2型糖尿病肾病蛋白尿中医证候分布特点研究

发布时间：2018-01-12 21:08

本文关键词：2型糖尿病肾病蛋白尿中医证候分布特点研究　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：糖尿病肾病(Diabetic kidney disease, DKD)是糖尿病的一种微血管并发症,一般是指糖尿病性的肾小球硬化症,有其特异的临床演变过程,早期为肾小球高滤过状态,继之出现微量白蛋白尿,尿中白蛋白逐渐增高进入临床白蛋白尿期,最后发展为肾功能衰竭。蛋白尿是糖尿病肾病的重要指标之一,关系到糖尿病肾病进展和预后,早期蛋白尿通过严格控制血糖、血压、血脂,可有效阻止病情进展,一旦出现临床期蛋白尿,则预示着疾病发展的速度加快,直至发展为终末期肾衰。所以控制和尽可能减少蛋白尿,成为延缓糖尿病肾病进展的重中之重,西医治疗糖尿病肾病蛋白尿主要以严格控制血压、血糖、血脂,改善血管微循环为主要治疗环节,中医药也是控制蛋白尿,延缓糖尿病肾病进展一个重要的治疗手段,若能通过中医改善早期微量蛋白尿和延缓临床期蛋白尿进展,则有很大的临床价值。研究目的：本研究在中医理论的指导下,尝试从蛋白尿角度出发,初步探讨糖尿病肾病早期微量蛋白尿与临床期蛋白尿中医证候分布特点,为进一步治疗糖尿病肾病蛋白尿提供比较可靠依据。本论文包括文献综述和临床研究两部分。文献综述共两篇,第一篇为西医综述,归纳了糖尿病肾病相关因素,以进一步更好的预防糖尿病肾病蛋白尿的发生发展,第二篇为中医综述,归纳了糖尿病肾病蛋白尿的中医病名归属、病因病机、辨证论治等。研究方法：临床研究部分对120例我院住院明确诊断糖尿病肾病蛋白尿患者进行了调查,依据Mogensen分期标准,将患者分为A、B两组,A组选取Ⅲ期微量蛋白尿(24小时尿蛋白定量在30mg-300mg之间),B组选取Ⅳ期临床期蛋白尿(24小时尿蛋白定量在0.5g-3.5g),参照2011年《糖尿病肾病中医防治指南》中的诊断标准,制定调查表,收集中医症状和体征信息,对所得数据进行频数统计和聚类分析。研究结果：通过对A组症状频数进行统计,发现症状由多到少依次为脾气虚、湿邪、肾精不足、瘀血的表现。A组聚类分析结果发现乏力出现在各个类别中,按照类别出现例数由多到少依次为脾气虚、湿盛、肾精不足、血瘀。B组症状频数统计可以看出乏力、,少气赖言所占比例仍较高,同时肾精不足的和血瘀比例明显增加,如夜尿多、腰酸、耳鸣、脱发等,并出现胸痛、肢体疼痛、肢体麻木等血瘀表现；B组聚类分析结果发现乏力出现在各个类别中,按照类别出现例数由多到少依次为第1类别,表现为夜尿多、腰酸、耳鸣、脱发、乏力、下肢水肿、失眠,主要与脾肾两虚有关,第3类表现为肢体疼痛、乏力、手足麻木、胸痛、肌肤甲错,主要与气虚血瘀有关,且出现肌肤甲错等血瘀重症；第4类别为乏力、少气懒言、大便不成形、食欲不振,主要与脾气虚有关,第5类为思睡、肢体沉重、头重如裹、肢体疼痛、大便粘,主要与湿盛有关,第8类别为耳鸣、大便排出费力、水肿、怕冷、夜尿多、畏寒、腰膝冷痛、脱肛、失眠,与肾阳虚有关。研究结论：1.糖尿病肾病蛋白尿的中医证候特点为本虚标实,早期蛋白尿和临床期蛋白尿有共同的病机,即脾气虚、肾精不足、血瘀、湿证,但程度轻重上有差别,早期蛋白尿本虚证以脾气虚兼肾精不足为主,大量蛋白尿患者为脾肾俱虚,标实证血瘀的证候更突出,可能与久病由脾及肾,久病入络有关。2.无论是早期蛋白尿还是临床期蛋白尿组,脾气虚病机更突出,传统阴虚燥热理论受到质疑。
[Abstract]:Diabetic nephropathy (Diabetic kidney, disease, DKD) is a kind of diabetic microvascular complications, generally refers to the diabetic glomerular sclerosis, the clinical evolution has its specific, early glomerular hyperfiltration, the microalbuminuria, proteinuria in white gradually increased in clinical albuminuria, finally renal failure. Proteinuria is one of the important indexes of diabetic nephropathy, related to the progression and prognosis of early diabetic nephropathy, proteinuria through strict control of blood glucose, blood pressure, blood fat, can effectively prevent the progression of the disease, once the clinical proteinuria, adumbrative disease development speed, until the development of end-stage renal failure. So as far as possible to control and reduce proteinuria, become a priority among priorities to delay the progress of diabetic nephropathy, western medicine treatment of proteinuria in diabetic nephropathy mainly in the strict control of blood pressure, blood sugar, Blood lipids, improve blood circulation as the main aspects of treatment, TCM is control of proteinuria and diabetic nephropathy is one of the important means of treatment, if can improve the early microalbuminuria and delay the progression of proteinuria by TCM clinical stage, it has a great clinical value. Objective: This study is based on the theory of traditional Chinese medicine under the guidance of try starting from the angle of proteinuria, preliminary study on early diabetic nephropathy microalbuminuria and clinical proteinuria characteristics of TCM syndrome distribution, provide a reliable basis for further treatment of diabetic nephropathy. This thesis consists of two parts: literature review and clinical research. The literature review consists of two parts, the first part is the review, summarized related the