| 引用本文: |
陈婷, 彭清华, 肖晓霞, 张哲源, 都鑫茹, 薛矜柔.2型糖尿病视网膜病变合并肾病的中医证素交互及病机研究[J].湖南中医药大学学报,2026,46(3):635-642[点击复制] |
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| 2型糖尿病视网膜病变合并肾病的中医证素交互及病机研究 |
| 陈婷,彭清华,肖晓霞,张哲源,都鑫茹,薛矜柔 |
| (湖南中医药大学, 湖南 长沙 410208) |
| 摘要: |
| 目的 探讨2型糖尿病视网膜病变（DR）合并糖尿病肾病（DKD）的中医证素分布与交互规律，分析其相关危险因素，结合DKD分期分析病机演变，为中西医结合防治提供依据。方法 回顾性纳入湖南中医药大学第一附属医院2018年1月至2023年6月入院的1 453例DR患者（不合并DKD 523例，合并DKD 930例，其中793例DKD有分期）。采用统计学分析、多因素Logistic回归及SHAP方法评估证素分布与交互。结果 DR患者病位以肾、脾、肺为主，病性多为阴虚、气虚、热；DKD患者年龄更大，男性比例较高，高血压患病率更高，病位以肝、肾为主，病性以湿、毒、血虚、精亏、水停等为主。在各DKD分期中，肾始终居首位且占比随DKD进展逐渐升高，肺、胃在Ⅰ~Ⅲ期较为常见，至晚期则显著减少，脾在Ⅱ~Ⅲ期占比更高，肝在Ⅳ~Ⅴ期作用增强，湿、毒、水停等后期占比增加，津亏、热、燥前期较多。Logistic回归分析显示，男性、高龄、高血压、肾、湿、毒、水停为独立危险因素；SH Additive exPlanations分析提示，“肾×湿”“肾×毒”交互作用最强，重要性超过传统西医危险因素。结论 DR合并DKD的中医病机呈现“阴虚燥热”向“阴阳两虚兼夹水湿浊毒”的动态演变，以“肾”为核心病位，以“湿”“毒”为关键病理产物，“肾亏湿蕴化毒”是核心病机，而基于证素分期特征的辨证干预，可为该共病的防治提供临床指导。 |
| 关键词: 糖尿病视网膜病变 糖尿病肾病 中医证素 Logistic回归 SHAP分析 |
| DOI：10.3969/j.issn.1674-070X.2026.03.028 |
| 投稿时间：2025-09-18 |
| 基金项目:湖南省自然科学基金高校联合基金项目（2025JJ90031）；湖南省中医药管理局重点课题（A2023048）；湖南省教育厅科学研究重点项目（23A0273）；湖南省教育厅科研项目（21C0227）。 |
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| Interaction of TCM syndrome elements and pathogenesis of type 2 diabetic retinopathy complicated with nephropathy |
| CHEN Ting, PENG Qinghua, XIAO Xiaoxia, ZHANG Zheyuan, DU Xinru, XUE Jinrou |
| (Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Objective To explore the distribution and interaction patterns of TCM syndrome elements for type 2 diabetic retinopathy (DR) complicated with diabetic kidney disease (DKD), analyze the associated risk factors, and explore the evolutionary pathogenesis based on DKD staging, thereby providing evidence for integrated Chinese and Western medicine prevention and treatment. Methods A retrospective analysis was conducted on 1 453 patients with DR admitted to the First Hospital of Hunan University of Chinese Medicine from January 2018 to June 2023, comprising 930 patients with DKD and 523 without DKD. Among them, 793 DKD cases had available staging data. Statistical analysis, multivariate logistic regression, and SHAP analysis were used to evaluate the distribution and interaction of syndrome elements. Results In DR patients, the disease locations were predominantly the kidney, spleen, and lung, while the disease characteristics were mainly yin deficiency, qi deficiency, and heat. DKD patients were generally older, with higher proportions of males and hypertension, and the disease locations were mainly the liver and kidney, with disease characteristics dominated by dampness, toxin, blood deficiency, essence deficiency, and water retention. With the progression of DKD stages, the kidney consistently ranked first in terms of disease location, with its proportion gradually increasing. The lung and stomach were more prevalent in stages I-Ⅲ but significantly decreased in the advanced stages. The spleen had a higher proportion in stages Ⅱ-Ⅲ; while the liver's role became more pronounced in stages Ⅳ-V. Dampness, toxin, and water retention increased in the later stage, whereas fluid deficiency, heat, and dryness were more common in the earlier stage. Logistic regression revealed that male gender, advanced age, hypertension, kidney, dampness, toxin, and water retention were independent risk factors. SHapley Additive exPlanations (SHAP) analysis indicated that the interactions between "kidney × dampness" and "kidney × toxin" were the strongest, surpassing the importance of traditional Western medical risk factors. Conclusion The TCM pathogenesis of DR complicated with DKD presents a dynamic evolution from "yin deficiency and dryness-heat" to "yin and yang deficiency complicated with water-dampness, turbidity and toxin." The kidney serves as the core disease location, with "dampness" and "toxin" being key pathological products. "Kidney deficiency with dampness accumulation transforming into toxin" represents the core pathogenesis. Pattern identification-based intervention according to staging characteristics of syndrome elements can provide clinical guidance for the prevention and treatment of this comorbidity. |
| Key words: diabetic retinopathy diabetic nephropathy TCM syndrome elements logistic regression SHAP analysis |
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