慢性肾脏病基础上急性肾损伤影响因素及中医证候临床调查

发布时间：2018-01-11 12:38

  本文关键词：慢性肾脏病基础上急性肾损伤影响因素及中医证候临床调查　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 慢性肾脏病 急性肾损伤 中医证候 临床调查

【摘要】：目的:从临床角度分析影响慢性肾脏病基础上急性肾损伤(AKI on CKD或A/C)预后的因素及中医证候,探讨其中医病机及证候规律,为中医药防治该病提供参考。方法:通过江苏省中医院病例系统查找2013年12月至2016年11月肾内科诊断为急性肾损伤(AKI)的住院病例,并查阅诊断为慢性肾脏病(CKD)或慢性肾衰竭(CRF)的病例,根据病史判断是否存在AKI。收集符合A/C诊断条件的病例资料,观察患者肾功能的变化,分析影响肾脏预后的临床因素,并观察中医证候及其对肾脏预后影响。结果:(1)一般资料:共收集病例66例,其中男性34例(51.52%),女性32例(48.48%);年龄最小的患者18岁,年龄最大的患者84岁,中位年龄58岁,其中40岁的患者22例(33.33%),40～60 岁患者 13 例(19.70%),60 岁患者 31 例(46.97%)。导致 CKD 患者发生AKI的病因以感染居多,共23例(34.85%),原发病进展15例(22.73%),低血容量共10例(15.15%),恶性高血压6例(9.09%),服用肾毒性药物、电解质紊乱各4例(6.06%),泌尿道梗阻2例(3.03%),其他病因2例。肾脏基础病慢性肾炎居多,共26例(39.39%),肾病综合征22例(33.33%),ANCA相关小血管炎8例(12.12%),糖尿病肾病、狼疮性肾病各4例(6.06%),高血压肾损伤2例(3.03%)。住院期间接受透析治疗的共36例(54.54%),其中完全恢复8例(12.12%),部分恢复10例(15.15%),未恢复18例(27.27%)。肾功能完全恢复的共26例(39.39%),部分恢复22例(33.33%),未恢复18例(27.27%)。(2)A/C患者预后分析:患者基础肾功能差、A/C时肾功能下降显著,A/C后肾脏恢复较差,组间差别有统计学意义(P0.05);病情加重因素为恶性高血压A/C后肾脏恢复较差,组间差别有统计学意义(P0.05);肾脏基础病为肾病综合征A/C后肾脏恢复较好,组间差别有统计学意义(P0.05);肾脏基础病为狼疮性肾炎、ANCA相关小血管炎A/C后肾脏恢复较差,组间差别有统计学意义(P0.05);患者血红蛋白、血白蛋白、二氧化碳结合率等下降,A/C后肾脏恢复较差,组间差别有统计学意义(P0.05);CKD3-4患者经治疗可能摆脱透析。(3)A/C患者中医证候特点:本研究A/C患者本虚证以脾肾气虚证多见,占34例(51.51%)。其余由高到低依次为气阴两虚证、肝肾阴虚证、脾肾阳虚证、阴阳俱虚证;标实证以湿浊证多见,占24例(21.21%),其余由高到低依次为湿热证、血瘀证、热毒证、风动证;各标实证在本虚证中分布差异,本虚证脾肾气虚中标实证频率由高到低依次为湿浊证、血瘀证、,湿热证、热毒证。患者中医辨证本虚证为气阴两虚证,标实证为湿浊证、湿热证患者A/C后肾脏恢复较差,组间差别有统计学意义(P0.05)。结论:(1)感染是导致CKD患者发生AKI的最常见病因。(2)病情加重因素为恶性高血压,肾脏基础病为ANCA相关小血管炎、狼疮性肾炎,基础肾功能差、发生A/C时肾功能下降显著、合并代谢性酸中毒、贫血、低蛋白血症者,A/C后预后较差。(3)肾脏基础病为肾病综合征者A/C后预后较好,CKD3-4期患者经治疗可能摆脱透析。(4)A/C属本虚标实证,本虚证以脾肾气虚证、气阴两虚证、肝肾阴虚证多见,标实证主要表现为湿浊证、湿热证、血瘀证,气阴两虚证、湿浊证、湿热证患者A/C后预后欠佳。
[Abstract]:Objective: to analyze the effects of chronic kidney disease based on acute kidney injury from a clinical perspective (AKI on or A/C CKD) and the prognostic factors of TCM syndrome, explore the TCM syndromes and disease, to provide reference of the disease prevention and treatment of traditional Chinese medicine. Methods: the Jiangsu Province Traditional Chinese Medicine Hospital system find from December 2013 to November 2016 were diagnosed in Department of Nephrology acute kidney injury (AKI) cases, and review the diagnosis for chronic kidney disease (CKD) or chronic renal failure (CRF) patients, according to the history and determine whether there is AKI. collection with A/C diagnostic conditions of the cases, the view change of renal function in patients with observation, analysis of clinical factors affecting prognosis of kidney, and to observe the traditional Chinese medicine the syndrome and its effect on renal prognosis. Results: (1) general information: 66 cases were collected, among which 34 cases were male (51.52%), 32 cases of female (48.48%); the youngest patient was 18 years old, the oldest patient was 84 years old in a year 榫，

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