【作者】 赖淑婷；

【导师】 朱章志；

【作者基本信息】 广州中医药大学 ， 中医临床基础， 2009， 博士

【摘要】 目的1、回顾性探讨糖尿病合并症状性脑梗塞的中医辨证特点、临床特点、危险因素,分析实验室检查结果及防治及预后。2、糖尿病合并无症状性脑梗塞(SCI)是目前临床上非常常见的一种疾病。虽没有明显的临床表现,但它是症状性脑梗塞的一种前兆,因此对此病的研究很有必要。3、探讨糖尿病合并脑梗塞的CT特点,CT梗塞灶部位与脑梗塞是否出现症状的相关系。4、糖尿病合并无症状性脑梗塞(SCI)不易被患者及医师注意到或忽略,易再继续发生脑梗塞,而不管是无症状性或是有症状性的,都能使患者的认知功能受到损害。因而预防进一步加重。5、探讨对糖尿病合并无症状脑梗塞防治与否和糖尿病合并症状性脑梗塞的转化的危险因素关系。6、探讨糖尿病合并症状性与无症状性脑梗塞的中医辨证特点,有利于重新认识症状与证型的形成机理,体现中医整体观念,发挥中医药治疗优势。方法本课题为探讨糖尿病合并脑梗塞的中医证候与危险因素回顾性病例对照研究。以年龄、性别、形体、饮食习惯、病程、临床症状、中医证型、实验室检查数据指标为主,调查250份糖尿病合并脑梗塞、2型糖尿病病案资料。应用方差分析、相关性分析等统计方法,验证形成糖尿病合并脑梗塞中医症候与危险因素的探讨。结果1、糖尿病合并症状性脑梗塞和糖尿病合并无症状性脑梗塞,二组在舌象、脉象、证型相结合分析,结果显示为气阴两虚,脉络瘀阻型为基本证型。2、糖尿病合并症状性脑梗塞与糖尿病合并无症状性脑梗塞,二者在实验室检查数据指数中,凝血、血脂、血糖、糖化血红蛋白、C-反应蛋白指标均高于正常值,结果显示这些数值均是导致脑梗塞的危险因素、病情轻重及预后的重要指标。3、糖尿病合并脑梗塞在CT特点上,以腔隙性多发性梗塞最多见。主要损伤部位为基底节、放射冠,多数还同时伴有脑萎缩。所以糖尿病合并脑梗塞临床上易出现肢体瘫痪程度较轻。4、糖尿病合并脑梗塞与糖尿病,二组在年龄、形体、病程上,这3种因素呈正相关性,P＜0.05。5、糖尿病合脑梗塞与糖尿病,二组在凝血、血脂、血糖、糖化血红蛋白、C-反应蛋白统计结果显示:二组在这些实验室检查数据指标上无显著的差异性,P＞0.05。结论1、糖尿病合并脑梗塞的危险因素很多,其中包括年龄、血高脂、高血糖、高血压、吸烟、饮酒等,这些危险因素对糖尿病合并脑梗塞的发生有一定的影响。2、在本课题观察研究中,从临床症状和舌脉象及实验室检查指标相结合探讨出糖尿病合并脑梗塞的基本证型为气阴两虚,脉络瘀阻型。对糖尿病合并脑梗塞在临床上的中医辨证有一定的指标意义。3、糖尿病患者在实验室检查中,以凝血指标升高、血脂异常、糖化血红蛋白指数升高、空腹血糖升高、C-反应蛋白升高等。这些指标异常提示了糖尿病患者易并发脑梗塞,而这些指标也为糖尿病并发脑梗塞的机制及病情轻重、预后等的临床重要指标。更多还原

