【目的】 探讨 2 型糖尿病视网膜病变（type 2 diabetic retinopathy，T2DR）的中医证型分布及其与血清炎症因子、脂联素（APN）水平的相关性，为 T2DR 的中医辨证分型提供客观依据。【方法】 采用横断面病例对照研究方法，选择 2022 年 9 月至2023 年 3 月在江西省赣州市人民医院眼科诊断为 T2DR 的患者共 42 例 84 眼，观察 T2DR 患者眼底荧光血管造影（FFA）分期与 中医辨证分型的关系，分析不同中医证型与血清炎症因子及 APN 水平的关系以及不同 FFA 分期的血清炎症因子及 APN 水平 差异，探讨 T2DR 患者各变量与不同中医证型之间的相关性。【结果】（1）42 例 T2DR 患者中，男性 27 例，女性 15 例，平均年 龄为（54.0±12.0）岁；其中，肝肾亏虚、目络失养证 14 例（33.3%），阴精不足、燥热内生证 15 例（35.7%），气阴两虚、络脉 瘀阻证 9 例（21.4%），阴阳两虚、血瘀痰凝证 4 例（9.5%），脾失健运、水湿阻滞证 0 例（0.0%）。（2）肝肾亏虚、目络失养证患 者 中 双 眼 眼 底 FFA 分 期 ≥ 4 期 [增 殖 期 糖 尿 病 视 网 膜 病 变（PDR）]者 占 78.6%（11/14）， 阴 精 不 足 、 燥 热 内 生 证 患 者 占 73.3%（11/15），气阴两虚、络脉瘀阻证患者和阴阳两虚、血瘀痰凝证患者均占 100%（9/9；4/4），但组间比较，差异无统计学意义（P = 0.272）。（3）42 例 T2DR 患 者 中 ， 有 35 例（83.3%）患 者 的 肿 瘤 坏 死 因 子 α（TNF-α）、 28 例（68.3%）患 者 的 C 反 应 蛋 白（CRP）、38 例（90.5%）患者的糖化血红蛋白（HbA1c）水平均高于正常值；但不同 FFA 分期患者的血清炎症因子 TNF-α、CRP、 白细胞介素 6（IL-6）、血管内皮生长因子（VEGF）及 APN、HbA1c 水平比较，差异均无统计学意义（P＞0.05）；同时，不同中 医证型的血清 APN、TNF-α、CRP、IL-6、VEGF 水平比较，差异也均无统计学意义（P＞0.05）。（4）相比肝肾亏虚、目络失养 证患者，阴阳两虚、血瘀痰凝证患者的眼部病程较短，两者的相关性接近差异有统计学意义（r = -0.467，P = 0.051）；相比 阴精不足、燥热内生证患者，阴阳两虚、血瘀痰凝证患者的 CRP 水平较高（r = 0.592，P = 0.010）；相比气阴两虚、络脉瘀阻 证患者，阴阳两虚、血瘀痰凝证患者的 CRP 水平较高（r = 0.668，P = 0.013）和糖尿病病程更长（r = 0.629，P = 0.021）。【结论】 血清 TNF-α 及 CRP 在 T2DR 中有更高的表达；肝肾亏虚、目络失养证和阴精不足、燥热内生证为 T2DR 的常见证型；阴阳两 虚、血瘀痰凝证与 CRP 密切相关，同时阴阳两虚、血瘀痰凝证型患者有更长的糖尿病病程。

Abstract： Objective To investigate the distribution of traditional Chinese medicine（TCM）syndromes in patients with type 2 diabetic retinopathy（T2DR）and to explore the correlation of TCM syndromes with serum inflammatory factors and adiponectin（APN） levels， so as to provide evidence for TCM syndrome differentiation of T2DR. Methods A cross-sectional case-control study was conducted in 42 patients（involving 84 eyes） diagnosed as T2DR in the Department of Ophthalmology，Ganzhou People’s Hospital from September 2022 to March 2023. The correlation between fundus fluorescein angiography（FFA） staging and TCM syndrome differentiation in patients with T2DR was explored. The relationship between TCM syndrome types and serum levels of inflammatory factors and APN，as well as the differences in serum inflammatory factors and APN levels of the patients with various FFA stages were analyzed. The correlation between each variable and TCM syndrome types in patients with T2DR was investigated. Results（1）Among the 42 patients with T2DR， 27 cases were male and 15 cases were female， and their age averaged（54.0±12.0） years old. Among them， 14 cases（33.3%） were differentiated as liver-kidney deficiency with malnutrition of eye collateral syndrome， 15 cases（35.7%） were differentiated as yin-essence deficiency with internal dry-heat syndrome， 9 cases （21.4%） were differentiated as qi-yin deficiency with collateral stasis and obstruction syndrome， 4 cases（9.5%）were differentiated as yin-yang deficiency with blood stasis and phlegm coagulation syndrome， and none case（0.0%） was differentiated as spleen dysfunction and water-damp obstruction syndrome.（2）FFA staging showed that FFA staging ≥ 4 [i.e.，having proliferative diabetic retinopathy（PDR）] was found in 78.6%（11/14）of the patients with liver-kidney deficiency with malnutrition of eye collaterals syndrome，73.3%（11/15）of the patients with yin-essence deficiency with internal dry-heat syndrome，100%（9/9）of the patients with qi-yin deficiency with collateral stasis and obstruction syndrome，and 100%（4/4） of the patients with yin-yang deficiency with blood stasis and phlegm coagulation syndrome. But the intergroup comparison showed no significant differences among various syndrome types（P = 0.272）. （3）Among the 42 patients with T2DR，35 patients（83.3%）had higher level of tumor necrosis factor-α（TNF-α），28 patients（68.3%）had higher level of C-reactive protein（CRP） and 38 patients（90.5%） had higher level of glycosylated hemoglobin（HbA1c）than the normal. However，there was no significant difference in the levels of serum inflammatory factors of TNF-α，CRP，interleukin-6（IL-6）and vascular endothelial growth factor（VEGF），APN and HbA1c among the patients with different FFA stages（P＞0.05）， neither did the difference in serum APN， TNF- α， CRP， IL-6 and VEGF levels among the patients with different TCM syndrome types（P＞0.05）.（4） The correlation analysis showed that the patients with yin-yang deficiency with blood stasis and phlegm coagulation syndrome had a shorter course of eye diseases than the patients with liver-kidney deficiency with malnutrition of eye collaterals syndrome（r = -0.467， P = 0.051）， had higher CRP level than the patients with yin-essence deficiency with internal dry-heat syndrome（r = 0.592， P = 0.010）， and had higher CRP level（r = 0.668， P = 0.013）and a longer course of diabetes（r = 0.629，P = 0.021）than the patients with qi-yin deficiency with collateral stasis and obstruction syndrome. Conclusion Increased serum TNF-α and CRP expressions are presented in the patients with T2DR. Liver-kidney deficiency with malnutrition of eye collaterals syndrome and yin-essence deficiency with internal dry-heat syndrome are the common syndromes in T2DR. Yin-yang deficiency with blood stasis and phlegm coagulation syndrome is closely correlated with CRP level， and the patients with yin-yang deficiency with blood stasis and phlegm coagulation syndrome have a longer course of diabetes.

R276.7

江西省中医药管理局科技计划项目（编号：2022B293）