The Literature And Clinical Study On The Distribution Characteristics Of TCM Syndrome Elements In Type 2 Diabetic Macrovascular Disease

Objective: Under the guidance of the research theory of "dimension reduction and upgrading",explore the distribution characteristics of Traditional Chinese Medicine(TCM)syndrome elements of type 2 diabetes mellitus(T2DM)and its macrovascular diseases,generalize and summarize the key syndrome elements of occurrence,development and pathogenesis transformation of disease,and provide reference for clinical syndrome differentiation and treatment.Methods: 1.Literature research: This research uses data mining research methods.By searching the literature of diabetic macrovascular disease,it extracts the TCM four diagnostic data,syndrome elements,and syndrome target locations,and conducts data standardization and statistical analysis.To summarize the distribution characteristics of TCM syndrome elements in diabetic macrovascular disease.2.Clinical study: This study adopted a multi-center clinical research method,included 325 patients with diabetic macrovascular disease and 120 patients with T2 DM in 5 research centers.The general data,four diagnostic data,color Doppler ultrasound of carotid arteries and lower limbs vessels,laboratory examination(TC,TG,LDL-C,HDL-C,Cys-C,Hcy)and other information were collected for syndrome differentiation of TCM.Descriptive analysis,Spearman correlation analysis,logistic regression analysis and other methods were used to explore the distribution characteristics of TCM syndrome elements in different stages of diabetic macrovascular disease.Results: 1.Literature research:(1)Included 287 articles of T2 DM,48 articles of T2 DM macrovascular disease,the top ten high frequency symptoms of T2 DM are: thirst,fatigue,more drinks,polyuria,frequent urination,constipation,frequent hunger,weakness of waist and knees,dry throat,lack of Qi and no desire to speak;the top ten high frequency symptoms during macrovascular disease are: pain,weakness,thirst,palpitations,dizziness,limb numbness,constipation,short yellow urine,chills,cold limbs,dry throat.(2)The top four high frequency syndrome elements of T2 DM are Yin deficiency,Qi deficiency,solid heat,phlegm and dampness.The top four high frequency syndrome elements of diabetic macrovascular disease are Yin deficiency,blood stasis,Qi deficiency and phlegm dampness.(3)The top three targets of high frequency syndrome elements of T2 DM are kidney,spleen and stomach.The top three targets of high frequency syndrome of diabetic macrovascular disease are pulse,spleen and kidney.2.Clinical study:(1)General information: There was no significant difference in gender and BMI between the group of T2 DM and the group of its macrovascular disease(p>0.05).The mean age and duration of diabetes in the group of macrovascular disease were higher than that in the group of T2DM(p<0.01).After grading the severity of peripheral atherosclerosis and comparing,it shows that with the increase of age and course of disease,the severity of diabetic macrovascular disease increases gradually(p<0.05).(2)Analysis of TCM symptoms: the top ten high frequency symptoms in the group of T2 DM were: thirst,frequent urination,polydipsia,polyuria,weakness of waist and knees,weight loss,fatigue,forgetfulness,dreaminess,frequent hunger;The top ten high frequency symptoms in the group of macrovascular disease were: fatigue,forgetfulness,weakness of waist and knees,frequent urination,dreaminess,more drinks,short yellow urine,turbid urine,insomnia and thirst.(3)Analysis of TCM Syndrome Elements:(1)There was no significant difference in BMI and course of disease among the syndrome elements(p>0.05).The average age of blood stasis syndrome was the highest(p<0.05).There were differences in gender distribution between the excess heat syndrome and Yin deficiency syndrome(p<0.05).(2)The top two high-frequency syndrome elements in the two groups were Qi deficiency syndrome and Yin deficiency syndrome,with a frequency of more than 50%.The distribution of phlegm-dampness syndrome and blood-stasis syndrome was significantly higher in the group of macrovascular disease than in the group of T2DM(p<0.01).(3)Through further comparison of the distribution of syndrome elements of different grades of vascular lesions,there were significant differences in Qi deficiency syndrome,Yin deficiency syndrome,phlegm-dampness syndrome,blood stasis syndrome,and excess heat syndrome at all levels(p<0.01),and there was no significant difference in Yang deficiency syndrome,blood deficiency syndrome,Qi stagnation syndrome,and excess cold syndrome at all levels(p>0.05).Qi deficiency syndrome and Yin deficiency syndrome were the high-frequency syndrome elements from grades 0 to Ⅲ.Phlegm-dampness syndromes increased from grade 0 to grade Ⅳ with the progression of the disease,and the frequency of blood stasis syndromes was on the rise.(4)Analysis of clinical indicators:(1)There was no significant difference in TC and HDL-C in different grades of vascular disease(p>0.05).There were differences in LDLC,TG,Cys-C and Hcy among different grades(p<0.05),and Cys-C and Hcy gradually increased with the aggravation of the disease.(2)Though Spearman correlation analysis of syndrome elements with general information and clinical indicators,it was found that phlegm-dampness syndrome was related to the prevalence,grades,and Hcy level of diabetic macrovascular disease,and blood stasis syndrome was related to age,course of disease,and diabetic macrovascular and its grades.There was a correlation between the excess heat syndrome and the male gender,all of the above were statistically significant(p<0.05).(3)Logistic regression analysis was used to explore the risk syndrome factors of the degree of vascular injury.Phlegm-dampness syndrome and blood stasis syndrome were the risk factors of TCM syndrome factors in the occurrence of diabetic macrovascular disease,and the differences were statistically significant(p<0.05).Conclusion: In the process of diabetes progressing with macrovascular disease,Qi deficiency and Yin deficiency are the main pathogenesis throughout this disease;the symptoms of phlegm dampness and blood stasis in the early stages of disease have disappeared,and with the occurrence and development of macrovascular disease,the evil tendency has spread.There are complex symptoms and progressive damage to blood vessels.Phlegm dampness and stasis are the key pathological elements in the process of diabetic macrovascular disease.