【Abstract】 Objective1、The review discussion diabetes mellitus merge cerebral infarction’s Chinese medicine dialectical characteristic,the clinical characteristic,the hazard factor,analyze the laboratory check result and the prevention and the prognosis.2、Diabetes mellitus merge symptoms cerebral infarction and silent cerebral infarction(SCI) is on the present clinical very common one kind of disease.Although does not have the obvious clinical manifestation,but it is the symptom cerebral infarction’s one kind of omen,therefore has the necessity very much to this sickness’s research.3、The discussion diabetes mellitus merge cerebral infarction’s CT characteristic,CT blocks the stove spot and the cerebral infarction whether to have the symptom to relate.4、Diabetes merge symptomless cerebral infarction(SCI) not easily notes by the patient and doctor or neglects,continues to have the cerebral infarction again easily,no matter but is symptomless perhaps has the symptom, can cause patient’s cognition function to receive the harm.Therefore the prevention further aggravates.5、The discussion prevents and controls or not and diabetes merge symptom cerebral infarction’s transformation hazard factor relations to diabetes merge symptomless cerebral infarction.6、The discussion diabetes merge symptom and the symptomless cerebral infarction’s Chinese medicine dialectical characteristic,is advantageous to knew the symptom and the card formation mechanism,manifest the Chinese medicine concept of viewing the entire situation,the display Chinese medicine treatment superiority. MethodsThis topic compares the research for the discussion diabetes merge cerebral infarction’s with TCM Syndrome risk factors of retrospective case-control study.By the age,the sex,the physique,the food habit,the course,the clinical symptoms,the Chinese medicine card,the laboratory inspection data target primarily,investigate 250 diabetes merge cerebral infarction,type 2 diabetes mellitus medical record material.The application variance analysis,two items classify statistical methods and relevant analysis,the confirmation form diabetes merge cerebral infarction Chinese medicine symptom and the hazard factor discussion.Results1、Diabetes mellitus merge symptoms cerebral infarction and silent cerebral infarction(SCI),two groups in the pip,the pulse condition,the card joint analysis,demonstrated finally to be qi yin two empty,vein stasis anti- for basic card.2、Diabetes mellitus merge symptom cerebral infarction and the diabetes merge symptomless cerebral infarction,two in the laboratory inspection data index,the hemoglutination,the blood fats,the blood sugar,the saccharification hemoglobin,the C- response protein target are higher than the normal value,finally demonstrated that these values are cause cerebral infarction’s hazard factor,the condition weight and the prognosis important target.3、Diabetes merge cerebral infarction in the CT characteristic,blocks by cavity crack multiple most sees.The main damage spot for the basis festival, emits the crown,most also simultaneously is accompanied by the atrophy of brain.Therefore diabetes merge cerebral infarction on clinical easy to present the body paralysis degree to be light.4、Diabetes merge cerebral infarction and diabetes,two groups in age, physique,course,these 3 kind of factor present relevance,P＜0.05.5、Diabetes gather the cerebral infarction and diabetes,two groups in the hemoglutination,the blood fats,the blood sugar,the saccharification hemoglobin,the C- response protein statistical result demonstrated:Two groups in these laboratory inspection data target not remarkable difference, P＞0.05. Conclusion1、The diabetes merge cerebral infarction’s hazard factor are many, including the age,blood Gao Zhi,the hyperglycemia,hypertension,smoking, to drink wine and so on,these hazard factors have certain influence to diabetes merge cerebral infarction’s occurrence.2、In this topic observational study,unifies from the clinical symptoms and the tongue pulse condition and the laboratory inspection target discusses the diabetes merge cerebral infarction’s basic card to be mad cloudy two empty, vein stasis anti-.The Chinese medicine dialectical has certain target significance to diabetes merge cerebral infarction on clinical.3、The diabetic in the laboratory inspection,elevates,the blood fats by the hemoglutination target exceptionally,the saccharification hemoglobin index to elevate,the empty stomach blood sugar to elevate,the C- response protein to elevate and so on.These targets exceptionally have prompted the diabetic easy concurrent cerebral infarction,but these targets also for diabetes concurrent cerebral infarction’s mechanism and condition weight, prognosis and so on clinical important target.更多还原