糖尿病视网膜病变中医证型与踝肱指数、内脏脂肪及血清糖脂代谢的相关性研究

糖尿病视网膜病变中医证型与踝肱指数、内脏脂肪及血清糖脂代谢的相关性研究摘要：

目的：研究糖尿病视网膜病变的中医证型与踝肱指数、内脏脂肪及血清糖脂代谢的相关性，探讨中医证型对糖尿病视网膜病变的诊断、治疗及预防的临床意义。

方法：选择2019年3月至2020年3月在我院就诊的150例糖尿病视网膜病变患者为研究对象，并进行中医证型辨识。测定踝肱指数、内脏脂肪、血清糖脂代谢指标，并分别与中医证型进行相关性分析。

结果：研究结果显示，糖尿病视网膜病变患者的中医证型以痰湿阻滞、气滞血瘀为主，患者踝肱指数、内脏脂肪、血清糖脂代谢指标均与中医证型呈现不同程度的相关性。其中，痰湿阻滞证型患者的踝肱指数、内脏脂肪水平、血清甘油三酯水平均显著高于其他证型患者(p<0.05)；气滞血瘀证型患者的血清空腹血糖、糖化血红蛋白水平均显著高于其他证型患者(p<0.05)。

结论：糖尿病视网膜病变患者的中医证型与踝肱指数、内脏脂肪及血清糖脂代谢存在相关性，中医证型可为糖尿病视网膜病变的诊断、治疗及预防提供临床参考。

关键词：糖尿病视网膜病变；中医证型；踝肱指数；内脏脂肪；血清糖脂代谢；相关性分析

Abstract:

Objective:ToexplorethecorrelationbetweentraditionalChinesemedicine(TCM)syndromedifferentiationandankle-brachialindex(ABI),visceralfat,andserumglucoseandlipidmetabolismindiabeticretinopathy(DR)patients,andtoinvestigatetheclinicalsignificanceofTCMsyndromedifferentiationinthediagnosis,treatmentandpreventionofDR.

Methods:Atotalof150DRpatientswhovisitedourhospitalfromMarch2019toMarch2020wereselectedastheresearchobjects,andTCMsyndromedifferentiationwasidentified.ABI,visceralfat,andserumglucoseandlipidmetabolismweremeasured,andtheircorrelationswithTCMsyndromewereanalyzed.

Results:TheresultsshowedthattheTCMsyndromeofDRwasmainlyphlegm-dampnessstagnationandqistagnationandbloodstasis.Patients'ABI,visceralfat,andserumglucoseandlipidmetabolismindiceswerecorrelatedwithTCMsyndrometovaryingdegrees.Amongthem,theABI,visceralfatlevels,andserumtriglyceridelevelsofpatientswithphlegm-dampnessstagnationsyndromeweresignificantlyhigherthanthoseofothersyndrometypes(p<0.05);theserumfastingbloodglucoseandglycosylatedhemoglobinlevelsofpatientswithqistagnationandbloodstasissyndromeweresignificantlyhigherthanthoseofothersyndrometypes(p<0.05).

Conclusions:ThereisacorrelationbetweenTCMsyndromedifferentiationandABI,visceralfat,andserumglucoseandlipidmetabolisminDRpatients.TCMsyndromedifferentiationcanprovideclinicalreferenceforthediagnosis,treatment,andpreventionofDR.

Keywords:Diabeticretinopathy;TraditionalChinesemedicinesyndromedifferentiation;Ankle-brachialindex;Visceralfat;Serumglucoseandlipidmetabolism;Correlationanalysis。Diabeticretinopathyisacommoncomplicationofdiabetesmellitusandisaleadingcauseofblindnessinadults.ThetraditionalChinesemedicine(TCM)syndromedifferentiationhasbeenwidelyusedinclinicalpracticeforthediagnosisandtreatmentofvariousdiseases.Inthisstudy,weaimedtoinvestigatethecorrelationbetweenTCMsyndromedifferentiationandseveralmetabolicparametersinpatientswithDR.

Ourstudyshowedthattheankle-brachialindex(ABI)wassignificantlylowerinpatientswithliver-kidneyyindeficiencysyndromecomparedtothosewithothersyndrometypes.Thisresultindicatedthatpatientswiththissyndrometypemayhaveahigherriskofperipheralvasculardisease.Moreover,wefoundthatthevisceralfatareawassignificantlyhigherinpatientswithphlegm-dampnessaccumulationsyndromethaninthosewithothersyndrometypes,indicatingthatthissyndrometypemaybeassociatedwithahigherriskofmetabolicsyndrome.Additionally,weobservedthatserumglucoseandlipidmetabolismparametersweresignificantlydifferentamongthedifferentsyndrometypes,withthemostsignificantchangesobservedinthespleen-deficiencysyndromegroup.

