老年慢性肾脏病3-5期中医辨治特点的探究

发布时间：2018-05-20 13:22

本文选题：老年人 + 慢性肾脏病　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:通过对老年慢性肾脏病(CKD)3-5期患者的中医辨治的临床调查,总结出其证型分布及中医辨证治疗特点,并进一步探讨出主要证型与实验室指标间的相关性,使我科(北京市中西医结合肾内科)诊治老年CKD3-5期的方案得到进一步优化,并提出理论及实践依据。方法:本课题采用回顾性研究及实时录入方法,选取2012年01月至2016年12月北京市中西医结合医院肾内科病房及门诊符合标准的122例老年CKD3-5期病例,逐一统计性别、年龄、原发病、CKD分期、证型、中医用药及相关辅助检查等内容。结果:老年CKD3-5期患者中,糖尿病肾病是慢性肾脏病最为常见的原发病,总共44例,不明原因导致的肾脏病排名第二,有25例,慢性肾小球肾炎18例、高血压肾损害16例、痛风性肾病8例。中医证型分布特点中,本虚证出现频数最多的是气阴两虚证(46例),其次依次为脾肾阳虚证(43例)、脾肾气虚证(17例)、肾元亏虚证(10例)、肝肾阴虚证(6例)。标实证中,毒瘀互结证(87例)最多见,水气证(38例)次之,湿热证(15例)、血瘀证(13例)则较为少见。临证常用生黄芪、丹参、川牛膝、白茅根、水蛭、女贞子、白花蛇舌草、党参等药物。血肌酐、血清β 2微球蛋白、尿酸在诊断老年CKD脾肾阳虚这一证型上的R0C曲线面积分别为0.681、0.837、0.427。结论:我科老年CKD3-5期患者本虚证中以气阴两虚、脾肾阳虚为多,标实证中以毒瘀互结证最为常见;在治疗过程中抓住核心病机,扶正与祛邪双管齐下,主要治法为:补脾益肾、活血通络、通腑降浊、清热解毒;补益活血药常用黄芪、党参、白术、淫羊藿、女贞子、丹参、川牛膝、水蛭;通腑解毒药多选用白茅根、白花蛇舌草、蒲公英、石苇、地榆、大黄。其次,血清β 2微球蛋白水平与老年CKD脾肾阳虚证密切相关,在一定程度上可以预测老年CKD脾肾阳虚证的发生,为中医证型的客观化提供临床依据,更好的指导了中医临床辨证治疗。
[Abstract]:Objective: to summarize the distribution of syndrome types and the characteristics of TCM syndrome differentiation and treatment, and to explore the correlation between the main syndromes and laboratory indexes through the clinical investigation of TCM differentiation and treatment of aged patients with chronic kidney disease (CKD) at stage 3-5. So that our department (Beijing integrated traditional and western medicine nephrology) program for the diagnosis and treatment of elderly CKD3-5 stage was further optimized, and put forward the theoretical and practical basis. Methods: a retrospective study and real-time input method were used to select 122 elderly CKD3-5 patients who met the criteria in the Department of Nephrology and Out-patient Clinic of Beijing Integrated Chinese and Western Medicine Hospital from January 2012 to December 2016. Primary disease CKD staging, syndrome type, Chinese medicine and related auxiliary examination and so on. Results: among the elderly patients with CKD3-5, diabetic nephropathy was the most common primary disease of chronic kidney disease, with 44 cases in total. The unexplained causes of renal disease ranked second, 25 cases, 18 cases of chronic glomerulonephritis, 16 cases of renal damage due to hypertension. 8 cases of gouty nephropathy. In the distribution of TCM syndromes, 46 cases of Qi and Yin deficiency syndrome appeared most frequently, followed by 43 cases of spleen and kidney yang deficiency syndrome, 17 cases of spleen and kidney qi deficiency syndrome, 10 cases of kidney deficiency syndrome and 6 cases of liver and kidney yin deficiency syndrome. In the standard evidence, 87 cases of toxin and blood stasis syndromes were most common, 38 cases of water and qi syndromes), 15 cases of damp-heat syndrome and 13 cases of blood stasis syndrome). Astragalus, Salvia miltiorrhiza, Radix Achyranthes bidentata, Roots, Leech, Ligustrum lucidum, Codonopsis and so on. The R0C curve area of serum creatinine, serum 尾 2 microglobulin and uric acid in the diagnosis of senile CKD syndrome type of deficiency of spleen and kidney yang was 0.681n0.837 ~ 0.427, respectively. Conclusion: the deficiency of qi and yin, deficiency of spleen and kidney and deficiency of spleen and kidney are the most common syndromes in the aged patients with CKD3-5 in our department, and the syndrome of toxin and blood stasis is the most common in the standard demonstration, and in the course of treatment, the core pathogenesis is grasped, the two ways of strengthening the spirit and dispelling evil are combined, the main treatment methods are: invigorating the spleen and nourishing the kidney. Astragalus, Codonopsis, Atractylodes macrocephala, Epimedium, Ligustrum lucidum, Salvia miltiorrhiza, Radix Achyranthes bidentata, leeches, etc. Rhubarb. Secondly, the level of serum 尾 2 microglobulin is closely related to the syndrome of deficiency of spleen and kidney yang in aged CKD, which can predict the occurrence of deficiency of spleen and kidney yang in elderly patients with CKD to a certain extent, and provide the clinical basis for the objectivity of TCM syndrome type. Better guidance of TCM clinical syndrome differentiation treatment.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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