Objective

2

To investigate the characteristics of traditional Chinese medicine （TCM） syndromes in patients with type 2 diabetes mellitus complicated with coronary heart disease （T2DM-CHD）.

Methods

2

Clinical data of T2DM-CHD patients who were admitted to seven tertiary grade-A Chinese medicine hospitals in five provinces and cities from January 1st， 2015 to December 31st， 2019 were retrospectively collected. A TCM syndrome questionnaire was designed， collecting data on patients' gender， age， smoking and drinking history， family history， pathogenic factors， vital signs， four examinations， blood routine examination， and biochemical examination. The distribution patterns of symptoms， syndrome elements， and TCM syndrome types were explored using the method of syndrome element weight measurement. Unordered multinomial logistic regression analysis was conducted to investigate the correlation between TCM syndrome types and baseline characteristics upon admission.

Results

2

A total of 2556 patients were included. The top three symptoms or signs were chest tightness （69.87%）， fatigue （48.90%）， and lassitude （47.61%）. Tongue manifestations were mainly dark red （45.58%）， pale red （29.38%）， and pale （15.30%）， with white coating （78.09%）， thin coating （58.26%）， and greasy coating （28.52%）. Pulse conditions were mostly thin （43.94%）， stringy （34.98%）， and slippery （24.14%）. A total of 7， 11 and 10 syndrome elements related to deficiency nature， excess nature， and location of disease were summarized. Deficiency syndrome elements were mainly

qi

deficiency （51.80%），

yang

deficiency （37.72%）， and

yin

deficiency （35.13%）， while excess syndrome elements were primarily phlegm （38.97%）， blood stasis （37.87%）， and dampness （24.84%）. The main affected organs included the heart （49.37%）， lungs （42.29%）， chest and diaphragm （12.25%）， spleen （12.09%）， and kidneys （9.66%）. There were 12 TCM syndrome types each accounting for more than 3%， including phlegm-dampness internal obstruction syndrome （11.07%）， phlegm-stasis obstruction syndrome （9.55%），

qi

deficiency and blood stasis syndrome （8.96%），

qi

deficiency and phlegm obstruction syndrome （8.69%），

yin

deficiency syndrome （6.57%），

yin

-

yang

qi

deficiency syndrome （6.18%）， blood stasis syndrome （5.71%），

qi

and

yin

deficiency syndrome （5.52%），

qi

and blood depletion syndrome （5.44%），

qang

qi

deficiency syndrome （4.97%），

yang

qi

deficiency combined with phlegm-stasis syndrome （4.03%）， and

qi

and

yin

deficiency combined with phlegm-stasis syndrome （3.29%）. The distribution differences of the 12 TCM syndrome types among different systolic blood pressure strata were statistically significant （

P

＜0.05）， and the syndromes of phlegm-dampness internal obstruction， phlegm-stasis obstruction，

qi

deficiency and blood stasis，

qi

deficiency and phlegm obstruction were the main types. Female gender was a risk factor for

yin

-

yang

qi

deficiency syndrome and

qi

and blood depletion syndrome. Age （≤60 years） was a risk factor for phlegm-stasis obstruction syndrome and blood stasis syndrome. Systolic blood pressure （＜140 mmHg） was positively correlated with phlegm-stasis obstruction syndrome，

qi

deficiency and blood stasis syndrome，

qi

deficiency and phlegm obstruction syndrome，

yin

-

yang

qi

deficiency syndrome， blood stasis syndrome，

qi

and

yin

deficiency syndrome，

qi

and blood depletion syndrome，

yang

qi

deficiency syndrome， and

yang

qi

deficiency combined with phlegm-stasis syndrome （

P

＜0.05）.

Conclusion

2

The pathogenesis of T2DM-CHD involves root deficiency （such as

qi

deficiency，

yang

deficiency， and

yin

deficiency） and branch excess （such as phlegm， blood stasis， and dampness）. Phlegm （dampness） and blood stasis are not only pathological products but also pathogenic factors throughout the development of the disease. The main affected organ is the heart， closely related to the spleen. Female gender， age （≤60 years）， and systolic blood pressure （＜140 mmHg） may be related factors for TCM syndrome types in patients with T2DM-CHD.