Correlation Study On TCM Syndrome Types And Their Influencing Factors In Type 2 Diabetic Retinopathy

Objective: To explore the correlation between different syndrome types and physical and chemical indicators and other influencing factors by sorting out and analyzing the distribution of TCM syndrome types,general information,fundus lesions and related physical and chemical indicators of patients with Type 2 diabetic retinopathy(T2DR).,and combined with the tutor’s clinical experience in treating diabetic retinopathy,analyze the clinical characteristics of the disease and the direction of syndrome differentiation and treatment,and provide a reference for the clinical diagnosis and treatment of T2 DR with traditional Chinese medicine.Methods: Using the retrospective research method,a total of 138 T2 DR patients who were admitted to the Department of Endocrinology and Ophthalmology of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from January 2020 to January 2022 were collected.The general data,four-diagnosis data,relevant physical and chemical indexes and fundus examination results of T2 DR patients were collected.According to the TCM diagnostic criteria for diabetic retinopathy in the "Guidelines for Clinical Evidence-Based Practice of Traditional Chinese Medicine in Diabetes(2016 Edition)" edited by Tong Xiaolin,syndrome differentiation was performed.All relevant data were entered into the computer,a database was established,and statistical description and analysis were carried out with the support of SPSS26.0.Results:1.The distribution of TCM syndrome types: 42 cases(30.4%)of deficiency of liver and kidney,dystrophy of eyes and collaterals,36 cases(26.1%)of syndrome of deficiency of qi and yin and stasis of collaterals and blood stasis,deficiency of yin and yang,blood stasis and phlegm coagulation There were 25 cases(18.1%)of the syndrome,20 cases(14.5%)of the syndrome of spleen dysfunction and dampness block,and 15 cases(10.9%)of the syndrome of deficiency of yin and fluid and endogenous dryness and heat.2.General information: The distribution of the course of diabetes,common comorbidities and complications among TCM syndrome types was statistically significant(P<0.05).(1)Diabetes course: Deficiency of yin and yang,blood stasis and phlegm coagulation syndrome is longer,and yin-jin deficiency and dryness-heat endogenous syndrome are shorter,and the disease course is positively correlated with yin-yang deficiency,blood stasis and phlegm coagulation syndrome,and is related to yin-jin deficiency,dryness and heat.Endogenous syndrome was negatively correlated(P<0.05).(2)Common comorbidities: the incidence of T2 DR comorbidities were hypertension in 74 cases(53.6%),old cerebral infarction in 47 cases(34.1%),and coronary heart disease in 31 cases(22.5%).Among them,T2 DR patients with hypertension were mainly distributed in the syndrome of deficiency of liver and kidney and dystrophy of eyes and collaterals(30cases,21.7%).(3)Common complications: The prevalence of diabetic complications in T2 DR patients was followed by diabetic lower extremity vascular disease in 92 cases(66.7%),diabetic peripheral neuropathy(DPN)in 86 cases(62.3%),and diabetic nephropathy(DN)in 45 cases(32.6%).Among them,diabetic lower extremity vascular disease had the highest prevalence of Qi-yin deficiency and collateral blood stasis syndrome(28 cases,20.3%);DPN had the highest prevalence of liver-kidney deficiency and eye and collateral dystrophy syndrome(31 cases,22.5%);DN had the highest prevalence of deficiency of both yin and yang,blood stasis and phlegm coagulation syndrome(17 cases,12.3%).3.Fundus examination and distribution of visual acuity: T2 DR TCM syndrome types and distribution of DR staging: Among T2 DR staging,T2DRⅠ stage is mainly distributed in qi-yin deficiency and collateral blood stasis syndrome(27 cases,19.6%),followed by yin Insufficient body fluid and endogenous syndrome of dryness and heat(11 cases,8.0%);T2DR stage II and III were mainly distributed in the syndrome of deficiency of liver and kidney and dystrophy of eyes and collaterals(14 cases,10.1%;12 cases,8.7%);T2DR stage IV was mainly distributed The syndrome of spleen dysfunction and dampness block(9 cases,6.5%),followed by liver and kidney deficiency,eye and