糖尿病合并慢性肾衰竭中医门诊临床数据研究

发布时间：2018-03-13 18:30

本文选题：核心方药　切入点：疗效评价　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的本研究通过对仝小林教授门诊病例资料的分析,挖掘中药治疗糖尿病合并慢性肾衰竭患者的人口学特征(性别、年龄、地址等)、就诊信息(就诊频次、就诊时间、随诊频次、随诊时间等)、疾病诊断情况(并发症及合并症)、主要症状体征(乏力、眠差、水肿等)、检验指标(血肌酐、血尿素氮、肾小球滤过率等)等信息,并研究其治疗本病的核心方药及用药规律(使用频次、配伍应用等),评价中药治疗本病的临床疗效。通过对这些数据的分析总结、验证仝小林教授治疗糖尿病合并慢性肾衰竭的临床辨证、用药经验。研究方法采用仝小林教授门诊病历系统录入糖尿病合并慢性肾衰竭的患者。利用数据挖掘方法,将无尺度复杂网络分析方法用于挖掘治疗本病的核心方药,以趋势图研究各相关指标疗效趋势,用卡方检验比较药物有效率。研究结果(1)基本信息:本研究纳入了 2005年至2015年3月期间于仝小林教授门诊就诊的糖尿病合并慢性肾衰竭患者160例,共1433次诊次。其中男性患者共106例,女性患者共54例。一年中二月份患者就诊次数最少,仅90次,三月份就诊次数最多,为146次。患者年龄段主要集中于40-70岁,以中老年人群为主。(2)疾病类型:160例患者中1型糖尿病3人,剩余为2型糖尿病157人。糖尿病并发症最多的分别是糖尿病视网膜病变、糖尿病周围神经病变及糖尿病自主神经病变。合并症最多的疾病类别依次为内分泌系统及营养代谢性疾病、循环系统疾病及消化系统疾病,单一疾病中,最常见的五种疾病分别是高血压、血脂异常、高尿酸血症、代谢综合征及脂肪肝。(3)症状及体征:最常见症状依次为乏力、水肿、便溏、眠差、肢体麻木、便秘、肢体疼痛、小便泡沫、视物模糊、口干。最常见的舌、脉诊依次为脉弦、苔腻、苔黄、脉沉、苔厚、脉滑、脉数、舌红、底络瘀、脉硬。(4)证素:证型的多样性及复合性不适合利用计算机进行统计分析,需要相互独立而又能准确表达证型含义的"最小单位"对中医辨证进行描述,因此本研究参考朱文锋教授提出的"证素"概念,对患者的中医辨证进行统计。其中最常见的3个病位证素分别是经络、脾胃、大肠,最常见的2个病性证素是血疲和浊毒,其次为火热、痰、气滞、气虚、阴虚。(5)方药:仝小林教授方中用药少则3味,多则30味,以8-9味最为常用。其处方总剂量最少45g,最多870g,平均每方总剂量为230.5±91.2g。治疗糖尿病合并慢性肾衰竭常用中药依次为大黄、黄芪、水蛭、丹参、黄连、生姜、茯苓、附子、红曲、威灵仙。本病的核心药物为大黄,核心药对为大黄、黄芪,核心方剂为大黄、黄芪、水蛭。(6)疗效与有效药物挖掘:血肌酐总体呈下降趋势,有效药物为附子、黄芪、丹参、水蛭、生姜、大黄;血尿素氮总体呈波动性下降趋势,有效药物为黄连;肾小球滤过率总体保持平稳,有效药物为半夏、淫羊藿、生姜、黄连、益母草、丹参;血尿酸总体保持水平,有效药物为威灵仙与丹参;24小时尿蛋白定量总体呈下降趋势,有效药物为水蛭和大黄;糖化血红蛋白总体呈下降趋势,有效药物为知母;空腹血糖总体呈下降趋势,未见有统计学意义的有效单药;收缩压总体呈轻微下降趋势,舒张压总体保持水平,两者有效药物均为水蛭;胆固醇总体呈下降趋势,未见有统计学意义的有效单药;甘油三酯总体呈下降趋势,有效药物为黄芪;低密度脂蛋白胆固醇总体呈下降趋势,未见有统计学意义的有效单药。结论糖尿病合并慢性肾衰竭病机主要以络脉瘀阻、浊毒内蕴为主,临床常见症状为乏力、水肿、便溏、眠差、肢体麻木等,常见舌、脉体征为脉弦、苔腻、苔黄、脉沉、苔厚等。治疗本病的核心方药为大黄、黄芪、水蛭。经过对门诊数据的分析,发现在治疗本病时,附子、黄芪、丹参、水蛭、生姜、大黄对血肌酐,黄连对血尿素氮,半夏、淫羊藿、生姜、黄连、益母草、丹参对肾小球滤过率,威灵仙、丹参对血尿酸,水蛭、大黄对24小时尿蛋白定量,知母对糖化血红蛋白,水蛭对血压(尤其是收缩压),黄芪对甘油三酯,以上药物对相关检验指标可能存在较好的改善作用。
[Abstract]:This study through the analysis of Professor Tong Xiao Lin outpatient data, mining the demographic characteristics of patients with chronic renal failure combined with traditional Chinese medicine for treating diabetes (gender, age, address, etc.), medical information (treatment frequency, treatment time and frequency of follow-up, follow-up time), disease diagnosis (complications) and the main symptoms (fatigue, poor sleep, edema), test indicators (serum creatinine, blood urea nitrogen, glomerular filtration rate, etc.) and other information, and to study the treatment of this disease core prescription and drug laws (use frequency, application compatibility etc.), evaluation of clinical curative effect of traditional Chinese medicine in the treatment of this disease. Through the analysis of these data summary, the clinical syndrome, chronic renal failure to verify Professor Xiaolin Tong in treatment of diabetes combined with medication experience. Research methods by Professor Tong Xiaolin outpatient medical records system entry of diabetes complicated with chronic renal failure patients using the number. According to the mining method, the scale-free complex network analysis method for mining the core prescription in the treatment of this disease, the curative effect of the trend trend related indicators, comparison of drug efficiency by chi square test. Results (1) basic information: This study included 160 cases of patients with chronic renal failure complicated with diabetes in Professor Tong Xiao Lin clinic during the period from 2005 to March 2015, a total of 1433 visits. The male patients with a total of 106 cases of female patients with a total of 54 cases a year. In February the least number of patients, only 90 times in March, most times, for 146 times. The patients age mainly concentrated at the age of 40-70, in the elderly population. (2) the type of disease: 160 patients with type 1 diabetes, 3 people, 157 people remaining for type 2 diabetes. Diabetic complications are the most lesions of diabetic retinopathy, diabetic peripheral neuropathy and diabetic autonomic combined. In most of the categories of diseases in