王辰光　石晓琪　任传云　张艳　史银春　苏琪　张华　关静　高梦蕉　陈宗俊　肖永华

摘要 目的：探討2型糖尿病患者舌苔特点及其与西医实验室指标的相关性，尝试从舌苔角度为糖尿病临床辨证论治与判断预后转归提供更多的参考依据。方法：选取2018年12月至2019年10月于北京中医药大学东直门医院收治的2型糖尿病患者214例作为研究对象，应用固定光源的舌象采集设备统一采集患者舌象资料。将舌象舌苔特点从苔色、苔质两部分细化为剥苔、水滑苔、黄苔、厚苔、腻苔、燥苔6个维度，参考疼痛程度的数字等级评分法，由2位高年资专家对214张舌象照片中舌苔特点的6个维度分别进行程度量化评分，并取其平均值录入Excel表格。同时收集患者舌象采集前后两周内的单次空腹静脉血糖、空腹指尖血糖、早餐后2 h指尖血糖、糖化血红蛋白、血常规、血脂、同型半胱氨酸和尿微量清蛋白/尿肌酐比值等实验室指标。研究2型糖尿病患者舌苔特点并分析以上实验室指标与舌苔的相关性。结果：214例2型糖尿病患者中，男117例，女97例，90.60%呈现腻苔的特点，其赋值结果为4.165±1.72;84.11%呈现厚苔的特点，厚苔值为3.371±1.621，其余出现频率由高到低依次为黄苔（51.40%）、剥苔（33.18%）、水滑苔（21.03%）、燥苔（11.68%），且腻苔的程度与总胆固醇、三酰甘油正相关（均P<0.05）;厚苔的程度与血尿酸值正相关（P<0.01）;剥苔的程度与糖化血红蛋白、空腹指尖血糖、空腹静脉血糖均正相关（均P<0.05）。结论：糖尿病患者舌苔的显著特点为腻、厚，其中腻苔程度较厚苔更深;通过判断舌苔腻、厚、剥等特点，除提供辨证论治的基本依据外，也一定程度有助于医师更直观、便捷地评价糖尿病患者的代谢功能，有助于患者临床血脂、血糖、血尿酸等的自我控制。

关键词 2型糖尿病;舌诊;舌苔;实验室指标

Abstract Objective：To explore the characteristics of tongue coating in patients with type 2 diabetes and their correlation with western medical laboratory indicators，and try to provide more reference for clinical diagnosis and treatment of diabetes and prognosis judgement of diabetes from the perspective of tongue coating.Methods：From December 2018-October 2019，a total of 214 patients with type 2 diabetes were admitted to the Department of Nephrology and Endocrinology Ⅱ，Dongzhimen Hospital，Beijing University of Chinese Medicine were selected as the research objects.Tongue image acquisition equipment with a fixed light source was used to uniformly collect the patient′s tongue image data.Tongue characteristics were refined from the two parts of color and quality of the tongue to 6 dimensions：peeling moss，slippery moss，yellow moss，thick moss，greasy moss，and dry moss.With reference to the numerical grade scoring method of pain degree，2 senior experts quantified the degree of the 6 dimensions of tongue coating characteristics in 214 tongue pictures，and took the average value and entered it into the Excel table.At the same time，the patient′s single fasting venous blood glucose，fasting fingertip blood glucose，fingertip blood glucose 2 h after breakfast，glycosylated hemoglobin，blood routine，blood lipids，homocysteine and ACR and other laboratory indicators were collected within 2 weeks before and after the collection of their tongue picture.To study the characteristics of the tongue coating of type 2 diabetic patients and analyze the correlation between the above laboratory indicators and the tongue coating.Results：Among the 214 patients with type 2 diabetes，117 were males and 97 were females.90.60% showed the characteristics of greasy fur，the value of which was 4.165±1.72; 84.11% showed the characteristics of thick fur，and the value of thick fur was 3.371±1.621.The remaining frequency of occurrence in descending order was yellow fur（51.40%），peeling fur（33.18%），slippery fur（21.03%），dry fur（11.68%），and the degree of greasy fur was positively correlated to total cholesterol and triacylglycerol（all P<0.05）; the degree of thick coating is positively correlated with blood uric acid value（P<0.01）; the degree of peeling coating was positively correlated with glycosylated hemoglobin，fasting fingertip blood glucose，and fasting venous blood glucose（all P<0.05）.Conclusion：The obvious features of tongue coating in diabetic patients are greasy and thick，and the degree of greasy coating is deeper than thick coating.By judging the characteristics of greasy，thick and peeling of the tongue coating，in addition to providing basic basis for dialectical treatment，it helps physicians to more intuitively and conveniently evaluate the metabolic function of patients with diabetes to a certain extent，and it can help patients with self-control of clinical lipids，blood glucose，blood uric acid，etc.

Keywords Type 2 diabetes; Tongue diagnosis; Tongue coating; Laboratory indicators

中图分类号：R241文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.18.022

随着人口老龄化和生活方式的改变，我国糖尿病的发病率已由1980年的0.67%升至2013年的10.4%，其中未診断的糖尿病患者占总数的63%[1]，糖尿病已成为我国重大的公共卫生问题。……