collateral dystrophy syndrome(7 cases,5.1%);T2DR Ⅴ and Ⅵ are mainly distributed in yin and yang deficiency,blood stasis and phlegm coagulation syndrome(8 cases,5.8%;4 cases,2.9%).4.Physical and chemical indicators:(1)Glucose metabolism index: Fasting blood glucose(FBG)level,Qi and Yin deficiency,collaterals and blood stasis syndrome were significantly higher than those of spleen dysfunction and dampness block syndrome,and were positively correlated with FBG level,(P<0.01);fasting C-peptide(FCP)level,yin and yang deficiency,blood stasis and phlegm coagulation syndrome is lower than yin-jin deficiency,dryness and heat endogenous syndrome,qi and yin deficiency,collateral blood stasis syndrome,liver and kidney deficiency,eye and collateral dystrophy syndrome,and It was negatively correlated with FCP level(P<0.05).(2)Blood lipid metabolism index: triglyceride(TG)level,spleen dysfunction and dampness block syndrome were higher than liver and kidney deficiency,eye and collateral dystrophy syndrome(P<0.05);total cholesterol(TC)level,Spleen dysfunction,dampness stagnation,qi-yin deficiency and collateral stasis syndrome were higher than those of yin-jin deficiency and dryness-heat endogenous syndrome(P<0.05).Loss of healthy movement and dampness block syndrome were higher than those of deficiency of yin and fluid,endogenous dryness and heat,deficiency of liver and kidney,and dystrophy of eyes and collaterals(P<0.05).(3)Coagulation function index: fibrinogen(FIB)level,deficiency of both yin and yang,blood stasis and phlegm coagulation syndrome were significantly higher than the other 4 syndrome types,and were positively correlated with FIB level,(P<0.01);activated partial thromboplastin time(APTT)level,yin and yang deficiency,blood stasis and phlegm coagulation syndrome,qi and yin deficiency,collateral blood stasis syndrome were lower than those of spleen dysfunction and dampness block syndrome,(P<0.05);prothrombin time(PT)level,yin and yang deficiency,blood stasis and phlegm coagulation syndrome,qi and yin deficiency,collateral stasis syndrome were lower than those of yin and jin deficiency,dryness and heat endogenous syndrome,liver and kidney deficiency,eye and collateral dystrophy syndrome(P<0.05).Conclusion:1.The TCM syndromes of the 138 T2 DR patients in this study were the most common syndromes: deficiency of liver and kidney,dystrophy of eyes and collaterals,followed by deficiency of qi and yin,stasis of collaterals and blood stasis,deficiency of yin and yang,blood stasis and phlegm Congealing syndrome,spleen dysfunction,dampness block syndrome,deficiency of yin and fluid,dryness and heat endogenous syndrome.2.In this study,patients with deficiency of yin and yang,blood stasis and phlegm coagulation syndrome had a longer course of disease,while those with deficiency of yin and fluid and endogenous dryness and heat had a shorter course of disease.Patients with T2 DR combined with hypertension are mainly characterized by deficiency of liver and kidney and dystrophy of eyes and collaterals;patients with T2 DR combined with diabetes mellitus and lower extremity vascular disease are mainly characterized by deficiency of both qi and yin and blood stasis of collaterals;Dystrophy is the main syndrome;patients with DN are mainly due to deficiency of both yin and yang,blood stasis and phlegm coagulation.3.In this study,the fundus lesions were mainly characterized by deficiency of yin and fluid in the early stage,endogenous syndrome of dryness and heat,deficiency of both qi and yin,blood stasis and phlegm coagulation.The dampness block is the main syndrome,and the late stage is mainly due to deficiency of both yin and yang,blood stasis and phlegm coagulation.4.The increase of TC,TG and LDL-C levels in this study was mainly seen in the syndrome of spleen dysfunction and dampness block;the shortening of APTT and PT coagulation time and the increase of FIB level were mainly seen in deficiency of both yin and yang,blood and blood stasis.In the syndrome of blood stasis and phlegm coagulation.5.In this study,the level of FBG was positively correlated with deficiency of qi and yin,and the syndrome of blood stasis and blood stasis;the level of FCP was negatively correlated with deficiency of yin and yang,and blood stasis and phlegm;related.