CKD5期透析伴心血管钙化患者中医证素的临床调查

发布时间：2018-05-17 22:32

本文选题：慢性肾脏病5期 + 透析　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：调查CKD5期透析伴心血管钙化患者的中医证素,总结其中医病机特点,为中医药防治心血管钙化提供参考。方法：收集符合纳入条件的HD和PD患者,通过影像学检查筛选出伴有心血管钙化的病例。在同等条件下采集血标本；采用中医传统四诊方法,采集临床资料,将获得临床信息录入调查表；对照《证素辨证学》进行证素判别；分析病位、病性分布及其影响因素,总结病机特点,比较HD与PD中医证素的差别。结果：(1)一般资料：共收集病例63例,53例检查提示伴心血管钙化,占84.1%；其中HD30例(56.6%),PD23例(43.4%)；男性29例(54.7%),女性24例(45.3%)；年龄最小36岁,最大85岁,平均年龄(62.51±13.13)岁；透析龄最小0.25个月,最大300个月,中位透析龄39(11,62)个月。50例透析患者表现为冠状动脉钙化,其CACs值最小0.41分,最大12055.72分,中位CACs值为62.45(262.12,879.04)分；另外3例分别表现为二尖瓣钙化、腹主动脉钙化及髂总动脉钙化,未计钙化值。原发病：慢性肾炎15例(28.3%),糖尿病肾病9例(17.0%),IgA肾病2例(3.8%),梗阻性肾病、膜性肾病、肾结石各1例(1.9%),其他24例(45.3%)。合并疾病：高血压49例(94.3%)、糖尿病19例(35.8%)、心脑血管疾病史24例(45.3%)。(2)透析伴心血管钙化患者病情分析：50岁以上患者CACs中位数值较高,但差异无统计学意义(P0.05)；透析龄60个月(5年)患者的CACs中位数值升高,但差异无统计学意义(P0.05)；PD发生心血管钙化的比例高于HD,PD组CACs中位数值高于HD组,但差异无统计学意义(P0.05)；有心脑血管并发症组的CACs中位数值显著升高,组间比较差别有统计学意义(P0.05),提示CACs高者易发生心脑血管事件。(3)中医病位、病性证素分布：53例透析伴心血管钙化患者,病位证素出现频数由高到低依次是：肾、脾、心、肺、肌肤、肝、心神、筋骨、经络、胃,提示主要病位在肾、脾,涉及心、肺、肌肤等。病性证素出现频数由高到低依次是：气虚、血虚、阳虚、阴虚、痰、湿、气滞、血瘀、精亏、燥、饮、水停,提示主要本虚病性为气虚、血虚、阳虚、阴虚；主要标实病性为痰、湿,涉及气滞、血瘀等。病位证素中,仅有肾、肺出现严重病变,其中肾的严重病变出现频数最高。本虚病性中气虚、血虚、阳虚、阴虚均出现了严重病变,尤以血虚、气虚为著；标实病性中仅痰、湿出现了严重病变。提示病位肾、肺及病性气虚、血虚、阳虚、阴虚、痰、湿的证候表现明显,病隋较重。病位证素以单个病位、两个病位相兼最为常见；病性证素以三个、四个、五个病位相兼常见；虚实夹杂证多见,占3/4,其次是纯虚证,占1/4,未见单纯实证。提示透析患者的病位、病性证素繁多,常同时存在,相兼复杂。各病位、病性证素的分布与冠状动脉钙化程度无明显关系,组间比较无统计学意义(P0.05)。病位肾、肺及病性阳虚的轻重与年龄有关,组间比较有统计学意义(P0.05)。组间两两比较,病位肾在(51-60)岁组的严重程度较50岁组重,较61-70岁组、71岁组轻,差别有统计学意义(P0.05),提示50岁以后。肾的证候表现明显；病位肺、病性阳虚随年龄增长,症候表现也加重,但差异无统计学意义(P0.05),提示病位肺、病性阳虚可能与年龄有关。病性痰的轻重在各透析龄组间差别有统计学意义(P0.05)。组间两两比较,虽然随着透析龄增长,病性痰证素的症候表现也加重,但差异无统计学意义(P0.05),提示病性痰证候的轻重与透析龄可能有关。PD病位脾、病性血虚的证候较HD明显,组间比较有统计学意义(P0.05)。提示PD患者临床更易出现脾与血虚的证候。病位、病性病变程度与各指标的关系：肺与TC负相关；肌肤与Ca正相关,与PTH负相关；气虚与TG正相关,与Alb负相关：血虚与Hb负相关,与Hs-CRP正相关：痰与血Hcy正相关。结论：(1)CACs高者更易发生心脑血管事件；(2)PD较HD有较高的心血管钙化发生比例,且冠脉钙化程度较HD严重,推测与PD对钙磷离子、氧化因子、炎症因子的清除不如H13充分有关。(3)透析伴心血管钙化的病位主要在肾、脾,涉及心、肺、肌肤：本虚病性突出,表现为气虚、血虚、阴虚、阳虚；标实病性以痰、湿、瘀、气滞为主；病位、病性证素相兼复杂。(4)透析伴心血管钙化患者的病性为本虚标实,主要病理因素为痰、瘀,治疗当在益气养阴、养血通脉的基础上,注重化痰行瘀。(5)PD患者的血虚、脾病证素较HD患者表现明显。
[Abstract]:Objective: To investigate the TCM Syndromes of patients with CKD5 dialysis with cardiovascular calcification, to summarize the characteristics of TCM pathogenesis, and to provide reference for the prevention and treatment of cardiovascular calcification by traditional Chinese medicine. Methods: to collect HD and PD patients conforming to the conditions, and to select the cases with cardiovascular calcification through imaging examination. Traditional methods of medical treatment, collect clinical information, obtain clinical information entry questionnaire, compare syndrome differentiation and syndrome differentiation, analyze disease location, disease distribution and influencing factors, summarize the characteristics of disease machine, compare the difference between HD and PD TCM syndrome. (1) general data: a total of 63 cases were collected, 53 cases were cue with cardiovascular. Calcification, accounting for 84.1%, was 84.1% (56.6%), PD23 (43.4%), 29 men (54.7%) and 24 women (45.3%); the minimum age 36, the maximum age of 85, the average age (62.51 + 13.13), the minimum dialysis age 0.25 months, the maximum 300 months, and the middle