| Objective:To explore the characteristics of tongue image in patients with type 2 diabetes mellitus(T2DM)of different courses,and analyze its correlation with various complications,blood glucose and laboratory indicators,so as to provide reference for the clinical application of tongue diagnosis with traditional Chinese medicine in the prevention and treatment of T2DM.Methods:Tongue images of 350 T2DM patients were collected using an intelligent tongue imager.Referring to the "Diagnostics of Traditional Chinese Medicine",the tongue features of all patients were divided into 19 dimensions,such as tongue spirit,red tongue,purple tongue,dark tongue,old and tender tongue,thin tongue,large tongue,tooth marks,cracks,moss peeling,tingling,ecchymosis,body fluid,yellow tongue,gray tongue,black tongue,rot tongue,thick tongue and greasy tongue.Two postgraduate students of TCM internal medicine led by senior TCM internal medicine experts who obtained the medical practitioner qualification certificate respectively scored the degree of tongue quality and coating quality characteristics of tongue pictures,such as tongue spirit,old and tender tongue,tongue thickness,tongue size,tooth marks,pringling,cracking,ecchymosis,moss peeling,body fluid,thick coating,greasy coating,etc.At the same time,the color characteristics of tongue color,such as tongue red,tongue dark,tongue purple,and tongue yellow,were measured by colorimetry RGB color mode.(Since the tongue images of T2DM patients included in this study basically did not show the three characteristics of moss rot,moss gray,and moss black,it was not considered in the quantification of tongue images).The general information,medical history,fasting blood glucose(FBG),2-hour postprandial blood glucose(2hPBG),fasting venous blood glucose(GLU),glycosylated hemoglobin(HbA1C),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),total cholesterol(TC),triglyceride(TG)were recorded(TG),lipoprotein(a)(LP(a)),glomerular filtration rate(GFR),blood Urea(Urea),uric acid(UA),creatinine(Cr),retinol binding protein(RBP),homocysteine(HCY)and other laboratory indicators.According to the course of disease,the patients were divided into grouPA with a course of less than 5 years,grouP B with a course of more than 5 years and less than 15 years,and grouP C with a course of more than 15 years.IBM SPSS software was used to process all the data and the tongue image characteristics and related factors of the three groups were analyzed.Results:(1)Characteristics of tongue quality and coating quality:there were significant differences in the scores of tongue spirit,old tenderness,pricking,thick coating and greasy coating among the three groups(P<0.05).The scores of tongue vigor and pricking in grouP C were lower than those in grouP A,and the scores of tongue tenderness,thick coating and greasy coating were higher than those in grouP A and grouP B.The tongue strength score of grouP C was lower than that of grouP B,and the tongue tenderness score was higher than that of grouP B(P<0.05).(2)Characteristics of tongue color and coating color:the differences of tongue G/R+G+B and coating B/R+G+B among the three groups were statistically significant(P<0.05).The tongue G/R+G+B value of grouP C was higher than that of grouP A,and the tongue B/R+G+B value of grouP B was lower than that of grouP A(P<0.05).(3)The correlation analysis of tongue characteristics in T2DM with different courses:①The correlation between tongue characteristics in T2DM patients with short courses:the tongue R+G+B was positively correlated with R+G+B of tongue coating(P<0.01),and negatively correlated with the score of coating stripping(P<0.01);R/R+G+B of tongue was positively correlated with the score of moss stripping(P<0.01),negatively correlated with R+G+B of tongue(P<0.01)and negatively correlated with B/R+G+B of tongue(P<0.01).The G/R+G+B of tongue was positively correlated with R+G+B of tongue(P<0.01),and negatively correlated with the score of moss stripping(P<0.01).The tongue strength score was negatively correlated with the tongue thickness score(P<0.01)and the tongue greasy score(P<0.05).The score of tenderness of tongue was positively correlated with the score of thickness of tongue(P<0.01)and greasy tongue(P<0.05).The score of tooth marks was positively correlated with the score of body fluid(P<0.05).The crack score was negatively correlated with B/R+G+B(P<0.01).