| 摘要: |
| 目的:分析糖尿病足首发溃疡患者的皮部分布和阴阳辨证特征。方法:选取2022年6月30日—2024年6月30日因糖尿病足首发溃疡就诊于北京中医药大学东直门医院周围血管病科的患者228例，从医院His病历系统提取患者的溃疡位置、年龄、性别、糖尿病病程、病史、四诊信息、专科查体、合并疾病等信息，根据患者的溃疡位置判断溃疡所属的皮部，根据患者的病史、四诊信息、专科查体等信息判断患者创面的阴阳辨证结果。结果:纳入的228例糖尿病首发足溃疡患者中，98.2％的患者年龄超过40岁；67.6％的患者糖尿病病程超过10年，合并高脂血症的患者占42.1％，合并高血压的患者占67.5％，合并缺血性心脏病的患者占50％，合并心功能不全的患者占20.2％，合并缺血性脑血管病的患者占48.2％，合并肾功能不全的患者占26.3％，合并贫血和合并低蛋白血症的患者占21.5％。足六经皮部上发生首发溃疡频数最多的是足厥阴皮部，共93次，占40.8％，频数最少的是足少阴皮部，共26次，占比11.4％。足溃疡的阴阳辨证中，频数最多的是阴证，共156例，占68.4％，最少的是半阴半阳证，共34例，占14.9％。一般人口学资料中，20～39年龄段和＞80年龄段患者发生足阳明皮部首发溃疡的比例较高，20～39年龄段和60～79年龄段患者发生足少阳皮部首发溃疡的比例较高，差异有统计学意义(P <0.05)；女性患者发生足太阴皮部首发溃疡的比例较高，差异有统计学意义(P <0.05)；糖尿病病程≤5年及10.01～15年的患者首发足溃疡辨证为阳证和半阴半阳证的比例较高，糖尿病病程5.01～10年及＞15年的患者首发足溃疡辨证为阴证的比例较高，差异有统计学意义(P <0.05)。合并疾病中，合并高脂血症患者发生足太阴皮部首发足溃疡的比例较低，发生足少阳皮部首发足溃疡的比例较高，合并心功能不全和肾功能不全的患者发生足少阴皮部首发足溃疡的比例较高，合并高血压病史的患者首发足溃疡辨证为阴证和半阴半阳证的比例较高，差异均有统计学意义(P <0.05)。结论:首发于足阳明皮部的溃疡与年龄相关，首发于足少阳皮部的溃疡与年龄及合并高脂血症相关，首发于足太阴皮部的溃疡与性别及合并高脂血症相关，首发于少阴皮部的溃疡与合并心功能不全及合并肾功能不全相关，而阴阳辨证与糖尿病病程、高血压病史相关。结合各经络、皮部的生理病理特性，能够对患者的中医辨证思路、引经药的使用以及预防进行相应的指导。 |
| 关键词: 糖尿病足溃疡 首发溃疡 皮部理论 阴阳辨证 |
| DOI：10.3969/j.issn.1007-6948.2025.05.017 |
| 投稿时间：2025-02-24 |
| 基金项目:国家重点研发计划项目(2019YFC1709302) |
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| Characteristics of first-ever foot ulcers of diabetic foot based on Yin-Yang syndrome differentiation and the cutaneous areas theory |
| WANG Tao,JU Shang,WANG Ning |
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| Abstract: |
| Objective To explore the characteristics of the cutaneous areas and Yin-Yang syndrome differentiation in patients with the first-ever foot ulcer. Methods A total of 228 patients with the first-ever foot ulcer who were admitted to Dongzhimen Hospital Beijing University of Chinese Medicine between June 30, 2022 and June 30, 2024 were selected. To extract patient information from the hospital's His medical record system, including ulcer location, age, gender, duration of diabetes, medical history, four diagnostic methods (inspection, listening and smelling, inquiry, and palpation), specialized physical examination, and comorbid diseases. The cutaneous areas corresponding to the ulcer location were determined, and the Yin-Yang syndrome differentiation of the wound was assessed based on the patients' medical history, four diagnostic methods, and specialized physical examination. Results 70.2% of 228 patients with diabetes first-ever foot ulcer were included, and 98.2% were over 40 years old; 67.6% of the patients had diabetes for more than 10 years, 42.1% had hyperlipidemia, 67.5% had hypertension, 50% had ischemic heart disease, 20.2% had cardiac insufficiency, 48.2% had ischemic cerebrovascular disease, 26.3% had renal insufficiency, and 21.5% had anemia and hypoproteinemia. The most frequent occurrence of initial ulcers on the cutaneous areas of the sixth meridian of the foot is in the pubic area of the foot, with a total of 93 times, accounting for 40.8%. The least frequent occurrence is in the pubic area of the foot, with a total of 26 times, accounting for 11.4%. In the Yin-Yang syndrome differentiation of foot ulcers, the most frequent is the yin syndrome, with a total of 156 cases, accounting for 68.4%, and the least is the semi-Yin and semi-Yang syndrome, with a total of 34 cases, accounting for 14.9%. In the general demographic data, the proportion of patients with the first ulcer of the cutaneous areas of Foot Yangming was higher in the age groups of 20 to 39 and > 80, and the proportion of patients with the first ulcer of the cutaneous area of Foot Shaoyang was higher in the age groups of 20 to 39 and 60 to 79, and the difference was statistically significant (P <0.05); the proportion of female patients with the first-ever ulcer of the cutaneous area of Foot Taiyin was higher, and the difference was statistically significant (P <0.05); the proportion of patients with the first-ever foot ulcer of patients with the duration of diabetes ≤ 5 years and 10.01 to 15 years was higher in the syndrome of Yang syndrome and semi-Yin and semi-Yang syndrome, and the proportion of patients with the first foot ulcer of patients with the duration of diabetes 5.01 to 10 years and 15 years was higher in the Yin syndrome. Among the combined diseases, patients with hyperlipidemia had a lower proportion of first-ever foot ulcers in the cutaneous area of Foot Taiyin, and a higher proportion of first-ever foot ulcers in the cutaneous area of Foot Shaoyang, and the difference was statistically significant (P <0.05); patients with cardiac insufficiency and renal insufficiency had a higher proportion of first-ever foot ulcers in the cutaneous area of Foot Shaoyin, and the difference was statistically significant (P <0.05); patients with a history of hypertension had a higher proportion of first-episode foot ulcers differentiated as Yin syndrome and semi-Yin semi-Yang syndrome, and the difference was statistically significant (P <0.05). Conclusion The ulcer first in the cutaneous area of Foot Yangming was related to age, the ulcer first in the cutaneous area of Foot Shaoyang was related to age and combined hyperlipidemia, the ulcer first in the cutaneous area of Foot Taiyin was related to gender and combined hyperlipidemia, the ulcer first in the cutaneous area of Foot Shaoyin was related to combined cardiac insufficiency and combined renal insufficiency, while the Yin and Yang syndrome differentiation was related to the duration of diabetes and the history of hypertension. |
| Key words: Diabetic foot ulcer first-ever foot ulcer cutaneous areas theory Yin-Yang syndrome differentiation |