dialysate age (11,62) months (11,62) for.50 patients with coronary artery calcification, and the minimum CACs value. The maximum 12055.72 points and median CACs value were 62.45 (262.12879.04); the other 3 cases were mitral valve calcification, abdominal aortic calcification and total iliac artery calcification, without calcification. The primary disease was chronic nephritis in 15 cases (28.3%), diabetic nephropathy in 9 cases (17%), IgA nephropathy in 2 cases (3.8%), obstructive nephropathy, membranous nephropathy, and 1 renal calculi (1.9%). He had 24 cases (45.3%), combined disease: 49 cases of hypertension (94.3%), 19 cases of diabetes (35.8%), and 24 cases of cardiovascular and cerebrovascular disease (45.3%). (2) analysis of the condition of patients with dialysis with cardiovascular calcification: the median value of CACs was higher in patients over 50 years old, but the difference was not statistically significant (P0.05); the median value of CACs in patients with dialysis age 60 months (5) was higher, but the difference was different There was no statistical significance (P0.05); the proportion of cardiovascular calcification in PD was higher than that of HD, and the median value of CACs in group PD was higher than that in group HD, but the difference was not statistically significant (P0.05); there was a significant increase in the median of CACs in the group of cardiovascular and cerebrovascular complications, and there was a significant difference between groups (P0.05), suggesting that those with high CACs were prone to cardio cerebral vascular events. (3) TCM disease. 53 cases of dialysis with cardiovascular calcification in patients with cardiovascular calcification, the frequency from high to low is the following: kidney, spleen, heart, lung, skin, liver, heart, muscles, meridians, stomach, indicating the main disease location in the kidney, spleen, involving the heart, lung, skin and so on. The frequency of the disease syndrome appears from high to low in turn: Qi deficiency, blood deficiency, Yang deficiency, yin asthenia, phlegm, dampness, Qi stagnation, blood stasis, deficiency, dryness, drinking and water stop, suggesting that the main deficiency of the disease is Qi deficiency, blood deficiency, Yang deficiency and yin deficiency. The main symptoms are phlegm and damp, involving qi stagnation, blood stasis and so on. Change, especially blood deficiency, Qi deficiency, only phlegm and dampness appeared in the disease. It suggested that the disease position kidney, lung and disease Qi deficiency, blood deficiency, Yang deficiency, yin deficiency, phlegm, wet syndrome were obvious, and the disease was more serious in the Sui Dynasty. The disease position syndrome was single disease position, two disease phase and most common; the disease syndrome was three, four, five diseases in phase and common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency of five diseases common; deficiency The syndrome of solid inclusion was common, accounting for 3/4, followed by pure deficiency syndrome, accounting for 1/4, and no simple demonstration. It indicated that the disease location of the dialysis patients was various, often existed at the same time and complex. There was no significant relationship between the distribution of the disease level and the degree of coronary artery calcification, and there was no statistical significance between the groups (P0.05). Age related, the comparison between groups was statistically significant (P0.05). 