2型糖尿病合并冠心病患者舌象特征与中医症状分布规律研究

Tongue manifestations and traditional Chinese medicine symptom patterns in type 2 diabetes mellitus complicated with coronary heart disease

关键词:  2型糖尿病合并冠心病  舌象特征  中医症状  关联规则  聚类分析

Key words:  type 2 diabetes mellitus complicated with coronary heart disease  tongue manifestation  traditional Chinese medicine symptom pattern  association rule mining  cluster analysis

摘要:

[目的] 分析总结2型糖尿病合并冠状动脉粥样硬化性心脏病（冠心病）患者舌象特征与中医症状分布规律，为相关研究提供参考。[方法] 选取2021年1月—2023年12月就诊于天津中医药大学第二附属医院的2型糖尿病合并冠心病患者，应用TFDA-1型舌象仪采集舌象，由专家进行舌象判读并记录患者中医临床症状；运用Excel软件进行舌象和中医症状频数分析；采用SPSS Modeler 18.0、SPSS statistics 26.0软件对舌象和中医症状分布进行关联规则与聚类分析。[结果] 纳入2型糖尿病合并冠心病患者702例。舌象分布中，暗红舌常伴裂纹舌、黄苔、厚苔；红绛舌常伴裂纹舌、白苔、少苔；舌尖红常伴裂纹舌、黄苔、厚苔。出现频数位列前5位的中医临床症状为乏力、胸闷、口干、失眠、肢体麻木。舌象特征与中医症状关联规则的分析结果以少苔-乏力；暗红舌、瘀斑舌-乏力；少苔-口干多见。聚类分析共得到两个结果。[结论] 2型糖尿病合并冠心病主要病机为血瘀，患者的舌之瘀象最为明显；以血瘀证和气阴两虚证两类证型常见，多表现为乏力、胸闷、口干等中医临床症状，宜选用活血化瘀法或益气滋阴法辨证施治。

Abstract:

[Objective] To characterize tongue manifestations and traditional Chinese medicine（TCM） symptom patterns in patients by type 2 diabetes mellitus（T2DM） complicated with coronary heart disease（CHD）. [Methods] The study enrolled 702 T2DM-CHD patients from the Second Affiliated Hospital of Tianjin University of TCM（January 2021—December 2023）. Tongue images were acquired using TFDA-1 tongue diagnosis apparatus and interpreted by experts. Clinical symptoms were recorded. Frequency analysis was performed with Excel，while association rule mining and cluster analysis were conducted using SPSS Modeler 18.0 and SPSS Statistics 26.0. [Results] Tongue manifestations：dark red tongue frequently coexisted with fissured tongue，yellow-thick coating，crimson tongue often presented with fissured tongue，white-thin coating. Red tongue tip commonly correlated with fissured tongue，yellow-thick coating. Top 5 TCM symptoms：fatigue（86.3%），chest tightness（79.2%），dry mouth（74.6%），insomnia（68.9%）， limb numbness（62.4%）. Key associations：thin coatin-fatigue；dark red tongue/ecchymotic tongue-fatigue；thin coating-dry mouth. Cluster analysis identified two distinct patterns. [Conclusion] Blood stasis is the core pathogenesis，evidenced by characteristic tongue signs（e.g.，dark red/ecchymotic tongue）. Two major TCM patterns emerged：1）Blood stasis syndrome. 2）Qi-yin deficiency syndrome，predominantly manifesting as fatigue，chest tightness， and dry mouth. Therapeutic strategies should emphasize blood-activating stasis-resolving methods or qi-replenishing yin-nourishing approaches.