| Objectives By study the distribution characteristics of TCM syndrome elements and combination in patients with type 2 diabetes mellitus complicated with chronic heart failure,analyze the relationship between syndrome elements and related risk factors,to explore the distribution regularity of syndrome elements,basic pathogenesis,to provide certain theoretical basis and scientific guidance for rational and standardized clinical treatment based on syndrome differentiation.Methods A total of 551 cases of type 2 diabetes mellitus with chronic heart failure in outpatient and inpatient clinics were collected.Case information collection forms were filled out and clinical diagnosis and treatment information were collected.Syndromes were judged according to the total contribution of each syndrome to the relevant syndromes.The distribution of syndrome elements and syndrome elements combination was expressed by composition ratio or rate;the distribution of syndrome elements at all levels of cardiac function was compared by chi-square test;the relationship between related syndrome elements and clinical indicators such as age,course of diabetes,HbAlc,NT-proBNP,LVEF,blood lipid was analyzed by binary logistic regression model.According to the statistical results,the distribution characteristics,basic pathogenesis,related factors of TCM syndrome elements and syndrome elements combination of type 2 diabetes mellitus with chronic heart failure were discussed.Results 1 Distribution of syndrome elements in type 2 diabetes mellitus with chronic heart failure: qi deficiency(78.4%)and blood stasis(77.7%)were the most common nature syndrome element,followed by phlegm turbidity(64.1%)and yin deficiency(56.1%),thirdly as yang deficiency(35.8%)and retained fluid(24.9%),other syndrome elements were less common.Heart(91.3%)was the most common location syndrome element,followed by kidney(51.2%)and spleen(39.2%),thirdly as lung(22.9%)and liver(19.1%),other location syndrome elements were rare.2 Distribution of syndrome elements in type 2diabetes mellitus complicated with chronic heart failure:(1)The most common combination of syndrome elements of deficiency ben is based on two syndrome elements(42.6%)and one syndrome element combination(40.3%),followed by three syndrome elements combination(14.9%);the order of occurrence frequency > 10% is: qi-yin deficiency(32.3%)> qi deficiency(24.7%)> qi deficiency,yin deficiency and yang deficiency(12.7%)> yang deficiency(10.5%).(2)The most common combination of excessive biao is based on two syndrome elements(44.5%)and single syndrome element(34.7%)combination,followed by the combination of three syndrome elements(14.3%);the order of occurrence frequency > 10% was: phlegm and blood stasis(36.7%)> blood stasis(19.8%)> blood stasis,phlegm and retained fluid(14.3%)> phlegm and retained fluid(12.2%).(3)The combination of disease location syndrome elements is two syndromes and three syndromes is the most common,followed by single syndromes.The order of occurrence frequency > 10% is heart(17.6%),heart,spleen and kidney(13.6%),heart and spleen(13.4%)and heart and kidney(10.9%).3 Distribution characteristics of syndrome elements in type 2 diabetes mellitus patients with chronic heart failure at different levels of cardiac function classification: the frequency of qi deficiency in cardiac function grade 2 is high;blood stasis,phlegm were more common in cardiac function grade 3,and the disease location was more common in the heart and spleen.the frequency of blood stasis,yang deficiency and retained fluid in cardiac function grade 4 is higher,andthe disease location is more common in heart,spleen and kidney.the frequency of yang deficiency and retained fluid increased with the increase of cardiac function classification.4 The relationship between syndrome elements and related indexes in type 2 diabetes mellitus complicated with chronic heart failure:(1)The relationship between disease nature syndrome elements and related indexes: in patients with long course of diabetes mellitus,phlegm and retained fluid were common;yang deficiency and retained fluid were common in patients with increased BMI;yin deficiency and blood stasis were common in patients with increased HbAlc;phlegm and blood stasis were common in patients with hyperlipidemia;yang deficiency was common in elderly patients.(2)The relationship between disease location syndromes and related indexes: in patients with long course of diabetes mellitus and hyperlipidemia,the disease location was mostly in the spleen;in patients with elevated HbAlc and MAU,the disease location was mainly in the kidney;the disease location of elderly patients was more common in the heart.Conclusions 1 The distribution of TCM syndromes of type 2 diabetes mellitus complicated with chronic heart failure are deficiency ben and excessive biao.The deficiency ben is mainly qi deficiency and yin deficiency,supplemented with yang deficiency,while the excessive biao is mainly blood stasis and phlegm,supplemented with retained fluid.The pathological changes of the viscera are mainly in the heart,spleen and kidney.Qi deficiency was more common in cardiac function grade 2;blood stasis and phlegm were common in cardiac function grade 3,and the disease location was in the heart and spleen;blood stasis,phlegm,yang deficiency and retained fluid were common in cardiac function grade 4,disease location were in the heart,spleen and kidney.2 Basic pathogenesis is based on deficiency of both qi and yin,and phlegm and blood stasis are important pathogenic factors,heart is the key disease location,the deficiency of spleen and kidney affects the development of the disease.All factors are cause and effect,the mixture of deficiency and reality,and the combination of them,leading to the function of heart disorder or even decline.3 The course of diabetes mellitus in patients with type 2 diabetes mellitus complicated with chronic heart failure is positively correlated with phlegm,retained fluid and disease location in spleen;BMI is positively correlated with yang deficiency and retained fluid;HbA1c was positively correlated with yin deficiency,blood stasis and disease location in kidney;NT-proBNP is positively correlated with phlegm;blood lipid was positively correlated with phlegm,blood stasis and location in spleen;There is no correlation between gender,LVEF and the distribution of syndrome elements.Figure [8];Table [23];Reference [92]. |
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