endocrine and nutritional and metabolic diseases, diseases of the circulatory system and digestive system diseases, single disease, the five most common diseases were hypertension, dyslipidemia, hyperuricemia, metabolic syndrome and fatty liver (3). Symptoms and signs are the most common symptoms were fatigue, edema, loose stools, poor sleep, limb numbness, limb pain, constipation, urine bubble, blurred vision, dry mouth. The most common tongue, pulse in pulse string, greasy moss, moss yellow, thick moss, pulse, slippery pulse, pulse, red tongue, bottom collaterals, hard veins (4). The syndrome: the syndrome type of diversity and compound are not suitable for statistical analysis by computer, need to be independent and be able to express the meaning of the card type "the smallest unit" of TCM is described, therefore this study proposes reference to Professor Zhu Wenfeng's "syndrome" concept, the statistics of the TCM syndrome patients. In the 3 most common disease syndrome factor are meridian, spleen and stomach, large intestine, the 2 most common disease syndrome of blood exhaustion and Zhuodu, followed by heat, phlegm, qi stagnation, Qi deficiency, yin deficiency. (5) recipe: Professor Xiaolin Tong Fang Zhong medication at least 3 taste, many 30, to 8-9 kinds of most commonly used. The total dose of the prescription of at least 45g, up to 870g, the average total dose was 230.5 + 91.2g. for treatment of diabetes mellitus complicated with chronic renal failure in traditional Chinese medicine rhubarb, astragalus root, leech, salvia, Rhizoma Coptidis, ginger, Poria, aconite, Monascus, Weilingxian. The core of this disease drug as the core of medicine Astragalus rhubarb, rhubarb, rhubarb, astragalus, as the core of prescription, leech. (6) effect and effective drug Mining: serum creatinine declined overall, effective drug for aconite, Radix Astragali, Salvia miltiorrhiza, leech, ginger, rhubarb; blood urea nitrogen showed a decreasing trend, effective drug for Coptis; glomerular filtration rate maintained Stable and effective drug for ginger, pinellia, epimedium, Coptis chinensis, Herba Leonuri, Salvia miltiorrhiza; serum uric acid level is maintained, effective drug Weilingxian and Salvia miltiorrhiza; 24 hours urine protein decreased, effective drug for leech and Rhubarb; glycated hemoglobin decreased, effective drug for Rhizoma Anemarrhenae; fasting blood glucose declined in general the trend, effective single drug is no statistic significance; systolic blood pressure showed a slight downward trend, the overall level of diastolic blood pressure, both drugs were effective for leech; cholesterol decreased, the effective single drug is no statistic significance; triglyceride declined overall, effective drug for astragalus; low density lipoprotein cholesterol in general decreased, effective monotherapy was statistically significant. No conclusion diabetic patients with chronic renal failure and pathogenesis mainly luomaiyuzu, Zhuodu connotation, clinical often Common symptoms were fatigue, edema, diarrhea, poor sleep, limb numbness, common tongue, pulse signs for string pulse, greasy moss, moss yellow, pulse, and so on. Thick moss core agent for the treatment of this disease as rhubarb, astragalus, leech. After analyzing the clinic data, found in the treatment of diseases attached, sub, astragalus, Danshen, leech, ginger, rhubarb on serum creatinine, blood urea nitrogen of Coptis, pinellia, epimedium, ginger, Coptis, motherwort, Clematis Salvia miltiorrhiza on glomerular filtration rate, and Salvia miltiorrhiza on blood uric acid, leech, rhubarb on 24 hour urinary protein, Zhimu on glycosylated hemoglobin, leech on blood pressure (especially systolic), Huangqi on triglyceride, above drugs might have good effect on the test indicators.

【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】：2017
【分类号】：R259;R277.5

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