基于ICD-11的广州市中老年人消渴病疾病负担归因于中医体质分析

doi:10.12114/j.issn.1007-9572.2023.0294

摘要/Abstract

摘要： 背景第72届世界卫生大会审议通过了《国际疾病分类第十一次修订本》（ICD-11），首次将起源于中医药的传统医学纳入章节编码，其中，消渴病编码为SD71（TM1）。目前，消渴病是临床高发疾病，中老年人是消渴病高发人群，中医体质偏颇是消渴病危险因素。目前尚未见到中医疾病负担及危险因素的研究。目的基于ICD-11传统医学章节及中医国家标准，测算广州市中老年人消渴病疾病负担，并归因于中医体质，评估中医体质监测在健康管理中的作用，为消渴病中医防治以及体质学说的应用提供参考。方法采用横断面调查的方法，于2020年，调查广州市≥50岁中老年人消渴病患病率及中医体质分布。运用全球疾病负担（GBD）的综合理论，测算广州市中老年人群消渴病的早死寿命损失年（YLL）、伤残寿命损失年（YLD）和伤残调整寿命年（DALY），评估广州市消渴病疾病负担情况。采用相对危险度（RR）评估不同中医体质对中老年人消渴病疾病的危险性。结果共调查广州市中1 576名老年人，失访55名，回收有效问卷1 521份，有效应答率为96.51%。其中男782名，年龄62（56，69）岁；女739名，年龄62（55，70）岁。广州市中老年人消渴病患病率为13.08%，标化患病率为12.64%。广州市中老年人体质分布最多的是痰湿质、气虚质、湿热质；其中消渴病患者分布最多的是痰湿质、阴虚质、气虚质。消渴病疾病负担DALY率为86.46‰，其中YLL率为4.86‰，YLD率为81.60‰。广州市中老年人单一体质占比为48.98%，复合体质占比为51.02%。阴虚质是导致消渴病的危险体质（RR=1.73，P<0.01），导致了疾病负担33 092 DALY，DALY率为10.98‰；占消渴病中老年人群疾病负担的12.70%。就不同年龄段而言，60~69岁年龄段痰湿质（RR=1.62，P<0.05）、阴虚质（RR=1.80，P<0.05）是危险体质，其中，痰湿质导致的消渴疾病负担为18 530 DALY，DALY率为18.75‰，占该年龄段消渴病疾病负担的21.63%。阴虚质导致的消渴疾病负担为10 520 DALY，DALY率为10.65‰，占该年龄段消渴病疾病负担的12.28%。痰湿质与阴虚质联合导致的疾病负担为26 780 DALY，DALY率为27.10‰，占该年龄段消渴病疾病负担的31.26%。就不同性别而言，男性痰湿质（RR=2.29，P<0.01），女性阴虚质（RR=2.27，P<0.01）是消渴病的危险体质。中老年男性痰湿质导致的消渴病疾病负担为45 017 DALY，导致的DALY率为30.96‰，占中老年男性消渴病疾病负担的36.82%。女性阴虚质导致的消渴疾病负担为28 753 DALY，导致的DALY率为18.43‰，占中老年女性消渴病疾病负担的20.79%。结论广州市≥50岁中老年人消渴病患病率较高，消渴病疾病负担沉重。阴虚质、痰湿质是导致中老年人消渴病的危险体质。建议进行中医体质监测与管理，以有效降低消渴病疾病负担。

关键词: 国际疾病分类第十一次修订本, 消渴病, 中年人, 老年人, 全球疾病负担, 中医体质类型

Abstract:

Background

The 72nd World Health Assembly reviewed and adopted the International Classification of Diseases Eleventh Revision (ICD-11) , which for the first time included traditional medicine originating from traditional Chinese medicine (TCM) in its chapter coding, of which the code for wasting thirst disorder is SD71 (TM1) . At present, wasting thirst disorder is a high clinical prevalence disease, with middle-aged and older adults being the high incidence population, and TCM constitutions bias are risk factors for wasting thirst disorder. There was no research on the burden of TCM diseases and risk factors.

Objective

Based on the ICD-11 chapter on traditional medicine and the national standards of TCM, the burden of wasting thirst disorder among middle-aged and elderly in Guangzhou was calculated and attributed to the TCM constitutions. The role of TCM constitutions monitoring in health management was evaluated, providing reference for the prevention and treatment of wasting thirst disorder by TCM and the application of constitutions theory.