② The correlation between tongue characteristics of T2DM patients in the middle course:the tongue R+G+B was positively correlated with R+G+B of tongue coating(P<0.01),and was positively correlated with B/R+G+B of tongue coating(P<0.01).And negatively correlated with the score of moss stripping(P<0.01).R/R+G+B of tongue was positively correlated with the score of moss stripping(P<0.01),negatively correlated with R+G+B of tongue(P<0.01)and negatively correlated with B/R+G+B of tongue(P<0.01).The G/R+G+B of tongue was positively correlated with R+G+B of tongue(P<0.05),and negatively correlated with the score of moss stripping(P<0.01).Tongue strength score was negatively correlated with tongue thickness score(P<0.05).The score of tenderness of tongue was positively correlated with the score of thickness of tongue(P<0.01)and greasy tongue(P<0.05).The score of tooth marks was negatively correlated with the score of moss stripping(P<0.05).The crack score was negatively correlated with the body fluid score(P<0.05).The ecchymosis score was positively correlated with the moss stripping score(P<0.05).③ The correlation between tongue characteristics in patients with long duration of T2DM:there was a positive correlation between tongue R+G+B and tongue R+G+B(P<0.01),and a positive correlation between tongue R+G+B and tongue B/R+G+B(P<0.01).And negatively correlated with the score of moss stripping(P<0.01).R/R+G+B of tongue was positively correlated with the score of moss stripping(P<0.01),negatively correlated with R+G+B of tongue(P<0.01)and negatively correlated with B/R+G+B of tongue(P<0.01).The G/R+G+B of tongue was positively correlated with R+G+B of tongue(P<0.05),and negatively correlated with the score of moss stripping(P<0.01).Tongue strength score was negatively correlated with tongue thickness score(P<0.05).The score of tenderness of tongue was positively correlated with the score of thickness of tongue(P<0.01)and greasy tongue(P<0.05).The score of tooth marks was negatively correlated with the score of moss stripping(P<0.05).The crack score was negatively correlated with the body fluid score(P<0.05).The ecchymosis score was positively correlated with the moss stripping score(P<0.05).4.Analysis of tongue features of complications of T2DM in different courses:①T2DM patients with Diabetic kidney disease(DKD)and without DKD only had significant differences in tongue and tooth marks scores in the middle course of the disease(P<0.05).Specifically,compared with T2DM patients without DKD,The tongue strength and tooth mark scores of T2DM patients with DKD in the middle course of the disease decreased.② There were significant differences between T2DM patients with Diabetic retinopathy(DR)and T2DM patients without DR In the short course of coating B/R+G+B and the middle course of tongue thin score and tongue G/R+G+B(P<0.05),specifically as follows:Compared with T2DM patients without DR,the B/R+G+B value of T2DM patients with DR Is higher.Compared with T2DM patients without DR,T2DM patients with DR Had higher tongue thinness score and greater tongue G/R+G+B value.③Only the body fluid score of T2DM patients with Diabetic peripheral neuropathy(DPN)was different from that of T2DM patients without DPN in the short course of disease,and the difference was statistically significant(P<0.05).The tongue and body fluid scores of T2DM patients with short course of disease combined with DPN are lower.④T2DM patients with Peripheral vascular disease(PVD)and T2DM patients without PVD only showed significant differences in the scores of tooth marks and cracks in the middle course of the disease(P<0.05).However,there was no significant difference in all tongue features in the long course of disease(P>0.05).Specifically,compared with T2DM patients without PVD in the middle course of the disease,T2DM patients with PVD in the middle course of the disease had smaller tooth mark scores and larger crack scores.(5)The correlation analysis of tongue appearance with BMI and laboratory indexes in T2DM with different courses:① In the short course group,tongue R/R+G+B was positively correlated with LP(a)(P<0.05);The tongue spirit score was positively correlated with GFR(P<0.01),and negatively correlated with Urea(P<0.01),Cr(P<0.05)and HCY(P<0.05).The score of tender tongue was positively correlated with Urea(P<0.05)and HCY(P<0.05),and negatively correlated with GFR(P<0.01).The tongue thinness score was negatively correlated with 2hPGB(P<0.05).The score of tooth marks was negatively correlated with HCY(P<0.05).The pricking score was positively correlated with RBP(P<0.05).The crack score was positively correlated with HCY(P<0.01)and negatively correlated with GFR(P<0.05).Ecchymosis was positively correlated with BMI(P<0.05),and negatively correlated with HbA1c(P<0.05)and TG(P<0.05).Body fluid score was positively correlated with Cr(P<0.05)and UA(P<0.05).The greasy fur score was negatively correlated with FBG(P<0.05).