湖南中医药大学学报2026，Vol.46Issue(3)：635-642,8.DOI:10.3969/j.issn.1674-070X.2026.03.028
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
Interaction of TCM syndrome elements and pathogenesis of type 2 diabetic retinopathy complicated with nephropathy
摘要
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.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Key words
diabetic retinopathy/diabetic nephropathy/TCM syndrome elements/logistic regression/SHAP analysis分类
医药卫生引用本文复制引用
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):635-642,8.基金项目
湖南省自然科学基金高校联合基金项目(2025JJ90031) （2025JJ90031）
湖南省中医药管理局重点课题(A2023048) （A2023048）
湖南省教育厅科学研究重点项目(23A0273) （23A0273）
湖南省教育厅科研项目(21C0227). （21C0227）
