Cluster Analysis-based Research On The Law Of Type2Diabetes Mellitus Syndrome

Object: To investigate the distribution regularities of traditional Chinese medicine(TCM) clinical syndrome types of type2diabetes mellitus(T2DM) and the main andsecondary symptoms of each syndrome type by using cluster analysis and principalcomponent analysis; to analyze the relationship between each syndrome type of T2DMand the related clinical detection index so as to provide objective basis for clinicalsyndrome differentiation.Methods: Based on the Inclusive Criteria,233cases of T2DM from both outpatientservice and hospital ward in TCM department and endocrinology department of airforce general hospital have been collected from June2013to December2013.Information of gender, age, personal history, major clinical manifestations, coatedtongue and pulse condition, physical examination of all the patients were recorded.Fourdiagnostic methods information was analyzed with frequency statistics method bySPSSl9.0statistical software, and54symptoms which≥10%were selected as variablesfor cluster analysis to generalize TCM syndromes for T2DM. The names of syndrometypes have been determined by two clinical experts with associate senior titles incombination with the professional knowledge.Principal component analysis has beenconducted for the symptoms, signs, tongue and pulse conditions of each syndrome type,and the contribution of each symptom to its syndrome can be obtained to find out themain and secondary symptoms of each syndrome type. Based on the results of clusteranalysis and principal component analysis, syndrome differentiation of233cases havebeen determined and distribution of each syndrome type has been analyzed. Varianceanalysis and rank sum test have been applied to discuss the relationship of each TCMsyndrome type of T2DM with age, history of diabetes, body mass index(BMI), fasting blood-glucose(FPG),2-hour postload plasma blood glucose(2hPG), glyeohemoglobinAlc(HbAlc), triglyceride(TG), total cholesterol(TC), low density lipoprotein-cholesterol(LDL-C), high density lipoprotein-cholesterol (HDL-C).Results:1. Frequency analysis for the four methods of diagnosis: symptoms were54whose frequency of T2DM patients≥10%, whose frequency more than50%werethirsty to drink more（59.7%）, mentally fatigued（59.2%）, numbness of limb（54.0%）,blurred vision（53.2%）、soreness and weakness of waist and knees（53.2%）, dry mouth（52.4%）、extreme chilliness（51.9%）, insomnia（50.2%）2.Cluster analysis results: four diagnostic methods information of233cases ofT2DM were clustered into five types by cluster analysis, including spleen-kidney qideficiency syndrome、syndrome of yin deficiency of liver and kidney、deficiency of Yinand excessive heat syndrome、deficiency of both vital energy and yin with phlegmretention syndrome、yang deficiency and blood stasis syndrome.3. Principal component analysis results:(1) Spleen-kidney qi deficiency syndrome: the main symptoms were mentallyfatigued, less eating and anorexia, breathe hard and laziness to speak, weak limbs,soreness and weakness of waist and knees; the secondary symptoms were palpitation,chest distress, fat body, dizziness, headache, less eating and anorexia, abdominalfullness and distention, small and weak pulse.(2) Syndrome of yin deficiency of liver and kidney: the main symptoms were dryeyes, pain in back and loin; the secondary symptoms were blurred vision, tinnitus,insomnia and dreaminess, night urination much, pale tongue and deep pulse.(3) Deficiency of Yin and excessive heat syndrome: the main symptoms werethirstily and desire for drinking, dry mouth, bitter taste, high frequency of urinating, redtongue, dry tongue with thin white fur; the secondary symptoms were large appetitewith rapid hungering, dry stool, light red tongue with yellow fur and stringy pulse.(4) Deficiency of both vital energy and yin with phlegm retention syndrome: themain symptoms were dysphoria in chestpalms-soles, night sweat, spontaneousperspiration, bulgy tongue with tooth prints, greasy fur, slippery pulse; the secondary symptoms were white and thick fur.(5) Yang deficiency and blood stasis syndrome: the main symptoms were lusterlesscomplexion, extreme chilliness, edema of lower limbs, foam in urine, pain of limbs,stabbing pain, dark purple lips; the secondary symptoms were scaly dry skin,discomforting evacuation, dark purple tongue with petechial.4. Distribution of T2DM syndromes: Based on the results of cluster analysis andprincipal component analysis, syndrome differentiation of233cases have beendetermined, and the results have shown that there were71cases of spleen-kidney qideficiency syndrome (30.5%) at most,49cases of yang deficiency and blood stasissyndrome (21.0%) were in the second place with45cases of deficiency of Yin andexcessive heat syndrome (19.3%),38cases of liver and kidney