| Object:1. To explore the clinical value and comprehensive judgment of the clinic al performance,fundus and related physical and chemical indicators for identificating blo-od stasis pathogenesis of diabetic retinopathy (DR),summing up basis and key points of comprehensive clinical differentiation for the DR blood stasis pathogenesis identification, in order to improve the clinical effect of diagnosis and treatment of DR.2. To investig-ate the scientific connotation of TCM theory such as the combination of "syndrome dif-ferentiation" and "disease differentiation"ã€"prolonged illness enters into venation"and its clinical application significance.Methods:A total of 93 patients in type 2 diabetes,who were referred to endocrin-ology DePartment of Chinese medicine hospital in Suzhou was studied.The patients wer-e divided into DR group and NDR group according to the western medicine diagnostic criteria.Collect the patients’TCM clinical syndrome of blood stasis syndrome,general data and physical and chemical inspection. Observe the relationship between what blood stasi-s of TCM clinical syndrome differentiation of DR can see,the course of the disease,and the physical and chemical indicators such as 3-DG,blood rheology,blood coagulation fu-nction indexes, blood glucose,blood lipid,C-reactive protein,blood pressure,trace elements, platelet parameters and DR.Result:1. The frequency of blood stasis symptoms below in DR group were high-er than the NDR grouprdark purple tongue,petechiae or ecchymosis on the body of the tongue,lingual vein varicose,oral color dark,complexion AnHei,eye week skin color dark, skin to a fault,fine collaterals,neck pain,stabbing pain of waist,subcutaneous ecchymosis,li-mb swelling,numbness,limb hemiplegia,depression,pulse string shibuya,pulse fine astringe-nt.The frequency of lip color dark,skin to a fault,subcutaneous ecchymosis,numbness,dark purple tongue,pulse string shibuya are significantly higher than NDR group, and the res-ults is statistically difference (P<0.01 or P<0.05).The frequency of headache,chest pain jo-int pain,visceral swelling,hemorrhoids,varicose veins of lower limbs,insomnia,pulse which was clavus and generation are higher in NDR group instead,but the results showe no s -tatistically difference(P>0.05).On the result of synthesis of blood stasis symptom of two groups,DR patients with higher incidence rate in blood stasis than NDR patients,but sh-ows no statistically difference(P>0.05).2.DR group compared with NDR group,levels of serum 3-DG,platelet maximum aggregation rate,plasma viscosity,blood plasma fibrinogen,e-rythrocyte aggregation index,D-dimer,HbA1c,total cholesterol,apolipoprotein B,the ratio of apolipoprotein B and apolipoprotein A,C-reactive protein,systolic blood pressure, pulse pressure difference,copper,ratio of copper and zinc are significantly increased,but the leve-1 of index of erythrocyte deformation,antithrombin â…¢ and trace element zinc is falling. The difference between the two groups present statistically significant(P<0.01 or P<0.05), suggesting the change of indicators metioned above are related to the occurrence of DR. The levels of low shear viscosity of whole blood,medium shear viscosity of whole bloo-d,high shear viscosity of whole blood,low shear reduct viscosity of whole blood,mediu-m shear reduct viscosity of whole blood,high shear reduct viscosity of whole blood,eryt-hrocyte sedimentation rate,rigid index of red blood cells,triglycerides,low density lipoprot-ein,diastolic blood pressure,and the level of platelet and platelet distribution width in DR group are also higher than NDR group,but shows no significant statistical differenc-e(P>0.05).3.DR group compared with NDR group,has longer duration,and with the incre-asing of the course of the disease,the incidence of DR will increase,the difference betw-een the two groups shows statistically significance(P<0.05).Blood stasis syndrome differ-entiation group compared with non-blood stasis group,the duration extended obviously,an-d as the growth of the course of the disease,the incidence of blood stasis will increase. The differences between the two groups showe obvious statistically significant(P<0.01).Conclution:1. Blood stasis is an important pathogenesis of DR,but the traditional four diagnostic differentiation method can not meet the full and accurate identification of DR pathogenesis of blood stasis,and therefore,comprehensive identify the DR pathoge-nesis of blood stasis,should be based on the traditional syndrome differentiation,and com-bines with relevant laboratory examination and what fundus can see.2.DR blood stasis pathogenesis of comprehensive identification key points include what metioned below:1) What the traditional syndrome differentiation can see:oral color dark,complexion AnHei,e-ye week skin color dark,skin to a fault,fine collaterals,neck pain,stabbing pain of waist, subcutaneous ecchymosis,limb swelling,numbness,limb hemiplegia,depression,dark purple t-ongue,petechiae or ecchymosis on the body of the tongue,lingual vein varicose,pulse str-ing shibuya,pulse fine acerbity;2)Laboratory indicatorsrserum 3-DQplatelet maximum agg-regation rate,blood plasma viscosity,plasma fibrinogen,erythrocyte aggregation index,eryth-rocyte deformation index,D-dimer,antithrombin III,HbAlc,total cholesterol,apolipoprotein B,apolipoprotein B/apolipoprotein A ratio,C-reactive protein,systolic blood pressure,pulse pressure difference,zinc,copper,copper and zinc ratio;3)The fundus examination.3.The cour-se of type 2 diabetes is closely related to the DR and blood stasis,and as the extensio-n of course,the incidence of DR and blood stasis are all also significantly elevating.It re-veales that DR is stubborn long illness,which is accord with the characteristics of "prol-onged illness enters into venation".Therefore,course of the disease can be used as one of DR identification of blood stasis pathogenesis diagnosis basis;and the theory of "prol-onged illness enters into venation" for DR TCM syndrome differentiation is of great cli-nical guiding significance. |
