基于中医“心肾相关”理论对慢性肾脏病患者继发心衰的研究

发布时间：2018-08-02 19:29

【摘要】：研究背景及目的:诸多研究已证实心、肾在病理及生理上存在交互影响,现代医学在病理方面提出心肾综合征来定义,并对其发病机制、诊疗做了进一步的探索,而中国古代医学也早已提出心肾相关的理论来论述。近几年来,由于心、肾交互影响加重了自身疾病的发展,使得患有肾脏疾病或心脏疾病的人群的死亡率日益增高,心肾相关方面的研究越来越受到重视,并有着重要的临床指导意义。本次研究基于中医传统理论研究慢性肾脏病患者继发心衰的发生率、危险因素、与肾小球滤过率降低程度的关系,进一步运用科学的数据证实中医"心肾相关"理论的科学性,而在心力衰竭的评估方面,选取了临床常用筛查指标——BNP(brain natriuretic peptide,脑钠肽),具体研究慢性肾脏病患者继发BNP400ng/L时的发生率、危险因素、与肾小球滤过率降低程度的关系。方法:研究资料选取于2015年11月-2016年4月入住大连医科大学附属第二医院肾内科病房,并且明确诊断为慢性肾脏病CKD4-5期的672病次,根据入院BNP检测结果,将400ng/L作为评估心力衰竭的界限,BNP400ng/L为升高组,对所有患者的人口学特征、病历资料及实验室检验结果等进行汇总,在相关数据分析方面,分类性资料用频数(百分数)表示,采用卡方检验处理;连续性资料用算数平均数±标准差表示,采用独立样本t检验,上述数据处理均使用统计学软件SPSS22.0。结果:1、慢性肾脏病患者BNP400ng/L的发生率为(294/672)43.75%。2、在所有纳入患者中,糖尿病肾病占慢性肾脏病患者病因的首位,且BNP400ng/L的发生率最高,其为59.16%。3、在所有分组分析中,就有无BNP升高的两组之间比较,性别、是否行透析治疗、院内死亡事件均无明显差异(P0.05)。4、在所有分组分析中,就有无BNP升高的两组之间比较,慢性肾脏病CKD4期与CKD5期之间存在明显差异(P0.05),CKD5期患者的BNP升高发生率明显大于CKD4期患者。5、在所有纳入患者中,BNP升高的危险因素包括年龄、血清总蛋白(TP)、钙(Ca)、甘油三酯(TG)、钠(NA)、血清白蛋白(ALB)、血清铁(SI)、铁饱和度(TS)、空腹血糖(FBG)。6、对糖尿病肾病及慢性肾小球肾炎亚组分析中,BNP升高的危险因素包括年龄、血红蛋白(Hb)、甘油三酯(TG)、空腹血糖(FBG)、甲状旁腺素(PTH);对于贫血亚组分析中,BNP升高的危险因素包括年龄、空腹血糖(FBG)、钠(NA)、甘油三酯(TG)、血清白蛋白(ALB);对于高尿酸血症亚组分析中,BNP升高的危险因素包括年龄、血清总蛋白(TP)、甘油三酯(TG)、血清白蛋白(ALB)。7、对死亡原因亚组分析中,心源性猝死所占比例最大,其约为36.84%,其次尿毒症脑病及休克均占约15.79%。结论:1、BNP400ng/L在慢性肾脏病CKD4-5期患者中的发生率为43.75%。2、年龄、甘油三酯为BNP400ng/L的独立危险因素。3、BNP400ng/L与肾小球滤过率降低程度有关,CKD5期患者的发生率明显高于CKD4期,并且肾脏本身疾病越重对心功能影响越大。4、慢性肾脏病患者继发心衰普遍存在,进一步证实了中医"心肾相关"理论的科学性。
[Abstract]:Research background and purpose: many studies have proved that the kidney has an interactive effect on the pathology and physiology. Modern medicine puts forward the definition of heart and kidney syndrome in pathology, and further explores its pathogenesis, diagnosis and treatment, and Chinese ancient medicine has already put forward the theory of heart and kidney related. In recent years, because of heart and kidney exchange Mutual influence aggravates the development of the disease and makes the mortality of the people with kidney disease or heart disease increasing. The research on the related aspects of heart and kidney is becoming more and more important and has important clinical significance. This study is based on the traditional Chinese medicine theory to study the incidence of secondary heart failure in patients with chronic kidney disease and the risk factors. In relation to the degree of glomerular filtration rate, the scientific data were used to confirm the scientific nature of the theory of "heart and kidney correlation" in traditional Chinese medicine. In the assessment of heart failure, the clinical screening index, BNP (brain natriuretic peptide, brain natriuretic peptide), was selected to study the incidence of secondary BNP400ng/L in patients with chronic kidney disease. The relationship between the risk factors and the reduction of glomerular filtration rate. Methods: the data were selected in the nephrology ward of the Second Affiliated Hospital of Dalian Medical University in April -2016, November 2015, and the diagnosis was clearly diagnosed as 672 times of chronic renal disease (CKD). According to the BNP test results, 400ng/L was used to assess the limits of heart failure, BNP 400ng/L is an elevated group. The demographic characteristics, medical records and laboratory test results of all the patients are summarized. In the analysis of related data, the classification data are expressed in frequency (percentage), using the chi square test; the continuous data are expressed with the average number of calculated numbers, and the independent sample t test is used. The above data are processed all Using statistical software SPSS22.0. results: 1, the incidence of BNP400ng/L in patients with chronic kidney disease is (294/672) 43.75%.2. In all the patients, diabetic nephropathy accounts for the first cause of chronic kidney disease, and the highest incidence of BNP400ng/L is 59.16%.3. In the group analysis, there is a comparison between the two groups with no BNP increase. There were no significant differences (P0.05).4. In all group analysis, there was a comparison between two groups with no BNP increase. There was a significant difference between CKD4 and CKD5 (P0.05) in chronic renal disease (P0.05). The incidence of BNP in CKD5 patients was significantly greater than that of.5 in the CKD4 stage patients, and in all the patients, BNP increased Risk factors include age, serum total protein (TP), calcium (Ca), triglyceride (TG), sodium (NA), serum albumin (ALB), serum iron (SI), iron saturation (TS), and fasting blood glucose (FBG).6 in subgroups of diabetic nephropathy and chronic glomerulonephritis. The risk factors for BNP increase include age, hemoglobin (Hb), triglycerides (TG), and fasting blood glucose. Parathyroid hormone (PTH); for anemic subgroup analysis, risk factors for elevated BNP include age, fasting blood glucose (FBG), sodium (NA), triglyceride (TG), and serum albumin (ALB). In the analysis of hyperuricemia subgroup, the risk factors for elevated BNP include age, serum total protein (TP), triglyceride (TG), and serum albumin (ALB).7, to the dead. In the sub group analysis, the proportion of sudden cardiac death was the largest, which was about 36.84%, followed by uremic encephalopathy and shock, which accounted for 15.79%. conclusion: 1, the incidence of BNP400ng/L in CKD4-5 patients in chronic renal disease was 43.75%.2, age, triglyceride as an independent risk factor of BNP400ng/L, BNP400ng/L and the degree of glomerular filtration rate decreased. The incidence of CKD5 patients was significantly higher than that in the CKD4 stage, and the more serious the renal disease was, the greater the heart function was.4. The secondary heart failure of the patients with chronic kidney disease was common, which further confirmed the scientific nature of the theory of "heart kidney related" in Chinese Medicine.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692;R541.6

【相似文献】