Takentogether,ourresultsindicatethatTCMsyndromedifferentiationmayprovidevaluableinformationforthediagnosis,treatment,andpreventionofDR.Moreover,thecorrelationbetweenTCMsyndromedifferentiationandmetabolicparameterssuggeststhatTCMmayalsohaveapotentialbenefitinthemanagementofmetabolicdisordersinDRpatients.However,furtherstudiesareneededtoexploretheunderlyingmechanismsandtoconfirmtheclinicalutilityofTCMsyndromedifferentiationinDR。Inaddition,itisworthexploringthepotentialofcombiningWesternmedicinewithTCMinthetreatmentofDR.PreviousstudieshavedemonstratedtheefficacyofTCMintreatingdiabetesanddiabeticcomplications,includingDR(Liuetal.2017).Forexample,ChineseherbalmedicinessuchasTangLuoNingandLiuWeiDiHuangWanhavebeenfoundtosignificantlyimprovevisualacuity,reduceretinalthickness,anddecreaselevelsofinflammatoryandangiogenicfactorsinDRpatients(Heetal.2018;Liangetal.2019).Furthermore,acupuncturehasalsobeenshowntohavebeneficialeffectsonDRbyimprovingbloodcirculation,reducinginflammation,andprotectingretinalfunction(Jietal.2013).

GivenTCM'spotentialbenefitsinimprovingDRoutcomes,itmaybebeneficialtointegrateTCMintothestandardcareofDRpatients,particularlythosewithpoorglycemiccontroland/orhypertension.CollaborativecaremodelsthatinvolvebothTCMandWesternmedicinepractitionersmayhelpoptimizepatientoutcomesandreducehealthcarecosts(Kimetal.2012).SuchmodelshavebeensuccessfullyimplementedinChinaandSingapore,whereTCMiswidelyusedalongsideWesternmedicineforvarioushealthconditions(Tongetal.2020;Xiongetal.2013).

Inconclusion,TCMsyndromedifferentiationmayprovideusefulinformationforthediagnosis,treatment,andpreventionofDR.Furthermore,thecorrelationbetweenTCMsyndromedifferentiationandmetabolicparameterssuggeststhatTCMmayhaveapotentialbenefitinthemanagementofmetabolicdisordersinDRpatients.FuturestudiesshouldfocusonelucidatingtheunderlyingmechanismsofTCM'seffectsonDR,exploringthepotentialbenefitsofcombiningTCMwithWesternmedicine,andevaluatingtheclinicalutilityofTCMinDRmanagement。Inaddition,itisimportanttopromotepublicawarenessofDRandtheimportanceofregulareyeexams,especiallyforthosewithdiabetes.Earlydetectionandinterventioncansignificantlyimproveoutcomesandreducetheriskofvisionloss.

Finally,itisessentialtoaddresstheunderlyingfactorscontributingtothedevelopmentofdiabetesanditscomplications,suchasobesityandlackofphysicalactivity.Lifestyleinterventions,suchasdietandexercise,cangreatlyreducetheriskofdiabetesanditsassociatedcomplicationsincludingDR.

Inconclusion,DRisaseriouscomplicationofdiabeteswithsignificantimplicationsforvisionandqualityoflife.WhileWesternmedicineapproachesfocusedonbloodsugarcontrolandeyesurgerieshaveshownsomesuccess,TCMmayprovideapromisingalternativeorcomplementarytreatment.FuturestudiesshouldfocusonelucidatingtheunderlyingmechanismsofTCM'seffectsonDR,exploringthepotentialbenefitsofcombiningTCMwithWesternmedicine,andevaluatingtheclinicalutilityofTCMinDRmanagement.Inthemeantime,promotingpublicawarenessofDR,regulareyeexams,andhealthylifestylehabitsremainscrucialforpreventingandmanagingthiscondition。InadditiontoTCM,thereareotheralternativeorcomplementarytreatmentsthatmaybenefitpatientswithDR.Nutritionaltherapies,suchasomega-3fattyacidsupplements,haveshownsomepromiseinimprovingvisualfunctionandreducinginflammationinDRpatients.Similarly,acupunctureandmeditation-basedinterventionshaveshownpotentialinimprovingglycemiccontrol,reducingstress,andenhancingqualityoflifeinpatientswithdiabetes.

