Study On The Distribution Of TCM Syndromes And Related Factors In Patients With Type 2 Diabetes Mellitus With Abnormal Carotid Artery Intima

Purpose:To investigate the distribution of TCM syndromes in patients with type 2 diabetes mellitus complicated with intimal abnormality of carotid artery and the correlation between intimal abnormality of carotid artery and visceral fat area.To analyze the correlation between different degrees of obesity and macroangiopathy in type 2 diabetes mellitus.Material and method:1.A total of 235 T2 DM inpatients were selected from September 2018 to June 2019 in the Endocrine Department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,and 200 inpatients were finally included.All subjects were divided into syndrome types according to "Guidelines for TCM Prevention and Treatment of Diabetes Mellitus" and the distribution of syndrome types were recorded.The basic data of patients were recorded by: age,gender,course of T2 DM,medical history of hypertension,smoking history and other general data.Detection indexes included Body Mass Index(BMI),Fasting Plasma Glucose(FPG),Hemoglobin A1C(Hb A1C),Triglyceride(TG),Total Cholesterol(CHOL),Low Density Lipoprotein(LDL-C),High Density Lipoprotein(HDL-C),Visceral Fat Area(VFA),Homocysteine(Hcy),Carotid Intima-media Thickness(c IMT),C-reactive Protein(CRP),Uric Acid(UA),Gamma-glutamyl Transpeptidase(GGT),Alanine Aminotransferase(ALT),Aspartate Transaminase(AST),etc.2.All subjects were divided into two groups according to carotid intima thickness,which respectively named normal c IMT group(c IMT<1.0 mm)and abnormal CIMT group(c IMT?1.0mm).The differences of basic conditions and related indexes between the two groups were compared;According to the diagnostic criteria of obesity and visceral adiposity in T2 DM patients in China,the subjects were divided into four groups:BMI<25kg/m~2 and VFA?100cm~2OB(-)VA(+)group;BMI?25kg/m~2 and VFA<100cm~2 OB(+)VA(-)group;BMI<25kg/m~2 and VFA<100cm~2OB(-)VA(-)group;BMI?25kg/m~2 and VFA?100cm~2OB(+)VA(+)groups.The differences of general conditions,biochemical and visceral fat indexes and c IMT abnormalities among the four groups were compared.Results:1.Distribution of TCM syndrome types: In c IMT abnormal group,the deficiency of both qi and yin and blood stasis syndrome(55.7%)were the main types,followed by the deficiency of both qi and yin(16.4%);Syndrome of phlegm-heat accumulation(14.8%);Yin deficiency of liver and kidney(13.1%);In normal c IMT group,deficiency of both qi and yin(52.6%)was the main syndrome,followed by deficiency of both liver and kidney yin(20.5%),phlegm-heat accumulation(14.1%),deficiency of both qi and yin and blood stasis(12.8%).2.The results of single factor analysis of clinical data of the two groups showed that 12 factors,including age,course of T2 DM,history of hypertension,Hb A1 C,CRP,UA,LDL-C,HDL-C,CHOL,TG,VFA,smoking history,had statistically significant effects on c IMT abnormalities(p<0.05).However,there was no significant difference in sex,FBG,BMI,GGT,ALT,AST between the two groups(P>0.05).3.Multivariate Logistic regression analysis indicated that the course of T2 DM,hypertension,LDL-C,VFA and smoking were the risk factors of c IMT abnormality(OR = 3.001,P = 0.014;OR=4.932,P=0.003;OR=1.552,P=0.035;OR=10.433,P=0.000;OR=2.744,P=0.020);However,HDL-C was the protective factor for cIMT abnormality(OR=0.037,P=0.001).4.The correlation analysis results of T2 DM patients with different obesity types revealed that there were significant differences in age,c IMT abnormality,T2 DM course,hypertension history,Hb A1 C,LDL-C,CHOL,TG and other 8 indexes among the four groups(p<0.05).Among them,the indexes of OB(-)VA(+)group patients were significantly higher than the other three groups in age,c IMT abnormality,hypertension history,CHOL and other 4 indexes,and the difference is statistically significant(p<0.05).Comparing with patients in OB(-)VA(+)group and OB(+)VA(+)group,LDL-C and TG levels had no significant difference,but they were higher than those in other two groups.Conclusions:1.The main syndrome type of T2 DM patients with abnormal c IMT is deficiency of both qi and yin and blood stasis,followed by deficiency of both qi and yin,phlegm-heat accumulation and liver-kidney yin deficiency respectively.2.The course of T2 DM,hypertension,LDL-C,VFA and smoking are the main risk factors for secondary c IMT abnormalities in T2 DM patients.HDL-C is the protective factor for c IMT abnormality.3.For T2 DM patients who are not obese and have increased VFA,the incidence of cIMT is obviously related to VFA.For such patients,we should strengthen management and pay close attention to the occurrence of macrovascular events.For non-obese T2 DM patients,we should pay close attention to the changes of VFA to prevent the occurrence of c IMT and macroangiopathy.