Methods

A cross-sectional survey was conducted in 2020 to investigate the prevalence of wasting thirst disorder and the distribution of TCM constitutions among middle-aged and elderly in Guangzhou. The comprehensive theory of Global Burden of Disease (GBD) , calculate the years of life lost (YLL) , years lived with disability (YLD) , and disability adjusted life year (DALY) of wasting thirst disorder in the middle-aged and elderly population in Guangzhou were used to evaluate the disease burden of wasting thirst disorder. Relative risk (RR) was used to assess the risk of different TCM constitutions for wasting thirst disorder in middle-aged and elderly people.

Results

A total of 1 576 middle aged and older adults in central Guangzhou were surveyed, 55 were lost, 1 521 valid questionnaires were recovered, and the effective response rate was 96.51%. Among them, 782 were male, aged 62 (56, 69) years; 739 were female, aged 62 (55, 70) years. The prevalence of wasting thirst disorder among middle-aged and elderly people in Guangzhou was 13.08%, with a standardized prevalence of 12.64%. The most distributed constitution among middle-aged and elderly people in Guangzhou were phlegm-dampness constitution, qi-deficiency constitution, and damp-heat constitution; among them, the most distributed constitutions in patients with wasting thirst disorder were phlegm-dampness constitution, yin-deficiency constitution, and qi-deficiency constitution. The DALY rate of wasting thirst disorder burden was 86.46‰, with a YLL rate of 4.86‰ and a YLD rate of 81.60‰. The proportion of single constitution and composite constitution was 48.98% and 51.02%, respectively. Yin-deficiency constitution was the risk constitution of wasting thirst disorder (RR=1.73, P<0.01) , which led to a disease burden of 33 092 DALY, with a DALY rate of 10.98, accouting for 12.70% of the disease burden in the middle-aged and elderly population with wasting thirst disorder. In terms of different age groups, phlegm-dampness constitution (RR=1.62, P<0.05) and yin-deficiency constitution (RR=1.80, P<0.05) were risk constitutions in the age group of 60-69 years, in which phlegm-dampness constitution resulted in a wasting thirst disorder burden of 18 530 DALY, with a DALY rate of 18.75‰, accounting for 21.63% burden of wasting thirst disorder in this age group; yin-deficiency constitution led to wasting thirst disorder burden of 10 520 DALY, with a DALY rate of 10.65‰, accounting for 12.28% of burden of wasting thirst disorder in this age group; the disease burden caused by the combination of phlegm-dampness constitution and yin-deficiency constitution was 26 780 DALY, with a DALY rate of 27.10 ‰, accounting for 31.26% of the burden of wasting thirst disorder in this age group. For different genders, male phlegm-dampness constitution (RR=2.29, P<0.01) and female yin-deficiency constitution (RR=2.27, P<0.01) were risk constitutions for wasting thirst disorder. The disease burden caused by phlegm-dampness constitution in middle-aged and elderly males was 45 017 DALY, resulting in a DALY rate of 30.96‰, accounting for 36.82% of the burden of wasting thirst disorder in middle-aged and elderly males. The burden of wasting thirst disorder caused by female yin-deficiency constitution was 28 753 DALY, resulting in a DALY rate of 18.43‰, accounting for 20.79% of the burden of wasting thirst disorder among middle-aged and elderly females.

Conclusion

The prevalence of wasting thirst disorder among middle-aged and older adults aged≥50 in Guangzhou is relatively high, with heavy disease burden. Yin-deficiency and phlegm-dampness constitutions are risk constitutions for wasting thirst disorder in middle-aged and elderly people. TCM constitutions monitoring and management can effectively reduce the burden of wasting thirst disorder .

Key words: International Classification of Diseases Eleventh Revision, Wasting thirst disorder, Middle aged, Aged, Global burden of disease, Constitutional type

赵兰慧,高婧,周尚成. 基于ICD-11的广州市中老年人消渴病疾病负担归因于中医体质分析[J]. 中国全科医学, 2024, 27(06): 751-757. DOI: 10.12114/j.issn.1007-9572.2023.0294.
ZHAO Lanhui,GAO Jing,ZHOU Shangcheng. Analysis of Traditional Chinese Medicine Constitutions Attributable to the Burden of Wasting Thirst Disorder among the Middle-aged and Older adults in Guangzhou Based on ICD-11[J]. Chinese General Practice, 2024, 27(06): 751-757. DOI: 10.12114/j.issn.1007-9572.2023.0294.

