糖尿病视网膜病变合并其他疾病的证素分布规律*

作者：张哲源1，陈 婷1，都鑫茹1，胡淑娟1，邹北骥2，彭清华1，肖晓霞1

单位：1.湖南中医药大学，湖南 长沙 410208； 2.中南大学，湖南 长沙 410083

引用：引用：张哲源，陈婷，都鑫茹，胡淑娟，邹北骥，彭清华，肖晓霞.糖尿病视网膜病变合并其他疾病的证素分布规律[J].中医药导报,2026,32(2):96-100.

DOI：10.13862/j.cn43-1446/r.2026.02.015

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摘要：目的：探究糖尿病视网膜病变（DR）患者合并糖尿病肾病（DKD）、冠心病（CAD）时的证素分布规律，为DR合并DKD、CAD时的辨证分型提供依据。方法：收集1 511名被诊断为DR的住院患者病历资料，并将患者分成DR组、DKD组、CAD组、DKD&CAD组。通过患者诊疗经过和诊断依据归纳总结中医证素，比较各组间证素的分布差异。结果：4组患者在心、肺、肝、肾、气虚、痰、血瘀、血虚、毒、燥、津亏、热、阳虚、精亏、湿、水停的证素分布上存在差异。DR患者，津亏与DKD患病呈负相关，水停、毒、湿、气虚、精亏与DKD患病呈正相关。心、气虚与CAD患病呈正相关。已存在CAD的DR患者中，肺与DKD患病呈负相关，肝、水停、毒、阳虚与DKD的患病呈正相关。已存在DKD的DR患者中，心、肝、阳虚与CAD患病呈正相关。结论：DR患者合并DKD和CAD时的证素分布存在差异。随DR进展至多并发症阶段，病位证素呈现从肺（上焦）向肝（下焦）的传变。阳虚是并发症进展中的核心证素；毒与水停提示DKD风险；心痰瘀组合提示CAD风险。

关键词：糖尿病视网膜病变；冠心病；糖尿病肾病；证素分布

Abstract：Objective: To investigate the distribution patterns of syndrome elements in patients with diabetic retinopathy (DR) complicated by diabetic kidney disease (DKD) and/or coronary artery disease (CAD), and to provide a basis for syndrome differentiation in such combined conditions. Methods: Medical records of 1,511 hospitalized patients diagnosed with DR were collected. Patients were divided into four groups: DR alone group, DKD group, CAD group, and DKD&CAD group. Traditional Chinese Medicine (TCM) syndrome elements were summarized based on diagnosis, treatment course, and diagnostic evidence. Distribution differences of syndrome elements among the groups were compared. Results: Significant differences were found among the four groups in the distribution of syndrome elements related to the heart, lung, liver, kidney, Qi deficiency, phlegm, blood stasis, blood deficiency, toxin, dryness, fluid depletion, heat, Yang deficiency, essence deficiency, dampness, and water retention. In DR patients, fluid depletion was negatively correlated with DKD occurrence, while water retention, toxin, dampness, Qi deficiency, and essence deficiency were positively correlated with DKD. Heart-related elements and Qi deficiency were positively correlated with CAD. Among DR patients with existing CAD, lung-related elements were negatively correlated with DKD occurrence, whereas liver-related elements, water retention, toxin, and Yang deficiency were positively correlated with DKD. Among DR patients with existing DKD, heart-related elements, liver-related elements, and Yang deficiency were positively correlated with CAD. Conclusion: The distribution of syndrome elements differs in DR patients complicated with DKD and CAD. As DR progresses to a stage with multiple complications, the disease location syndrome elements show a transmission pattern from the lung (upper Jiao) to the liver (lower Jiao). Yang deficiency is the core syndrome element in the progression of complications; toxin and water retention indicate DKD risk; the combination of heart-phlegm and blood stasis suggests CAD risk.

Key words：diabetic retinopathy; coronary artery disease; diabetic kidney disease; distribution of syndrome elements

发布时间：2026-03-05

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