The Study On Quantizing Diagnostic Criteria Of Type 2 Diabetes (Heat Syndrome) Based On The Three Phase Syndrome Differentiation Theory Proposed By Professor YueRen Song

1.ObjectiveTo establish a classing and quantizing diagnostic criteria for Type 2 diabetes mellitus(T2DM)patients with heat syndrome,and explore the correlation between the laboratory indicators and the heat syndrome of T2 DM.2.MethodsSelecting candidate diagnostic indicators of the quantizing diagnostic criteria and related laboratory indicators with method of literature research and theoretical research,and establishing a clinical information questionnaire.According to the inclusion and exclusion criteria,we select 250 cases(200 cases as the reserch group,50 cases as the test group)from The Teaching Hospital of Chengdu University of TCM from November 2016 to November 2017.The cases in the reserch group were divided into the heat syndrome group and the non-heat syndrome group according to the Chinese medicine diagnostic criteria in this study,we selected factors related to the quantizing diagnostic criteria by comparising among the two groups.The factors were valued by conditional probability reforming method,the diagnostic threshold was established by maximum likelihood diserimination method,and the classification standard was established by quartile method,carried out retrospective test and prospective test by calculating the related evaluation indicators.Then we realized the automatic diagnosis about heat syndrome of T2 DM based on HTML.Finally we explored the correlation between the heat syndrome of T2 DM,the degree of heat syndrome and the laboratory indicators by statistical comparison method.3.Results(1)The reserch group was divided into the heat syndrome group(106 patients)and the non-heat group(94 patients),there is no statistical difference between the two groups in gender,age,course of the disease,family of the disease,body mass index(BMI),smoking history and types of complications(P>0.05).Statistical difference between the two groups were found in drinking history and the number of complications(P<0.05),The number of patients who drink too much in the heat syndrome group is more than the non-heat syndrome group,the number of patients who with multiple complications in the non-heat syndrome group is more than the heat syndrome group.(2)The classing and quantizing diagnostic criteria for T2 DM patients with heat syndrome is as follow:(1)element which are valued: thirst(7 points),bitter taste in mouth(2 points),halitosis(8 points),swelling and aching of gum(6 points),excessive drink(3 points),searing breath(5 points),copious sweat(3 points),genitals wet(5 points),dysphoria(8 points),polyphagia(4 points),dark urine(3 points),constipation(3 points),skin furuncle or ulcer(5 points),red tongue(17 points),yellow tongue fur(7 points),dry tongue fur(9 points),rapid pulse(6 points),smooth pulse(8 points);(2)the diagnostic threshold:37 points;(3)classing diagnostic criteria: slight heat syndrome(37-47 points),midrange heat syndrome(47-60 points),serious heat syndrome(over 60 points).(3)The retrospective test about the quantizing diagnostic criteria shows that: sensitivity 95.28%,specificity 95.74%,mistake diagnostic rate 4.26%,omission diagnostic rate 4.72%,diagnostic index 191.02%,Youden index 91.02%,available index 4.70%,odds product 453.66,positive predictive value 96.19%,negative predictive value 94.74%,crude agreement rate 95.50%,positive likelihood ratio 22.39,negative likelihood ratio 0.05.The prospective test shows that: sensitivity 96.30%,specificity 95.65%,mistake diagnostic rate 4.35%,omission diagnostic rate 3.70%,diagnostic index 191.95%,Youden index 91.95%,available index 4.70%,odds product 572.29,positive predictive value 96.30%,negative predictive value 95.65%,crude agreement rate 96.00%,positive likelihood ratio 22.15,negative likelihood ratio 0.04.(4)There is no statistical difference between the heat syndrome group and the non-heat syndrome group in FPG,2hPG,HbA1 c,TC,TG,HDL-C,LDL-C,BUA(P>0.05).The difference of the BUA level between the serious heat syndrome group and the light heat syndrome group,the serious heat syndrome group and the midrange heat syndrome group were statistically significant(P<0.05),average BUA level of the serious heat syndrome group is higher than the light heat syndrome group and the midrange heat syndrome group.4.Conclusion(1)Drinking too much is relevant to the formation of heat syndrome of T2 DM.The probability of developing multiple complication of the patients with heat syndrome are higher than non-heat syndrome,which is consistent with the development of pathogenesis of T2 DM.(2)Upon test,the sensitivity,specificity,diagnostic index,Youden index,odds product,positive predictive value,negative predictive value,crude agreement rate,positive likelihood ratio of the quantizing diagnostic criteria we established are quite high,while the mistake diagnostic rate,omission diagnostic rate,available index,negative likelihood ratio are low,confirmed that the diagnostic criteria is indeed valuable for clinical practicing.(3)The increased BUA level is related to the aggravated degree of heat syndrome,this positive correlation only exists in the patients with serious heat syndrome.