慢性肾脏病中医食疗情况调查及初步效果分析

发布时间：2018-01-07 14:14

本文关键词：慢性肾脏病中医食疗情况调查及初步效果分析　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：慢性肾脏病(Chronic kidney disease CKD)是一种慢性疾病,全球发病率逐年增加,医疗卫生费用支出也不断上升,已经成为国际的公共卫生问题。1869年就有人提出饮食和营养处方是治疗CKD的组成部分,科学合理的低蛋白饮食可以可延缓肾脏病进展、减少并发症,改善机体营养,还可以减轻经济负担。中医食疗具有药食同源的特点,是具有中医特色的饮食疗法,历史悠久。中医食疗在治疗水肿、肾风、肾劳等具有丰富的文献资料,相关的文献挖掘和临床研究越来越受到肾科医生的重视。中医食疗疗效显著、无毒副作用,同时满足人们对美味的追求,提高患者依从性等优点。本研究通过回顾性研究探索中医食疗对CKD肌酐(Serum creatinine Scr)及肾小球滤过率(Glomerular filtration rate GFR)的影响,为指导CKD患者的中医食疗提供参考。方法：对2015年6月1日至2016年1月31日在广东省中医院慢性病门诊规律就诊的CKD3-5期非透析患者进行问卷调查,调查后筛选eGFR60ml/min/1.73m2,年龄在18-80岁患者,排除临床数据缺失或随访时间不足半年、并发严重内科疾病者。根据调查问卷了解患者的中医食疗情况；通过门诊系统及住院系统采集患者的人口学资料、疾病临床特征、实验室指标、中西医用药情况等。数据使用SPSS17.0软件进行分析。根据患者是否使用中医食疗分为两组,比较两组间Scr和GFR的变化。结果：本研究纳入126例患者,中位随访时间127.68(77.68,156.36)周。中医食疗组组内比较,半年的△Scr和△eGFR的差异具有统计学意义(p＜0.05),一年和二年的△Scr和△eGFR的差异无统计学意义。非食疗组组内比较二年的△Scr和△eGFR的差异具有统计学意义,半年和一年的△Scr和△eGFR差异无统计学意义。中医食疗组和非食疗组的△Scr和△eGFR行组间比较,差异无统计学意义。危险因素分析,使用logistic回归中的Likelihood Ratio方法进行分析。模型Ⅰ中,中医食疗的危险度是非中医食疗的0.46倍(95%CL 0.221,0.968)。模型Ⅱ中,中医食疗和非中医食疗组相比,中医食疗和中药汤剂风险分别为0.44(95%CL0.212,0.951)和0.27(95%CL 0.071,1.093)食疗药材统计发现,平性和温性的药物占主体,这些药物多数归肺部、肾、脾三经。食用频次统计发现,淮山出现的频次最多,占57.58%。讨论：饮食治疗在延缓CKD进展中占据重要地位。中医食疗源远流长,在防治疾病方面具有其一定的优势,其治疗CKD作用越来越受到重视。本研究发现中医食疗组中患者的eGFR变化趋势较平缓,非食疗组中eGFR变化较明显。进行多因素的分析发现,中医食疗是CKD的保护因素。中医食疗具有稳定病情和延缓CKD进展的作用。本研究是一个回顾性研究,存在数据缺失、患者回忆偏差、调查问卷设计欠全面等不足,因此还需大样本、随访时间更长的前瞻性临床研究来评估中医食疗对CKD的影响。
[Abstract]:Objective: chronic kidney disease (Chronic kidney disease CKD) is a chronic disease, the global incidence increased year by year, health care costs are rising,.1869 has become a public health problem in international year was made on diet and nutrition prescription is part of a scientific and reasonable treatment of CKD, low protein diet can be delay the progression of renal disease, reduce complications, improve nutrition, but also can reduce the economic burden. The Chinese diet has the characteristics of homology of medicine and food, diet therapy, has the characteristics of traditional Chinese medicine has a long history. The Chinese diet in the treatment of renal edema, renal wind, has rich literature, literature mining and clinical research more and more by nephrologists attention. The Chinese diet has obvious curative effect, no toxic side effect, at the same time to meet the pursuit of delicious, improve the compliance of patients. This research through retrospective research The exploration of Chinese diet on CKD (Serum creatinine Scr) creatinine and glomerular filtration rate (Glomerular, filtration rate GFR) effect, provide a reference for the Chinese diet guide CKD patients. Methods: from June 1, 2015 to January 31, 2016 in Guangdong Province Traditional Chinese Medical Hospital outpatient treatment of chronic disease of CKD3-5 non dialysis patients by questionnaire investigation, screening of eGFR60ml/min/1.73m2. At the age of 18-80 patients, the exclusion of missing data or clinical follow-up for half a year, with severe medical conditions. According to the questionnaire to understand the Chinese diet of patients; through the outpatient system and demographic data acquisition system in hospital patients, clinical features, laboratory indicators of disease, traditional Chinese medicine and Western medicine and so on. The data were analyzed using SPSS17.0 software. According to whether the patients using the Chinese diet were divided into two groups, were compared between the two groups in Scr and GFR. This study included 126 patients, the median follow-up time was 127.68 (77.68156.36) weeks. The Chinese diet group, the difference was statistically significant in the first half of delta Scr and delta eGFR (P < 0.05), no statistically significant difference between one year and two years of delta Scr and delta eGFR. The difference was statistically significant the non diet group compared two years of delta Scr and delta eGFR, Delta Scr and delta was no statistically significant difference of eGFR half a year and one year. The Chinese diet group and non therapy group of delta Scr and delta eGFR groups, the difference was not statistically significant. The risk factor analysis, using Likelihood Ratio logistic regression method in the analysis. In the first model, the risk of Chinese diet is 0.46 times of non Chinese diet (95%CL 0.221,0.968). Model II, compared to the Chinese diet and non Chinese diet group, Chinese diet and traditional Chinese medicine decoction risk was 0.44 (95% CL0.212,0.951) and 0.27 (9 5%CL 0.071,1.093) found that therapeutic medicine statistics, flat and temperature of drugs accounted for the main body, most of these drugs to the lungs, kidney, spleen and three. Food frequency statistics found that Chinese yam appear most, accounted for 57.58%. discussion: diet therapy plays an important role in the progression of CKD. The Chinese diet has a long history, has the certain the advantages in the prevention and treatment of diseases, the treatment effect of CKD is paid more and more attention. The study found that the change trend of eGFR in the group of patients with the Chinese diet is gentle, non eGFR diet group changed obviously. Analysis of multi factors, the Chinese diet is a protective factor for CKD. The Chinese diet has a stable condition and effect of delaying the progress of CKD. This study is a retrospective study of patients with missing data, recall bias, questionnaire design less comprehensive problems, so we need a large sample, prospective clinical follow-up longer research To evaluate the effect of traditional Chinese medicine diet on CKD.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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