血尿酸水平在2型糖尿病阴虚热盛证型中的分布
【摘要】 目的 探讨2型糖尿病中医阴虚热盛证型患者的血尿酸水平分布规律,为中医证型客观化提供参考依据。方法 对49例西医已确诊为2型糖尿病,且进行中医辨证分型为阴虚热盛型患者,再按照是否兼湿证和兼瘀证而分为单纯型、兼湿型、兼瘀型、兼湿兼瘀型4组，检测血尿酸水平。结果 单纯阴虚热盛证型组，在血尿酸水平上高于阴虚热盛兼证组。差异均有显著性，P0.05；阴虚热盛兼湿、兼瘀、兼湿兼瘀三组之间两两比较，差异均无显著性，P0.05。结论 导致2型糖尿病阴虚热盛证型组血尿酸水平升高的原因可能在于“单纯阴虚热盛”组血尿酸水平的明显增高；湿和瘀可能都不是引起2型糖尿病阴虚热盛证型组血尿酸升高的原因。
Relationship between uric acid and the Yin deficiency and heat excess syndrome tape of traditional Chinese medicine in type two diabetes。
WANG Dong—yun,GONG Ying,WANG Kui—liang.TCM Hospital,Wulumuqi 830000,China。
【Abstract】 Objective To discuss elementarily the relationship between uric acid and the Yin deficiency and heat excess syndrome type of traditional Chinese medicine in type 2 diabetes mellitus （T2DM）,which provide objective index for differentiation of symptoms and signs in T2DM. Methods 49patients who were finally diagnosed as DM2 and Yin deficiency and heat excess syndrome（YDHES） were divided into the simple Yin deficiency and heat excess, the Yin deficiency and heat excess syndrome combined with wetness, the Yin deficiency and heat excess syndrome combined with blood stasis, the Yin deficiency and heat excess syndrome combined with wetness and blood stasis. The indexes of serum uric acid in each syndrome were tested. Results The simple Yin deficiency and heat excess syndrome was obviously higher than the Yin deficiency and heat excess syndrome combined with wetness syndrome on the blood level of the uric acid（P0.05）,and there was no statistical significance among the Yin deficiency and heat excess syndrome combined with wetness syndrome and with blood stasis syndrome and with both wetness and blood stasis syndromes（P0.05）. Conclusion The cause leading to increase serum uric acid of the Yin deficiency and heat excess syndrome in T2DM could be the high level of uric acid in the simple Yin deficiency and heat excess syndrome and the two facts both wetness and blood stasis couldn’t lead to increase the level of uric acid in the group of Yin deficiency and heat excess syndrome.
【Key words】 type 2 diabetes mellitus; uric acid; the Yin deficiency and heat excess syndrome; wetness syndrome; blood stasis syndrome。
近年来的研究发现,血尿酸水平对2型糖尿病及其并发症的影响越来越不容忽视。有学者认为阴虚热盛证型属2型糖尿病的早期阶段［1］,在2型糖尿病早期阶段,高胰岛素血症比较显著,胰岛素能促进肾脏对尿酸的重吸收,高胰岛素血症会使肾脏排泄尿酸减少,由此导致血尿酸增高［2］。
有学者认为,高尿酸血症与痰湿瘀浊有关［3］。我们希望通过对血尿酸水平在2型糖尿病阴虚热盛证型中的分布的研究,观察是否能得出同样结论,以指导临床实践。
1 对象与方法。
1.1 研究对象 本研究共收集49例病例,均来源于2006年2～12月期间在乌鲁木齐市中医医院内一科病房的已确诊为2型糖尿病的住院患者。
1.2.1 2型糖尿病诊断标准 采用1999年ADA公布的诊断标准［3］。
1.2.2 血尿酸增高的诊断标准 血清标本、尿酸酶法检查血尿酸水平, 420μmol/L （7.0mg/L）作为血尿酸增高标准［4］。
1.2.3 中医证候诊断标准 采用 2004年中国中西医结合学会糖尿病专业委员会［5］ 制订的证候诊断阴虚热盛型、兼湿证型、兼瘀证型分型标准。
1.2.4 排除标准 神志不清、痴呆、有精神疾病患者、不愿意合作者、痛风急性发作期者。
1.3 研究方法。
1.3.1 血尿酸测定 患者在禁食高嘌呤食物、避免剧烈运动及大量饮酒12h后,取清晨空腹静息状态下采肘前静脉血4ml,送检血尿酸,该指标采用日本Olympus AU400全自动生化仪进行检测。