图/表 9

参考文献 27

[1]	REDDY B，FAN A Y. Incorporation of complementary and traditional medicine in ICD-11[J]. BMC Med Inform Decis Mak，2022，21（Suppl 6）：381. DOI：10.1186/s12911-022-01913-7.
[2]	苗力元，田添，周晓农. 国内外棘球蚴病疾病负担研究进展[J]. 中国血吸虫病防治杂志，2023，35（3）：307-312. DOI：10.16250/j.32.1374.2023036.
[3]	胡馨予，刘德亮，黄宝利，等. 名中医李惠林从"祛邪"论治糖尿病经验[J]. 陕西中医，2023，44（8）：1121-1124.
[4]	张美珍，郝晓晖，卜祥伟，等. 调枢法在糖尿病中的应用[J]. 中国中医基础医学杂志，2023，29（5）：833-835; 833-835，842. DOI：10.19945/j.cnki.issn.1006-3250.2023.05.022.
[5]	LIU J L，LIU M，CHAI Z L，et al. Projected rapid growth in diabetes disease burden and economic burden in China：a spatio-temporal study from 2020 to 2030[J]. Lancet Reg Health West Pac，2023，33：100700. DOI：10.1016/j.lanwpc.2023.100700.
[6]	梁珊珊，周智华，李成程，等. 1990—2019年中国糖尿病疾病负担及发病预测分析[J]. 中国全科医学，2023，26（16）：2013-2019. DOI：10.12114/j.issn.1007-9572.2023.0009.
[7]	邹云涛，张伦忠，林燕. 中医体质与缺血性中风相关性研究现状[J]. 山东中医杂志，2023，42（4）：412-416. DOI：10.16295/j.cnki.0257-358x.2023.04.021.
[8]	何晓翠. 2型糖尿病血糖波动患者的中医体质及相关性研究[D]. 南宁：广西中医药大学，2022.
[9]	王志会，王临虹，李镒冲，等. 2010年中国60岁以上居民高血压和糖尿病及血脂异常状况调查[J]. 中华预防医学杂志，2012，46（10）：922-926.
[10]	WHO. ICD-11 for Mortality and Morbidity Statistics[EB/OL]. （2023-08-19）[2023-08-20].
[11]	中医临床诊疗术语　第1部分：疾病：GB/T 16751.1-2021[S/OL]. [2023-08-20].
[12]	中医体质分类与判定：ZYYXH/T 157-2009 [S].北京：中国中医药出版社，2009.
[13]	周智华，袁晓霞，周尚成. 2015—2019年广州市急性心肌梗死死亡特征及疾病负担分析[J]. 现代预防医学，2022，49（4）：577-580; 577-580，586.
[14]	赵兰慧.基于ICD-11的中医优势病种疾病负担及归因于中医体质分析[D].广州：广州中医药大学，2022.
[15]	曾令乾. 慢性病疾病负担的计算及应用[D]. 合肥：中国科学技术大学，2019.
[16]	付凌晖，刘爱华.人口[A].中国统计年鉴，北京：中国统计出版社，2021：29-74.
[17]	袁晓霞. 基于大数据的广州市糖尿病疾病负担及危险因素研究[D]. 广州：广州中医药大学，2021.
[18]	杨道炬，何浩，梁惠陶，等. 广州地区成年居民中医体质类型调查研究[J]. 新中医，2013，45（9）：47-49. DOI：10.13457/j.cnki.jncm.2013.09.017.
[19]	潘燕妮，周卓宁，匡泽京，等. 浅析从太阴病论治痰湿体质2型糖尿病[J]. 广西中医药大学学报，2023，26（2）：1-3. DOI：10.3969/j.issn.2095-4441.2023.02.001.
[20]	刘一灵. 糖尿病肾脏疾病Ⅲ-Ⅴ期中医体质与证候的相关性分析[D]. 哈尔滨：黑龙江中医药大学，2022.
[21]	张伯礼，吴勉华，林子强. 中医内科学[M]. 北京：中国中医药出版社，2019.
[22]	韩文坛. 2型糖尿病中医体质调查研究[D]. 北京：北京中医药大学，2011.
[23]	李红，谭年花，陈斌，等. 中医体质类型与2型糖尿病相关性的系统评价[J]. 中医药导报，2021，27（11）：211-216. DOI：10.13862/j.cnki.cn43-1446/r.2021.11.050.
[24]	雷欣. 老年2型糖尿病中医体质分布状况及痰湿体质调理方的临床研究[D]. 太原：山西中医药大学，2021.
[25]	张美菱，杨宇峰，石岩. 基于"阴平阳秘"探析2型糖尿病中医病机[J]. 辽宁中医药大学学报，2020，22（8）：24-26. DOI：10.13194/j.issn.1673-842x.2020.08.007.
[26]	赵燕，龙艳. 广州地区1146例老年人群中医体质类型分析及其"治未病"健康管理初探[J]. 中医临床研究，2021，13（27）：17-19. DOI：10.3969/j.issn.1674-7860.2021.27.007.
[27]	汤丽莉，柯文琼，林俐. 中医体质辨识管理在体检中心健康指导中的应用[J]. 中医药管理杂志，2021，29（21）：224-225. DOI：10.16690/j.cnki.1007-9203.2021.21.112.