deficiency syndrome(16.3%),30cases of deficiency of both vital energy and yin with phlegm retentionsyndrome (12.9%).5. The relationship between each syndrome type and test indication of T2DM(1) Comparison of the age, diabetes history, BMI of T2DM: there were statisticallysignificant differences in diabetes history, age and BMI of each syndrome type (p＜0.05). Patients with deficiency of yin and excessive heat syndrome were younger thanthose with spleen-kidney qi deficiency syndrome, liver and kidney yin deficiencysyndrome and yang deficiency and blood stasis, and the differences were highlystatistically significant (p＜0.01); patients with yang deficiency and blood stasissyndrome were older than those with deficiency of Yin and excessive heat syndrome,and the differences were statistically significant(p＜0.05). Diabetes history of patientswith yang deficiency and blood stasis syndrome was higher than those of patients withdeficiency of Yin and excessive heat syndrome and deficiency of both vital energy andyin with phlegm retention syndrome, and the differences were statistically significant(p＜0.05). BMI of patients with deficiency of both vital energy and yin were obviouslyhigher than those of the patients with other syndrome types, and the differences werestatistically significant (p＜0.01).(2) Comparison of blood glucose indications of each syndrome type of T2DM: there were statistically significant differences in FPG,2hPG and HbAlc of each syndrometype (p＜0.01). FPG of patients with yang deficiency and blood stasis syndrome washigher than those of patients with spleen-kidney qi deficiency syndrome and liver andkidney yin deficiency syndrome, and the differences were statistically significant (p＜0.05); FPG of patients with deficiency of yin and excessive heat syndrome was higherthan that of patients with spleen-kidney qi deficiency syndrome, and the differenceswere statistically significant (p＜0.01).2hPG of patients with yang deficiency andblood stasis syndrome was higher than those of patients with spleen-kidney qideficiency syndrome, liver and kidney yin deficiency syndrome and deficiency of bothvital energy and yin syndrome, and the differences were statistically significant (p＜0.05);2hPG of patients with deficiency of yin and excessive heat syndrome was higherthan that of patients with spleen-kidney qi deficiency syndrome, liver and kidney yindeficiency syndrome, and the differences were statistically significant (p＜0.01). HbAlcof patients with yang deficiency and blood stasis syndrome was higher than those ofpatients with the other four syndrome types, and the differences were statisticallysignificant (p＜0.05), HbAlc of patients with deficiency of Yin and excessive heatsyndrome and deficiency of both vital energy and yin with phlegm retention syndromewere higher than those of patients with spleen-kidney qi deficiency syndrome and liverand kidney yin deficiency syndrome, and the differences were statistically significant (p＜0.01).(3) Comparison of lipid indexes of each syndrome type of T2DM: the differencesin TC, TG, LDL-C and HDL-C of each syndrome type were not significant(p＞0.05).Conclusion:1.The most common symptoms of T2DM are thirsty to drink more andmentally fatigued. Deficiency syndrome is the most in T2DM, excessive heat syndrome,dampness-phlegm syndrome, blood stasis syndrome and other accompanying symptomsare also seen; As the courses of disease increase, complication will increase andindividual symptoms tend to be more complicated.2. The results of cluster analysis show that, T2DM can be divided into fivesyndrome types, including syndrome of spleen-kidney qi deficiency, liver and kidney yin deficiency, deficiency of Yin and excessive heat syndrome, deficiency of both vitalenergy and yin with phlegm retention syndrome and yang deficiency and blood stasissyndrome, among which spleen-kidney deficiency syndrome is the most. Principalcomponent analysis was conducted for each syndrome type, and the main and secondarysymptoms of each syndrome type have been determined to provide objective basis forclinical syndrome differentiation.3.There are differences in age, medical history, BMI and blood glucose index withineach syndrome type and they are statistically significant. Patients with deficiency of Yinand excessive heat syndrome are younger than those with short medical history and highBMI; patients with yang deficiency and blood stasis syndrome are older than those withlong medical history and poor blood glucose control. BMI of patients with deficiency ofboth vital energy and yin syndrome are relatively high. Blood glucose indications ofpatients with yang deficiency and blood stasis syndrome are obviously higher than thoseof patients with other syndromes. The differences of blood lipid parameters within eachsyndrome type are not statistically significant.