② In the middle course group,tongue R+G+B was negatively correlated with BMI(P<0.05).Tongue G/R+G+B was positively correlated with Urea(P<0.05)and negatively correlated with BMI(P<0.01).The tongue spirit score was positively correlated with GFR(P<0.01),and negatively correlated with Urea(P<0.01),Cr(P<0.01),and HCY(P<0.01).The score of tongue tenderness was positively correlated with Urea(P<0.05),Cr(P<0.05)and HCY(P<0.05),and negatively correlated with GLU(P<0.01)and GFR(P<0.01).The tongue thinness score was negatively correlated with RBP(P<0.05).The tongue size score was positively correlated with TC(P<0.05)and LDL(P<0.05).The tooth mark score was positively correlated with GFR(P<0.01),TP(P<0.01)and ALB(P<0.01),and negatively correlated with Urea(P<0.01)and Cr(P<0.05).The prick score was negatively correlated with LP(a)(P<0.05).The crack score was negatively correlated with GFR(P<0.05).Ecchymosis score was negatively correlated with BMI(P<0.05).The coating thickness score was positively correlated with FBG(P<0.05),TC(P<0.05),LDL(P<0.05)and LP(a)(P<0.05).The greasy fur score was positively correlated with FBG(P<0.05),TC(P<0.05)and LDL(P<0.01).③ In the long course group,the tongue R+G+B was negatively correlated with 2hPGB(P<0.01).Tongue G/R+G+B was positively correlated with Urea(P<0.05)and Cr(P<0.05),and negatively correlated with 2hPGB(P<0.05),HbA1(P<0.05)c and GFR(P<0.05).R+G+B was positively correlated with UA(P<0.05).B/R+G+B was positively correlated with TG(P<0.05).Tongue size score was positively correlated with HbAlc(P<0.05).The score of tooth marks was positively correlated with TP(P<0.05)and ALB(P<0.05).The pricking score was positively correlated with GFR(P<0.05)and negatively correlated with Cr(P<0.05).The crack score was positively correlated with LP(a)(P<0.05).Ecchymosis score was positively correlated with TP(P<0.05)and ALB(P<0.05).The moss stripping score was positively correlated with 2hPGB(P<0.01),negatively correlated with Cr(P<0.05)and negatively correlated with UA(P<0.05).Conclusion:(1)The tongue features of patients with T2DM were significantly different between those with short course of disease and those with long course of disease.Compared with the patients with short course of T2DM,the patients with long course of T2DM had lower tongue spirit score,less tongue prick,less purple tongue,older tongue texture,and more yellow,thick and greasy tongue coating.(2)In patients with medium and long course of T2DM,dark tongue was positively correlated with yellow fur,and ecchymosis was positively correlated with peeling of fur,indicating that the pathogenesis of blood stasis and heat and Yin injury often occurred at the same time in patients with medium and long course of T2DM.(3)Compared with the patients without PVD,the patients with PVD had smaller tooth mark score and larger tooth crack score.The pathogenesis of "fever" in middle course T2DM patients with PVD is more obvious than that in patients without PVD.(4)In patients with short and medium course of T2DM,the degree of tongue vitality and tongue tenderness is mainly affected by renal function,and the worse the renal function,the lower the tongue vitality score and the older the tongue.(5)The ecchymosis score of T2DM patients with short course was positively correlated with BMI,the degree of tongue dark in T2DM patients with medium course was positively correlated with BMI,but there was no correlation between the degree of tongue dark,ecchymosis and BMI in T2DM patients with long course,indicating that blood stasis is an important pathogenesis of overweight and obesity in T2DM patients.The degree of tongue dark is positively correlated with blood glucose level in T2DM patients with a long course of T2DM,indicating that the degree of tongue dark may be used as a reference index to reflect blood glucose control in T2DM patients with a long course of disease. |
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