102例慢性肾脏病3-5期非透析患者中医证候特征及其相关性分析

发布时间：2018-01-22 12:02

  本文关键词： 慢性肾脏病 中医证候 分布规律　出处：《湖北中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的对102例慢性肾脏病(Chronic Kidney Disease,CKD)3-5期非透析患者的中医证候进行辨证分析,并结合临床指标进行相关分析,探讨其中医证候分布特点及其与相关因素的关系,为临床中医药防治慢性肾脏病提供理论依据,并为相关研究提供借鉴。方法本研究以来自湖北省中医院肾病门诊及住院部的102例慢性肾脏病3-5期非透析患者作为对象,采用统一问卷调查方式收集其临床资料,包括一般情况如姓名、性别、年龄、体重、基础病因、病程等,实验室指标包括血红蛋白、24小时尿蛋白定量、血肌酐、尿素氮、血清白蛋白、血尿酸、总胆固醇、甘油三酯、甲状旁腺激素等。根据中医证候诊断标准进行辨证分析,对各证型出现的频率及百分比予以统计,并与一般情况及临床生化指标进行相关统计学分析,探讨CKD3-5期非透析患者的中医证候特征以及与相关影响因素之间的联系。结果1.一般资料情况:102例CKD3-5非透析患者中男性有56例,占54.90%;女性有46例,占45.1%,男女比率为1.22:1。年龄为20~84岁,其中18-44岁18例(17.64%);45-59岁47例(46.07%);60-74岁30例(29.41%);75-89岁7例(6.87%);平均51.4岁。2.原发病中,慢性肾小球肾炎33例,占32.35%;糖尿病肾病21例,占20.59%;高血压肾损害17例,占16.67%;尿酸性肾病9例,占8.82%;慢性肾盂肾炎5例,占4.90%;其他疾病等共17例,占16.67%。数据显示,慢性肾脏病患者原发病因复杂,以慢性肾小球肾炎、糖尿病肾病、高血压肾损害为主。3.中医症状出现频率:前10位的症状依次为倦怠乏力、腰膝酸软、夜尿频多、气短懒言、食少纳呆、脘腹胀满、肢体困重、大便不实、五心烦热、口干咽燥等,以正虚症状居多,亦兼夹邪实症状,表明慢性肾衰竭是以本虚为主,多虚实夹杂,符合本虚标实的中医病理学特点。4.中医证型分布情况:102例患者本虚证中脾肾气虚证49例,脾肾阳虚证13例,气阴两虚证28例,肝肾阴虚证10例,阴阳俱虚证2例;邪实证中湿热证36例,湿浊证21例,瘀血证27例,水气证8例,热毒证4例。本虚证中脾肾气虚证最多,占48.02%,明显高于其他证型,余为气阴两虚证脾肾阳虚证肝肾阴虚证阴阳俱虚证,标实证中以湿热证、瘀血证、湿浊证为主,分布占35.29%,27.45%,20.59%,而水气证,浊毒证较少。本虚与标实兼夹中,脾肾气虚证、气阴两虚证与各邪实证均可兼夹,以与湿热证、瘀血证相兼夹为主,其次为湿浊证,亦可无邪实证。而肝肾阴虚证多与瘀血证相兼夹。总体来看,多兼夹湿热、湿浊及瘀血等实邪为主。5.性别的不同对患者本虚证、邪实证的分布均无相关影响;而年龄段的不同只对邪实证分布有影响,对本虚证的分布无影响;表现为青年人多见于湿热证,余证均较少;中年人亦以湿热证为主,占绝大部分,瘀血证、湿浊证也常见,而浊毒、水湿证居少;年轻老年人以瘀血证居多,湿热证其次,水湿证、浊毒亦较少,老年人在各邪实证上分布无明显差异。6.不同分期证型分布情况:102例患者3期有40人,占39.22%,4期有43人,占42.16%,5期有19人,占18.62%。以4期人数最多,依次为3期、5期。本虚证中3期、4期患者以脾肾气虚证最为多见,其次为气阴两虚证,而脾肾阳虚证,肝肾阴虚证随肾功能进展逐渐增多,以5期最为多见。邪实证中3期,4期患者以湿热证,瘀血证多见,浊毒证,水气证较少,5期以湿浊证,瘀血证多见,水气证最少。7.临床指标与证型关系:本虚证中,肝肾阴虚证、脾肾阳虚证患者血肌酐、尿素氮、甲状旁腺激素水平均明显高于脾肾气虚证、气阴两虚证患者,而脾肾阳虚证患者血红蛋白水平明显低于其他3证的患者,说明脾肾阳虚证、肝肾阴虚证在肾功能损害较重的患者中多见,且血清PTH水平较高,脾肾阳虚证患者多贫血,且较重。邪实证中,湿浊证患者血尿素氮、血肌酐水平较高,血红蛋白水平相应低,水气证患者血清白蛋白水平低,肾功能相对较差,湿热证患者尿蛋白表现突出。结论1.102例CKD3-5期非透析患者中男性多于女性,以中年人为主。原发病以慢性肾小球肾炎最常见,糖尿病肾病、高血压肾损害居多。2.患者最常见症状为怠倦乏力,本虚证以脾肾气虚证最多,气阴两虚证其次,脾肾阳虚证、肝肾阴虚证、阴阳俱虚证较少且随CKD进展而逐增。邪实证以湿热证、瘀血证多见,湿浊证、浊毒证多见于后期。兼证以脾肾气虚兼湿热证最多,脾肾气虚兼瘀血证、气阴两虚兼湿热证、肝肾阴虚兼瘀血较多。3.不同性别对中医证型分布未见明显影响,不同年龄段对本虚证分布无明显影响,对邪实证有一定影响。4.血红蛋白、血清白蛋白、血清尿素氮、血肌酐、甲状旁腺激素等与中医证型分布有关系,水气证患者多伴低白蛋白血症,湿热证多见于蛋白尿患者,脾肾阳虚证患者多伴有贫血。
