主 办:北 京 中 医 药 大 学
ISSN 1006-2157 CN 11-3574/R

北京中医药大学学报 ›› 2020, Vol. 43 ›› Issue (10): 849-858.doi: 10.3969/j.issn.1006-2157.2020.10.009

• 临床研究 • 上一篇    下一篇

3 211例代谢综合征患者中医舌象特征多中心研究*

朱晓云1, 汤阳2, 朱莉莉2, 冯磊3, 刘喜明1#   

  1. 1 中国中医科学院广安门医院 北京 100053;
    2 北京中医药大学;3 中国中医科学院
  • 收稿日期:2019-12-05 出版日期:2020-10-30 发布日期:2020-11-04
  • 通讯作者: #刘喜明,男,博士,教授,主任医师,博士生导师,主要研究方向:中医药防治内分泌和代谢性疾病的临床与基础研究,E-mail:lxmhos@aliyun.com
  • 作者简介:朱晓云,女,助理研究员
  • 基金资助:
    *国家科技重大专项项目(No.2011ZX09102-011-08),国家科技支撑计划项目(No.2009BAI80B04),国家自然科学基金项目(No.81804085)

TCM analysis of tongue characteristics in 3,211 patients with metabolic syndrome based on multicenter database*

Zhu Xiaoyun1, Tang Yang2, Zhu Lili2, Feng Lei3, Liu Ximing1#   

  1. 1 Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China;
    2 Beijing University of Chinese Medicine, Beijing 100029, China;
    3 China Academy of Chinese Medical Sciences, Beijing 100700, China
  • Received:2019-12-05 Online:2020-10-30 Published:2020-11-04
  • Contact: Prof. Liu Ximing, Ph.D., Chief Physician, Doctoral Supervisor. Guang’anmen Hospital, China Academy of Chinese Medical Sciences. No. 5 Beixian’ge Street, Xicheng District, Beijing 100053. E-mail: lxmhos@aliyun.com
  • Supported by:
    National Science and Technology Major Projects (No. 2011ZX09102-011-08); National Science and Technology Support Program (No. 2009BAI80B04); National Natural Science Foundation of China (No. 81804085)

摘要: 目的 分析代谢综合征(Metabolic Syndrome, MS)患者的舌象特征,为研究中医舌象辨证与人体生物学基础的联系提供证据与支撑。方法 通过MS临床流行病学调查数据库提取患者舌象资料及理化数据,SPSS17.0软件对数据进行描述性统计分析以及Logistic回归分析。结果 共纳入3 211例MS患者,男女构成比1.06∶1,其中血脂、血压、血糖均异常者最多,占32.70%(1 050例);其次为血脂伴血压不伴血糖异常者,占31.45%(1 010例);血糖伴血压不伴血脂异常者占22.39%(719例);多在40~69岁,平均年龄(53.86±10.33)岁,男性年龄分布较女性前移;异常舌形以胖大舌(32.4%)、裂纹舌(14.2%)、齿痕舌(11.0%)出现的频率最高;舌色以红舌(38.2%)出现的频率最高,其次是淡白舌(17.0%)、淡紫舌(15.1%),舌下络脉青紫曲张出现频率亦较高(14.4%);苔色以黄苔和白苔为主,分别占53.9%和46.0%;苔质以薄苔(37.6%)和腻苔(36.8%)出现频率最高,其次是厚苔(25.4%)。Logistic回归分析发现血压升高与舌形胖大、舌色红绛、舌有瘀斑/点、舌下络脉青紫曲张、舌苔薄等具有显著相关性;血脂异常与舌色淡紫、舌下络脉青紫曲张、舌苔腻、舌苔厚、舌苔水滑有显著相关性;空腹血糖升高与舌色淡白正相关,与舌下络脉青紫曲张、舌苔润、舌苔水滑负相关。同时,舌象变化与理化指标间存在密切联系,舌色加深、舌有瘀斑及舌下络脉青紫曲张与血液黏稠度显著增高有关。结论 不同类型MS患者的舌象各有特点,以实证多见,均存在着不同程度舌色加深、瘀斑及舌下络脉青紫曲张等血瘀表现。MS患者舌象与疾病因子、理化指标及血流变之间存在一致性与相关性,是MS多种因素联合作用的反映,可为MS的临床诊疗提供客观化依据。

关键词: 代谢综合征, 流行病学, 舌象特征, 中医病机

Abstract: Objective To analyze the characteristics of tongue in patients with metabolic syndrome (MS) and provide evidence and support for the correlation between TCM pattern differentiation based on tongue characteristic and basis of human biology. Methods Data of MS patients’ tongue images and their physical and chemical examination results were extracted from MS clinical epidemiological investigation database. SPSS17.0 software was used for descriptive statistical analysis and stepwise logistic regression of the data. Results 3,211 MS patients were included in the study with a male-to-female ratio of 1.06∶1. The number of patients with abnormal levels of blood lipids, blood pressure (BP) and fasting plasma glucose (FPG) was the largest (1,050), accounting for 32.70%. The number of those with abnormal levels of blood lipids and BP and normal levels of FPG came next (1,010), accounting for 31.45%, followed by the number of cases with abnormal levels of FPG and BP and normal levels of blood lipids (719), accounting for 22.39%. The average age of the patients was 53.86±10.33 with the majority aged from 40 to 69. The age distribution of men is younger than that of women. The most frequently observed abnormal tongue shapes were enlarged tongue (32.4%), cracked tongue (14.2%) and teeth-marked tongue (11.0%). In terms of tongue color, red tongue (38.2%) was the most frequently encountered, followed by pale tongue (17.0%) and light purple tongue (15.1%). Varicose sublingual vein cyanosis (14.4%) was also seen at a high frequency. The colors of tongue coatings were mainly yellow and white, accounting for 53.9% and 46.0% respectively. Most of the tongue coatings were thin (37.6%), greasy (36.8%) or thick (25.4%). Logistic regression showed that increase in blood pressure was significantly related to enlarged tongue, red and crimson tongue, stasis macules and spots on the tongue, varicose sublingual vein cyanosis and thin tongue coating, etc. Abnormal levels of blood lipids were significantly correlated with light purple tongue, varicose sublingual vein cyanosis, greasy tongue coating, thick tongue coating and glossy tongue coating. Increase in fasting blood glucose was positively related to pale tongue. However, there was a negative correlation between blood glucose and varicose sublingual vein cyanosis, moist tongue coating and glossy tongue coating. Meanwhile, there was a close relationship between changes in tongue image and patients’ physical and chemical examination results. Deep tongue color, stasis macules and spots on the tongue and varicose sublingual vein cyanosis were related to significant increase in blood viscosity. Conclusion Tongue images of MS patients of different types demonstrate different characteristics. Most of them present excess pattern with blood stasis featuring deep tongue color, stasis macules and spots on the tongue and varicose sublingual vein cyanosis. There is consistency and correlation between tongue image and pathogenic factors, physical and chemical examination results and hemorheological parameters of patients with MS, which reflects the influence of multiple factors on MS. The present findings can provide Objective basis for clinical diagnosis and treatment of MS.

Key words: metabolic syndrome, epidemiology, tongue characteristics, TCM pathogenesis

中图分类号: 

  • R241.25