22, the severity of the kidney in the (51-60) year group was heavier than that of the 50 year old group, compared with the 61-70 year old group and the 71 year old group. The difference was statistically significant (P0.05). It was suggested that after 50 years of age, the symptoms of the kidney were obvious; the disease in the lung and the disease Yang deficiency increased with age, but the symptom was also aggravated, but the difference was also aggravated, but the difference was also different, but the difference was different, but the difference was different, but the difference was different There was no statistical significance (P0.05), suggesting that the disease level lung may be related to the age of the disease. The severity of the phlegm is statistically significant (P0.05). The symptoms of the phlegm syndrome are also aggravated with the age of dialysis (22), but the difference is not statistically significant (P0.05), suggesting the severity of the phlegm syndrome. The syndrome of.PD disease was more likely to be related to the spleen, and the syndrome of disease sex blood deficiency was more obvious than that of HD (P0.05). It suggested that the symptoms of spleen and blood deficiency were more likely to appear in the patients with PD. The relationship between the degree of disease and the degree of disease and the index of the disease was negatively related to the lung and TC; the skin was positively related to Ca and negatively correlated with PTH; Qi deficiency was positively related to TG and Alb. Negative correlation: negative correlation of blood deficiency with Hb and positive correlation with Hs-CRP: positive correlation between phlegm and blood Hcy. Conclusion: (1) the patients with high CACs are more likely to have cardio cerebral vascular events; (2) PD has a higher proportion of cardiovascular calcification than HD, and the degree of coronary calcification is more severe than HD. It is presumed that the clearance of calcium and phosphorus ions, oxidation factors, and inflammatory factors is not as sufficient as H13 (3). (3 ) dialysis with cardiovascular calcification mainly in the kidney, the spleen, involving the heart, lung, skin: the deficiency of the disease is prominent, manifested as Qi deficiency, blood deficiency, yin deficiency, Yang deficiency; the underlying disease is phlegm, dampness, stasis, qi stagnation. (4) the disease of patients with dialysis with cardiac calcification is a virtual standard, and the main pathological factors are phlegm, stasis, treatment. On the basis of Supplementing Qi and nourishing yin and nourishing blood and promoting blood circulation, we should pay attention to phlegm and blood stasis. (5) blood deficiency of PD patients, spleen disease syndrome is more obvious than HD patients.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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