factors of diabetic nephropathy, with the further development of better prevention of diabetic nephropathy proteinuria, second for TCM review, summarized the proteinuria of diabetic nephropathy The TCM disease name attribution, etiology and pathogenesis, syndrome differentiation and treatment. Methods: clinical study of 120 cases in our hospital diagnosed in patients with diabetic nephropathy proteinuria were investigated according to Mogensen criteria, the patients were divided into A, B two groups, A group selected phase III (24 hours urine protein urinary protein between 30mg-300mg), group B: IV clinical stage proteinuria (24 hour urine protein in 0.5g-3.5g), according to diagnostic criteria, TCM guidelines for prevention and treatment of diabetic nephropathy in 2011 < > in the questionnaire to collect information, TCM symptoms and signs of frequency statistics and cluster analysis on the data. The results of the study: through the statistics of A symptom frequency, symptom was followed by the more to less spleen deficiency, dampness, deficiency of kidney, blood stasis group.A clustering analysis results show that the fatigue appeared in various categories, the number of cases by according to categories More to less in the spleen deficiency, dampness, deficiency of kidney, blood stasis group.B symptom frequency statistics can be seen, fatigue, less gas Lai said the proportion is still high, at the same time, kidney deficiency and blood stasis increased significantly, such as nocturia, backache, tinnitus, hair loss, and chest pain, limb pain the numbness, blood stasis; group B cluster analysis results showed that fatigue appeared in various categories, the number of cases in accordance with the categories from more to less were first categories for nocturnal enuresis, backache, tinnitus, fatigue, alopecia, lower extremity edema, insomnia, and spleen kidney two empty, third types of performance limb pain, weakness, numbness, pain, skin armour fault, mainly related to Qi deficiency and blood stasis, and blood stasis and other severe skin armour fault; fourth categories for fatigue, less gas lazy words, shapeless stool, loss of appetite, mainly related with spleen deficiency, fifth for drowsy, heavy limbs, heavy Wrap, limb pain, stool sticky, mainly related to dampness, eighth categories for tinnitus, stool laborious, edema, cold, nocturia, chills, cold waist and knee pain, prolapse, insomnia, associated with kidney yang deficiency. Conclusions: the characteristics of TCM Syndromes of 1. diabetic nephropathy proteinuria in superficiality. Early stage clinical proteinuria and albuminuria are common disease, namely spleen deficiency, kidney essence deficiency, blood stasis and dampness, but there is a difference of degree, early proteinuria this deficiency of spleen qi deficiency and kidney deficiency, proteinuria in patients with spleen and kidney asthenia, blood stasis syndrome sthenia more prominent, may be related to chronic illness by the spleen and kidney, chronic illness into the network of.2. whether early clinical proteinuria or albuminuria group, spleen qi deficiency disease is more prominent, the traditional theory of Yin hot questioned.

【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】：2016
【分类号】：R277.5;R259

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