[Abstract]:The purpose of 102 cases of chronic kidney disease (Chronic Kidney, Disease, CKD) 3-5 non dialysis patients with TCM syndrome differentiation and analysis, combined with clinical indicators of correlation analysis, to explore the relationship between the distribution of TCM syndrome and its related factors, and provide a theoretical basis for clinical prevention and treatment of TCM of chronic kidney disease, and to provide reference for the related studies. Methods 102 cases of chronic kidney disease in this study from Hubei Provincial Traditional Chinese Medical Hospital outpatient and inpatient department of nephropathy stage 3-5 non dialysis patients as the object, using the clinical data collection questionnaire survey, including the general situation such as name, gender, age, weight, basic course, etiology, laboratory indexes including hemoglobin, 24 hours urine protein, serum creatinine, urea nitrogen, serum albumin, serum uric acid, total cholesterol, triglyceride, parathyroid hormone syndrome. According to TCM syndrome diagnostic criteria Analysis of frequency and percentage of each type of statistics, and statistical analysis was performed with the general condition and clinical biochemical indicators between the factors of CKD3-5 non dialysis patients with the characteristics of TCM syndromes and related effects of contact. Results of the 1. general information: 102 cases of CKD3-5 in non dialysis patients with male 56 cases women, accounting for 54.90%; 46 cases, accounting for 45.1%, the ratio of male to female is 1.22:1. age 20~84 years, 18-44 years old in 18 cases (17.64%); 45-59 47 cases (46.07%); 60-74 30 cases (29.41%); 75-89 7 cases (6.87%); the average age of 51.4.2. in the pathogenesis of chronic glomerular. In 33 cases, accounting for 32.35%; 21 cases of diabetic nephropathy, accounted for 20.59%; 17 cases of hypertensive renal injury accounted for 16.67%; uric acid nephropathy in 9 cases, accounting for 8.82%; 5 cases of chronic pyelonephritis, other diseases accounted for 4.90%; a total of 17 cases, accounting for 16.67%. data show that patients with chronic kidney disease etiology complex, chronic kidney 灏忕悆鑲剧値,绯栧翱鐥呰偩鐥，

本文编号：1454611