体质	中老年人群（n=1 521）		消渴病患者（n=199）
体质	人数	构成比（%）	例数	构成比（%）
平和质	45	2.96	4	2.01
气虚质	377	24.79	56	28.14
气郁质	73	4.80	9	4.52
湿热质	353	23.21	36	18.09
痰湿质	688	45.23	100	50.25
特禀质	22	1.45	2	1.01
血瘀质	200	13.15	20	10.05
阳虚质	256	16.83	29	14.57
阴虚质	304	19.99	60	30.15

体质	中老年人群（n=1 521）		消渴病患者（n=199）
体质	人数	构成比（%）	例数	构成比（%）
平和质	45	2.96	4	2.01
气虚质	377	24.79	56	28.14
气郁质	73	4.80	9	4.52
湿热质	353	23.21	36	18.09
痰湿质	688	45.23	100	50.25
特禀质	22	1.45	2	1.01
血瘀质	200	13.15	20	10.05
阳虚质	256	16.83	29	14.57
阴虚质	304	19.99	60	30.15

年龄段（岁）	YLL率			YLD率			DALY率
年龄段（岁）	男性	女性	合计	男性	女性	合计	男性	女性	合计
50~59	3.81	2.15	2.98	58.27	46.51	52.42	62.08	48.66	55.40
60~69	4.11	3.45	3.77	81.87	83.93	82.93	85.97	87.38	86.70
70~79	8.65	7.64	8.11	100.82	129.42	116.04	109.46	137.06	124.15
80~	13.57	9.94	11.44	133.09	158.25	147.91	146.66	168.20	159.34
合计	5.44	4.31	4.86	78.65	84.35	81.60	84.09	88.67	86.46

年龄段（岁）	YLL率			YLD率			DALY率
年龄段（岁）	男性	女性	合计	男性	女性	合计	男性	女性	合计
50~59	3.81	2.15	2.98	58.27	46.51	52.42	62.08	48.66	55.40
60~69	4.11	3.45	3.77	81.87	83.93	82.93	85.97	87.38	86.70
70~79	8.65	7.64	8.11	100.82	129.42	116.04	109.46	137.06	124.15
80~	13.57	9.94	11.44	133.09	158.25	147.91	146.66	168.20	159.34
合计	5.44	4.31	4.86	78.65	84.35	81.60	84.09	88.67	86.46

体质类型	RR值	95%CI	P值
平和质	0.67	0.26~1.73	0.41
气虚质	1.19	0.89~1.58	0.24
气郁质	0.94	0.50~1.76	0.85
湿热质	0.73	0.52~1.03	0.07
痰湿质	1.22	0.94~1.58	0.13
特禀质	0.69	0.18~2.61	0.59
血瘀质	0.74	0.48~1.14	0.17
阳虚质	0.84	0.58~1.22	0.37
阴虚质	1.73	1.31~2.28	<0.01