diabetic peripheral neuropathy’conduct statistical analysis of data,and explore the distribution characteristics of six syndromes of type 2 diabetic peripheral neuropathy,and the correlation between different syndromes and clinical information such as clinical Toronto score(TCSS)and biochemical indicators.To investigate the correlation between TCSS and peripheral neuropathy in type 2 diabetes mellitus.It provided reference for the clinical differentiation and treatment of type 2 diabetic peripheral neuropathy through six channels and the breakthrough of treatment difficulties.MethodsThis study was divided into two parts,literature study and clinical study.Literature studied summarized DPN typing,pathogenesis,evaluation methods and treatment progress from the perspective of western medicine.From the point of view of traditional Chinese medicine,the etiology and pathogenesis,syndrome differentiation and classification,and characteristic treatment of traditional Chinese medicine were expounded.The clinical study collected 129 inpatients in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from April 2018 to February 2019 through investigation,refered to the clinical pathway of syndrome plus syndrome by identifying and treating yin-yang syndrome,which was the dominant disease in our hospital,the information collection table was set up to record the general information of patients,the data of six channels syndrome differentiation and classification,TCSS score,laboratory indicators and so on,establish database for statistical analysis.ResultsA total of 129 patients with type 2 diabetic peripheral neuropathy were included.Generally,the ratio of male to female was 0.9:1.The oldest was 83 and the youngest was 40.Patients under 44 years old accounted for 4.65%,those aged 45-59 years old accounted for 37.21%,and those aged over 60 years old accounted for 58.14%.Postmenopausal women accounted for 91.18%.The majority of the people was in Guangdong province and married.The duration of the disease was less than 5 years(21.71%),5-10 years(25.58%),and more than 10 years(52.71%).The family history of diabetes was 35.66%,the history of drinking was 15.5%,the history of smoking was 25.58%,and the regular use of hypoglycemic drugs was 47.29%.Hypertension and diabetic nephropathy accounted for 52.71%and 24.81%,respectively.The mean BMI of the patients was(23.4±3.57)kg/m2,the waist-to-hip ratio was(0.93±0.07),and the ratio of arterial ultrasonography sclerosis and atherosclerosis with plaques was 80.34%.Six-channel syndrome types,the proportion of each kind of this syndrome were:Shao Yin deficiency and cold dampness syndrome(26.36%),Cold dampness blocking Shao Yang meridians syndrome(19.38%),On the hot under cold,evil causes Jue Yin syndrome(17.05%),Tai Yin and Yang Ming the same disease-damp-heat blocking collaterals syndrome(15.5%),Wind cold and dampness block Tai Yang meridian syndrome(13.95%),Cold and dampness blockage of Jue Yin meridian syndrome(7.75%).TCSS classification:9-11 points(31.01%)accounted for the highest proportion,followed by 12-19 points(28.68%),6-8 points(25.58%),0-5 points(14.73%).In the TCSS project,the highest positive rate of neurological symptoms was numbness(89.15%),the highest positive rate of neural reflex was ankle reflex(90.7%),and the highest positive rate of sensory test was touch(68.22%).The six certificated TCSS scores were as follows from high to low:Cold and dampness blockage of Jue Yin meridian syndrome>Shao Yin deficiency and cold dampness syndrome>Tai Yin and Yang Ming the same disease-damp-heat blocking collaterals syndrome>On the hot under cold,evil causes Jue Yin syndrome>Cold dampness blocking Shao Yang meridians syndrome>Wind cold and dampness block Tai Yang meridian syndrome.In which the syndrome of Cold and dampness blockage of Jue Yin meridian syndrome had the highest score,and Wind cold and dampness block Tai Yang meridian syndrome had the lowest score.There were statistically significant differences in TCSS scores between different syndromes(P<0.05),Cold and dampness blockage of Jue Yin meridian syndrome,Tai Yin and Yang Ming the same disease-damp-heat blocking collaterals syndrome,Shao Yin deficiency and cold dampness syndrome,On the hot under cold,evil causes Jue Yin syndrome four type with Wind cold and dampness block Tai Yang meridian syndrome score difference was statistically significant(P<0.05).Cold and dampness blockage of Jue Yin meridian syndrome,Shao Yin deficiency and cold dampness syndrome and Cold dampness blocking Shao Yang meridians syndrome was statistically significant(P<0.05).Statistics showed that correlation between different syndromes and homocysteine,founded that On the hot under cold,evil causes Jue Yin syndrome and Cold dampness blocking Shao Yang meridians syndrome made the difference was statistically significant(P<0.05).The level of homocysteine in Jue Yin syndrome was significantly higher than that in Shao Yang meridian syndrome.Gender,age,course of the disease in different syndrome types distribution there was no significant difference(P>0.05),blood pressure,body mass index,blood sugar,C peptide levels and glycosylated hemoglobin,blood lipid,uric acid,urine trace albumin/creatinine ratio,24-hour urine protein quantitative and six-channel syndrome type distribution difference had no statistical significance(P>0.05).Age,duration,systolic blood pressure,creatinine,uric acid,homocysteine,blood sugar 2 hours after meal and TCSS score was significantly positive correlation(P<0.05),C peptide level 2 hours after meal,and estimated glomerular filtration rate was negatively related to the TCSS score was significantly(P<0.05),diastolic blood pressure,body mass index,waist-to-hip ratio,fasting glucose,fasting C peptide,urine trace albumin/creatinine ratio,24-hour urine protein quantitative and TCSS score had no significant correlation(P>0.05).Conclusion129 patients,the ratio of male and female nearly 1:1,the elderly population,abdominal obesity,and a certain genetic predisposition to diabetes.Type 2 diabetic peripheral neuropathy type ratio distribution:Shao Yin deficiency and cold dampness syndrome>Cold dampness blocking Shao Yang meridians syndrome>On the hot under cold,evil causes Jue Yin syndrome>Tai Yin and Yang Ming the same disease-damp-heat blocking collaterals syndrome>Wind cold and dampness block Tai Yang meridian syndrome>Cold and dampness blockage of Jue Yin meridian syndrome.In terms of TCSS score,the score of nerve damage of the three Yin meridians was higher than that of the three Yang meridians on the whole.The score of Cold and dampness blockage of Jue Yin meridian syndrome was the highest,while the score of Wind cold and dampness block Tai Yang meridian syndrome was the lowest,which conformed to the transmission law of the six meridians.Age,course of disease,systolic blood pressure,creatinine,uric acid,homocysteine,and 2-h postprandial blood glucose were may be risk factors for type 2 diabetic peripheral neuropathy.C-peptide level 2 hours after meal and estimated glomerular filtration rate were may be protective factors for type 2 diabetic peripheral neuropathy.The higher the estimated levels of C-peptide level 2 hours after meal and estimated glomerular filtration rate,the lower the degree of nerve damage in type 2 diabetic peripheral neuropathy. |
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