中医杂志

目的 探讨糖脂代谢病患者及其主要证型的舌象图像特征分布规律。方法 纳入841例糖脂代谢病患者（糖脂代谢病组）及380例非糖脂代谢病受试者（非糖脂代谢病组），其中糖脂代谢病组患者辨证分为肝郁脾虚证283例、痰湿阻滞证311例、气滞血瘀证247例。使用舌诊仪采集两组舌象图像数据，通过TDAS V3.0软件获取两组舌质舌苔颜色纹理及形质特征（TB，舌质；TC，舌苔；L，明度；a，红色-绿色轴；b，黄色-蓝色轴；Y，亮度；Cr，红色信号与亮度值之间的差异；Cb，蓝色信号与亮度值之间的差异；CON，对比度；ASM，角度方向二阶矩；ENT，熵值；MEAN，平均值；perAll，舌苔面积/全舌面积；perPart，舌苔面积/无舌苔面积）；分析糖脂代谢病组不同证型患者舌象图像诊断特征，并采用Logistic回归分析糖脂代谢病不同证型的影响因素。结果 糖脂代谢病组舌质指标中TB-L、TB-Y、TB-Cb大于非糖脂代谢病组，TB-a、TB-b、TB-Cr小于非糖脂代谢病组；糖脂代谢病组舌苔指标中TC-L、TC-Y、TC-Cb、perAll、perPart高于非糖脂代谢病组，TC-a、TC-b、TC-Cr低于非糖脂代谢病组（P<0.05）。糖脂代谢病组不同证型比较，肝郁脾虚证、痰湿阻滞证TB-L、TB-Y高于气滞血瘀证，痰湿阻滞证TB-a、TB-Cr低于气滞血瘀证，痰湿阻滞证perAll高于气滞血瘀证（P<0.05）。糖脂代谢病组点刺舌高于非糖脂代谢病组，肝郁脾虚证齿痕舌高于其他两证，痰湿阻滞证的腻苔、气滞血瘀证的瘀点舌分别高于其他两证（P<0.05）。Logistic回归分析得出，腻苔、点刺舌、瘀点舌、齿痕舌、perAll、TB-Cb是肝郁脾虚证的影响因素；腻苔、齿痕舌、TC-Cb、TC-Cr是痰湿阻滞证的影响因素；裂纹舌、瘀点舌、齿痕舌、TB-Y是气滞血瘀证的影响因素（P<0.05）。结论 较非糖脂代谢病，糖脂代谢病患者舌质颜色偏暗，舌苔偏厚腻。肝郁脾虚证糖脂代谢病患者舌质偏红，在纹理表现上更为细腻，多见齿痕；痰湿阻滞证患者舌苔明亮度更高，苔质纹理更粗糙，多有腻苔表现；气滞血瘀证患者舌质明亮度更低，多有瘀点。

Objective To explore the distribution pattern of tongue image characteristics in patients with glucolipid metabolic disorders and its main syndromes. Methods A total of 841 patients with glucolipid metabolic disorders(disease group), and 380 healthy subjects(control group) were included. The disease group was classified into three syndrome types: 283 cases of liver depression and spleen deficiency syndrome, 311 cases of phlegm-dampness obstruction syndrome, and 247 cases of qi stagnation and blood stasis syndrome. Tongue image data were collected using the TFDA-1 Tongue Diagnosis Instrument, and the TDAS V3. 0 software was used to analyze the color, texture, and morphological features of the tongue body(TB) and tongue coating(TC) in patents with different syndromes of disease group(including lightness(L), red-green axis(a), yellow-blue axis(b), luminance(Y), difference between red signal and brightness(Cr), difference between blue signal and brightness(Cb), contrast(CON), angular second moment(ASM), entropy(ENT), mean value(MEAN), tongue coating area/tongue surface area(perAll), and tongue coating area/non-coated area(perPart)). Logistic regression analysis was conducted to identify influencing factors for different syndrome types of glucolipid metabolic disorders. Results The tongue body indicators TB-L, TB-Y, and TB-Cb in the disease group were significantly higher than those in the control group, while TB-a, TB-b, and TB-Cr were significantly lower. The tongue coating indicators TC-L, TC-Y, TC-Cb, perAll, and perPart in the disease group were significantly higher than those in the control group, while TC-a, TC-b, and TC-Cr were significantly lower(P<0. 05). Comparing with the different syndromes in disease group, the TB-L and TB-Y of the liver depression and spleen deficiency syndrome, and the phlegm-damp obstruction syndrome were higher than those of the qi stagnation and blood stasis syndrome; the TB-a and TB-Cr of the phlegm-damp obstruction syndrome were lower than those of the qi stagnation and blood stasis syndrome; the perAll of the phlegm-damp obstruction syndrome was higher than that of the qi stagnation and blood stasis syndrome(P<0. 05). In the analysis of the morphological characteristics of tongue signs, more spotted tongue in disease group compared with control group, more teeth-marked tongue in liver depression and spleen deficiency syndrome than the other two syndromes, more greasy coating in phlegm-damp obstruction syndrome, and more stasis spots of tongue in qi stagnation and blood stasis syndrome(P<0. 05). Logistic regression analysis identified that greasy coating, spotted tongue, stasis spots of tongue, tooth-marked tongue, perAll, and TB-Cb are the influencing factors of liver depression and spleen deficiency syndrome; greasy coating, tooth-marked tongue, TC-Cb, and TC-Cr are the influencing factors of phlegm-damp obstruction syndrome; cracked tongue, stasis spots of tongue, tooth-marked tongue, and TB-Y are the influencing factors of qi stagnation and blood stasis syndrome(P<0. 05). Conclusion Compared to healthy individuals, patients with glycolipid metabolic disorder have darker tongue color and thicker, greasy tongue coating. Glycolipid metabolic disorder patients of liver depression and spleen deficiency syndrome exhibit a reddish tongue with finer textures and more tooth marks; patients of phlegm-damp obstruction syndrome have lighter tongue coating with a coarser texture and a higher prevalence of greasy coating; patients of qi stagnation and blood stasis syndrome display lower tongue brightness with a higher prevalence of blood stasis spots.