【作者】 黄坤丹；

【导师】 张军；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 [目的]分析总结2型糖尿病合并冠心病患者中医证候特点,初步探索2型糖尿病合并冠心病中医辨证规律,为中医证候研究提供有益参考。[方法]调查2007年1月～2009年12月于北京医院中医科门诊及病房诊治的2型糖尿病合并冠心病患者的临床资料,对症状、体征、证候、冠状动脉造影／CT结果等进行统计分析,总结2型糖尿病合并冠心病患者的临床特点和中医证候分布特点。[结果]本组60例2型糖尿病合并冠心病患者年龄较大,以60岁以上老年患者为主,占78.3%,男女比例1.14：1；肥胖或超重者居多,分别占55.0%、11.7%；71.8%的男性患者有吸烟史。冠状动脉重度狭窄占68.3%,双支病变、三支病变分别占23.3%、65.0%。冠状动脉三支病变组年龄(70.53±8.88岁)最大,与单支病变组(60.29±10.42岁)比较具有统计学差异(P<0.05)。患者多合并高血压、血脂异常,分别占85.0%、80.0%,合并高血压或血脂异常患者的冠脉病变较不合并者严重,但未达到统计学差异。本组患者心血管系统症状不典型,40.00%及26.67%有胸闷、心悸,18.33%的患者有胸痛。中医辨证分型主证以气阴两虚为主,占81.6%,阴阳两虚证者冠状动脉三支病变、重度狭窄比率最大,气阴两虚证者次之,阴虚热盛证者比率最小,表现出从阴虚热盛到气阴两虚,再到阴阳两虚冠状动脉病变范围逐渐增大,病变程度逐渐加重的趋势,但未达统计学差异。兼证证型中,兼血瘀者最多(78.3%),其次为兼痰浊者(48.3%)；痰瘀互阻者17例,占28.33%,为复合兼证证型最多。兼证的比较中未显示出与冠脉病变的相关性。兼痰浊证组患者BMI最大(25.73±2.84kg／m2),与非痰浊证者相比,具有统计学差异(P<0.05)[结论]本组60例2型糖尿病合并冠心病患者年龄较大,肥胖或超重者居多,多合并高血压病、血脂异常,男性患者多有吸烟史。患者冠脉病变以双支、三支病变,重度病变为主。中医证型分析示2型糖尿病合并冠心病是本虚标实之证,本虚以气阴两虚为主,标实多为血瘀、痰浊,且多表现为痰瘀互阻。瘀血作为糖尿病的病理产物,在2型糖尿病合并冠心病的发展过程中具有重要的作用。在临床治疗时,应注意益气养阴,活血化瘀方法的使用。肥胖是糖尿病及冠心病的重要危险因素,痰浊与肥胖相关,化痰祛浊、控制体重,是治疗2型糖尿病合并冠心病的重要组成部分。更多还原

【Abstract】 Objective:explore the characteristics of traditional Chinese medicine syndromes of the Type 2 Diabetes Mellitus Patients with Coronary Heart Disease.Method:The 60 cases of Type 2 Diabetes Mellitus Patients with Coronary Heart Disease from Jan,2007 to Dec 2009 were systemically reviewed in this clinical tria. The symptoms, TCM Syndrome differentions, BMI, blood pressure, blood lipids, physical and chemical inspection were statistically analyzed, the clinical characteristics and the principle of TCM patterns changes in the Type 2 Diabetes Mellitus Patients with Coronary Heart was summarized.Result:Most of the Type 2 Diabetes Mellitus Patients with Coronary Heart Disease in this group are old persons,78.3% of them are older than 60 years old.The ratio of men to women was 1.14 to 1.The patients who were Obese or overweight were in the majority, accounting for 55.0% and 11.7%.71.8% of male patients are smokers. the Type 2 Diabetic Patients with Coronary Heart Disease are characteristic of diffuse coronary artery disease and narrow serious. Severe coronary artery stenosis accounting for 68.3%.double and triple vessel lesions accounting for 23.3% and 65.0%.Many patients with hypertension and dyslipidemia,accounting for 85.00% and 80.0%.Patients’symptoms of cardiovascular system were atypical.40.00% and 26.67% of patients feel chest tightness and palpitations,18.33% of patients feel Heartache.Qi-yin syndrome was the largest in deficiency syndromes, accounting for 81.6%.Patients who lack both yin and yang are characteristic of diffuse coronary artery disease and narrow serious.blood stasis was the largest in excess syndromes. accounting for 78.3%. blood-phlegm stasis accounting for 28.33%.patients combine with turbid phlegm obstructing have maximum BMI (25.73±2.84kg/m2)Conclusion:In this clinical trial, Most of the Type 2 Diabetes Mellitus Patients with Coronary Heart Disease are old persons, The patients who were obese or overweight were in the majority, Many patients with hypertension and dyslipidemia. The Type 2 Diabetes Mellitus combine with Coronary Heart Disease is disease with deficiency in the root and excess in the branch, the most syndromes of the Type 2 Diabetes Mellitus Patients with Coronary Heart Disease were qi and Yin Deficiency. Blood stasis as a pathological product of diabetes, played an important role in the process of development of the disease. We can include that, in the clinical treatment of the Type 2 Diabetes Mellitus Patients with Coronary Heart Disease, the methods of replenishing qi and nourishing yin,promoting blood circulation by removing stasis should be used properly. obesity are important risk factors for Diabetes and coronary heart disease.Phlegm and obesity are closely related. Removing the phlegm turbidity and Weight control are important parts of Treatment of the Type 2 Diabetes Mellitus combine with Coronary Heart Disease. We should make full use of the principle of preventing possible disease, in order to prevent the disease’s further development, and improve the quality of survival and life of patients.更多还原