2026 年第 9 期 第 21 卷

高海拔地区糖尿病患者中医证候分布与周围神经病的关系及对预后的影响

Relationship between traditional Chinese medicine syndrome distribution and peripheral neuropathy as well as its influence on prognosis in diabetic patients at high altitude area

作者：蒲蔚荣都增强王文娟章立苏延娟姜红叶

英文作者：Pu Weirong Du Zengqiang Wang Wenjuan Zhang Li Su Yanjuan Jiang Hongye

单位：青海省中医院内分泌科，西宁810000

英文单位：Department of Endocrinology Qinghai Provincial Hospital of Traditional Chinese Medicine Xining 810000 China

关键词：糖尿病；高海拔地区；中医证候；周围神经病；预后

英文关键词：Diabetesmellitus;Highaltitudearea;TraditionalChinesemedicinesyndrome;Peripheralneuropathy;Prognosis

• 摘要：

• 目的 回顾性分析高海拔地区糖尿病患者中医证候变化及其特点，探讨患者中医证候与周围神经病和预后的关系。方法 采用回顾性队列研究设计，收集2023年1月至2025年4月青海省中医院收治的150例高海拔地区糖尿病患者临床资料，依据是否发生周围神经病分为发生组56例、未发生组94例。并按照预后情况分为预后良好组81例、预后不良组69例。分析患者中医证候分布情况（气阴两虚证、血瘀脉络证、湿热困脾证等），并分析患者中医证候与周围神经病发生及预后的关系。结果 多因素Logistic回归分析结果显示，影响高海拔地区糖尿病患者发生周围神经病的独立风险因素为甘油三酯升高、糖化血红蛋白升高、糖尿病病程（＞10年）、家族遗传史（有）（比值比=1.908、1.327、1.422、1.303，均P＜0.05）。高海拔地区糖尿病患者以气阴两虚证、血瘀脉络证、湿热困脾证为主要证候表现。与未发生组相比，发生组血瘀脉络证、气阴两虚证、湿热困脾证占比升高，阴虚热盛证、阴阳两虚证占比下降（均P＜0.05）。Logistic回归分析结果表明，气阴两虚证、湿热困脾证、血瘀脉络证均与糖尿病患者发生周围神经病相关（均P＜0.05）。气阴两虚证、湿热困脾证、血瘀脉络证与糖尿病患者预后不良密切相关（均P＜0.05）。结论 临床治疗中需关注高海拔地区糖尿病患者血瘀脉络证、气阴两虚证、湿热困脾证发生的变化，且需准确把握中医证候变化特点，更利于开展高海拔地区糖尿病患者周围神经病发生风险及预后评估。

• Objective To retrospectively analyze the changes and characteristics of traditional Chinese medicine (TCM) syndromes in diabetic patients at high altitude area, and explore the relationship of TCM syndromes with peripheral neuropathy and prognosis. Methods A retrospective cohort study was conducted. Clinical data of 150 diabetic patients residing at high altitude area admitted to Qinghai Provincial Hospital of Traditional Chinese Medicine from January 2023 to April 2025 were collected. The patients were divided into neuropathy group (56 cases) and non-neuropathy group (94 cases) according to the presence of peripheral neuropathy, and further classified into good prognosis subgroup (81 cases) and poor prognosis subgroup (69 cases) based on clinical outcomes. The distribution of TCM syndromes including Qi-Yin deficiency syndrome, blood stasis blocking collaterals syndrome, damp-heat trapping spleen syndrome was analyzed, and the correlations of TCM syndromes with the incidence of peripheral neuropathy and prognosis were explored. Results Multivariate Logistic regression analysis indicated that elevated triglyceride, increased glycated hemoglobin, diabetes duration over 10 years and positive family genetic history were independent risk factors for peripheral neuropathy in high altitude area diabetic patients (odds ratio=1.908, 1.327, 1.422, 1.303, all P＜0.05). The dominant TCM syndromes of diabetic patients at high altitude area were Qi-Yin deficiency syndrome, blood stasis blocking collaterals syndrome and damp-heat trapping spleen syndrome. Compared with the non-neuropathy group, the proportions of blood stasis blocking collaterals syndrome, Qi-Yin deficiency syndrome and damp-heat trapping spleen syndrome were higher, while the proportions of yin deficiency with exuberant heat syndrome and Yin-Yang deficiency syndrome were lower in the neuropathy group (all P＜0.05). Logistic regression analysis demonstrated that Qi-Yin deficiency syndrome, damp-heat trapping spleen syndrome and blood stasis blocking collaterals syndrome were correlated with the development of diabetic peripheral neuropathy (all P＜0.05). The three above-mentioned syndromes were closely associated with poor prognosis of diabetic patients (all P＜0.05). Conclusion Clinical practitioners should monitor the variation of blood stasis blocking collaterals syndrome, Qi-Yin deficiency syndrome and damp-heat trapping spleen syndrome in diabetic patients at high altitude area, and accurately grasp the evolving characteristics of TCM syndromes, which facilitates risk assessment of peripheral neuropathy and prognostic evaluation for such population.