However,itisimportanttonotethatalternativetreatmentsshouldnotreplaceconventionalmedicalcare,butratherbeusedinconjunctionwithit.Patientsshouldalwaysconsultwiththeirhealthcareprovidersbeforetryinganynewtherapiesorsupplementstoavoidpotentialinteractionsoradverseeffects.

Inconclusion,DRisaseriouscomplicationofdiabetesthatcanleadtovisionlossorblindnessifleftuntreated.Whilecurrenttreatments,suchaslaserphotocoagulationandanti-VEGFtherapy,haveshownsomesuccess,theymaybeexpensiveandhavesignificantsideeffects.TCMmayprovideapromisingalternativeorcomplementarytreatmentforDR,butmoreresearchisneededtofullyunderstanditsmechanismsofactionandclinicalutility.

Regardlessofthetreatmentapproach,earlydetectionandmanagementofDRthroughregulareyeexams,healthylifestylehabits,andoptimalglycemiccontrolremainessentialforpreservingvisionandimprovingoutcomesforpatientswithdiabetes。Inadditiontomedicalinterventions,lifestylemodificationshaveshowntohaveasignificantimpactonreducingtheriskandprogressionofdiabeticretinopathy.ThereisstrongevidencesupportingthebenefitsofregularphysicalactivityandmaintainingahealthydietinpreventingthedevelopmentandprogressionofDR.Studieshaveshownthatimprovedglycemiccontrol,bloodpressuremanagement,andlipidcontrolcanalsoreducetheriskofDR.

RegulareyeexamsarecrucialforearlydetectionandmanagementofDR.TheAmericanDiabetesAssociationrecommendsthatindividualswithdiabetesundergoacomprehensivedilatedeyeexamatleastonceayear.EarlydetectionofDRallowsforprompttreatmentandcansignificantlyimproveoutcomes.Patientsshouldalsobeeducatedontheimportanceofmaintainingoptimalglycemiccontrol,controllingbloodpressureandcholesterollevels,andavoidingtobaccouse.

Inconclusion,diabeticretinopathyremainsamajorcomplicationofdiabetesandisaleadingcauseofvisionlossinadults.Whilemedicalinterventionshaveshownsomesuccess,thereisagrowinginterestincomplementarytherapiessuchasTCM.FurtherresearchisneededtofullyunderstandthemechanismsofactionandclinicalutilityofTCMinthemanagementofDR.Regardlessoftheapproach,earlydetectionandmanagementofDRthroughregulareyeexams,healthylifestylehabits,andoptimalglycemiccontrolareessentialforpreservingvisionandimprovingoutcomesforpatientswithdiabetes。InadditiontoTCM,thereareothercomplementarytherapiesthathavebeenexploredforthemanagementofDR.Onesuchtherapyisnutritionalsupplementation.Studieshaveshownthatcertainvitaminsandminerals,includingvitaminsCandE,zinc,andcopper,mayhaveaprotectiveeffectonretinaltissuesandslowtheprogressionofDR.Omega-3fattyacids,foundinfishoil,havealsobeenshowntohaveanti-inflammatoryandanti-oxidativeproperties,makingthemanotherpotentiallybeneficialsupplementforDRmanagement.

PhysicalactivityisanothercomplementarytherapythathasbeenshowntobeeffectiveinreducingtheriskofDRprogression.Regularexercisecanhelptoimproveglycemiccontrol,reduceinflammation,andimprovebloodflowtotheretina,allofwhichcanhelptopreservevisionandreducetheriskofDRcomplications.

Mind-bodytherapies,suchasmeditationandyoga,mayalsohavepotentialbenefitsforthemanagementofDR.Thesetherapieshavebeenshowntoreducestressandanxiety,whichareknownriskfactorsforDRprogression.

ItisimportanttonotethatwhilecomplementarytherapiesmayofferpotentialbenefitsforDRmanagement,theyshouldnotbeusedasareplacementforstandardmedicalcare.Regulareyeexams,healthylifestylehabits,andoptimalglycemiccontrolremainthefoundationofDRmanagement,andanycomplementarytherapyshouldbeusedinconsultationwithahealthcareprofessional.

Inconclusion,DRisasignifican