摘要
目的：研究糖尿病患者无症状性心肌缺血（ＳＭＩ）的发生率、相关因素及其中医辨证分型的特点。方法：用动态心电图（Ｈｏｌｔｅｒ）对３３４例无心绞痛病史和安静时心电图正常的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者进行检测；然后根据结果分为Ｈｏｌｔｅｒ正常组和Ｈｏｌｔｅｒ异常组。观察对比了各种相关因子的变化和相互关系，并观察临床中医辨证分型的特点。结果：ＳＭＩ检出率３４．１％（１１４例），２组间冠心病相关因子如吸烟、遗传、高血压、肥胖、甘油三酯、高密度脂蛋白胆固醇、血肌酐、乳酸脱氢酶比较差异无显著性（Ｐ＞０．０５）；而Ｈｏｌｔｅｒ异常组总胆固醇、蛋白尿均高于Ｈｏｌｔｅｒ正常组（Ｐ＜０．０５），同时，病程长于Ｈｏｌｔｅｒ正常组（Ｐ＜０．０５）。糖尿病合并视网膜病变的发生率Ｈｏｌｔｅｒ异常组（２２．８％）亦高于Ｈｏｌｔｅｒ正常组（１０．９％），Ｐ＜０．０５；患糖尿病的时间Ｈｏｌｔｅｒ异常组（９．６±２．４）年，Ｈｏｌｔｅｒ正常组（４．５±３．５）年，２组差异显著，Ｐ＜０．０５。结论：对糖尿病病史９年以上，伴有高脂血症、蛋白尿的患者，即使没有心绞痛症状，也应积极地进行Ｈｏｌｔｅｒ及其它心脏无创性检查，以便早期发现和治疗ＳＭＩ?
Objective:To investigate the incidence,related factors and TCM differentiationtyping characteristic of asymptomatic myocardial ischemia(SMI) in patients with diabetes.Methods:Three hundred and thirtyfour cases of noninsulindependent diabetes (NIDDM),that no angina pectoris history and ECG normal in silent condition,were examinated by dynamic ECG (Holter).Then,they were divided into Holter normal group and Holter abnormal group based on examination results.In addition,to observe and compare the changes of related factors and its relationship as well as the TCM differentiationtyping feature.Results:Incidences of SMI were 341% (114 cases),the relatedfactors as smoking,heredity,hypertension,fat,triglyceride(TG),high density lipoproteincholesterol (HDLC),blood creatintine.lactate dehydrogenase (LDH) were no obvious differences between 2 groups(P>005);while the level of total cholesterol(TC) and proteinuria in Holter abnormal group were higher than in Holter normal group (P<005);the disease course was longer in Holter abnormal group than that in Holter normal group (P<005).On the other hand,the incidences of diabetic retinopathy were 228% in Holter abnormal group,it was higher than that in Holter normal group (109%),P<005;the duration of diabetes were (96±24) years and (45±35) years in Holter abnormal and Holter normal group respectively,there was obvious difference between 2 groups (P<005).Conclusions:The patients with diabetes,who were over 9 years disease course and accompanied with hyperlipidemia and proteinuria,should be examinated the heart function by nontraumatic way and Holter in spite of no angina pectoris symptom.The chief type of TCM differentiationtyping in patients with diabetes complicated by SMI was Xinyang Buzhen and Tanzhuo Bisai types;but in simple diabetes patients were both Qi and Yin difficiency.There have obvious significance to use reasonably the Buyi Xinqi,Wentong Xinyang,Xingqi Huoxue ,Qushi Huatan ,Kaiyu Jiangzhi recipes for preventing and delaying the development of SMI.
基金
国家中医药管理局重点课题
关键词
糖尿病
心肌缺血
心电图
辨证分型
noninsulindependent diabetes\ \ asymptomatic myocardial ischemia\ \ Holter\ \ differentiationtyping
