慢性肾炎气阴两虚证的证候临床特点探讨

发布时间：2018-05-30 02:15

本文选题：慢性肾炎 + 气阴两虚证　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：探讨慢性肾小球肾炎(简称慢性肾炎,CGN)气阴两虚证的证候临床特点,为此病证的临床中医辨证提供参考和依据。方法：从2015年3月1日-11月31日期间在江苏省中医院肾内科住院的病患中,收集符合纳入标准的182例病患,回顾性研究这些病例的临床资料,运用Excel软件进行气阴两虚证候积分计算,观察、分析其证候积分、一般资料(年龄、性别、病程、病理类型)、血液指标(血尿素氮、血肌酐、血尿酸、血清白蛋白、血总胆固醇、血甘油三酯、血钾、血钙、血磷、血二氧化碳结合力)、尿液指标(尿蛋白、尿隐血、尿白细胞、尿红细胞、24小时尿蛋白定量)等客观指标的临床特点,并对以上数据进行统计学处理。根据统计结果总结慢性肾炎气阴两虚证的证候临床特点,为临床预防、诊断及治疗此病证提供辨证依凭和根据。结果：年龄分布特点：(1)年龄分布于18-83岁。(2)患者平均年龄49.25±15.02岁,女病患的平均年龄大于男病患。(3)人数分布：青年组中年组老年组。(4)年龄组的不同对证候积分产生的影响不明显(P0.05)。性别分布特点：(1)病患男女比为1：1.84。(2)各年龄组上女病患人数均较男病患多。男病患人数分布：青年组老年组中年组,女病患人数分布：中年组青年组老年组。(3)不同性别的病患在各年龄组上的分布无明显差别(P0.05),性别对证候积分产生的影响不明显(P0.05)。病程分布特点：(1)病程分布于3月-480月。(2)人数分布：病程大于24个月者病程在12个月以下者病程在13～24个月者。(3)患者平均病程58.73±92.53月。女性病患的平均病程大于男性病患。女性病患人数在所有病程组中均多于男性。(4)男病患在病程12月以下者人数最多,女病患在病程大于24个月者人数最多。(5)不同性别病患在各病程组上的分布差异不显著(P0.05)。气阴两虚证候积分均值：病程在13-24个月者病程在12个月以下者病程在24个月以上者。(6)可认为病程的不同对气阴两虚证候积分产生了明显影响(P0.05)。病理类型分布特点：(1)患者中行肾穿活检者和未行者人数比为1：2.71。(2)分布人数：IgA肾病患者膜性肾病患者系膜增生性肾炎(非IgA肾炎)患者膜增殖性肾炎者、局灶或节段性肾小球硬化者微小病变型肾炎患者。(3)男性与女性均在IgA肾病中患病人数最多,膜性肾病患病人数紧随其后。气阴两虚证候积分均值：膜性肾病患者局灶或节段性肾小球硬化组IgA肾病组和系膜增生性肾炎(非IgA肾炎)组膜增殖性肾炎组微小病变型肾炎组。(4)可以认为病患的病理类型对气阴两虚证候积分的影响显著(P0.01)。血液指标特点：(1)ALB、Ca2+、TC与气阴两虚证候积分显著相关(P0.05),此三者水平异常者证候积分均值高于水平正常者。其中ALB、Ca2+是否异常对证候积分的影响显著(P0.01)。BUN、Scr、UA、TG、K+、P3+、CO2CP与证候积分比较无统计学意义(P0.05)。(2)所有血液指标中,ALB同气阴两虚证候积分相关性最密切,其次是Ca2+,Scr与此病证证候积分相关性最不密切。尿液指标特点：(1)人数分布：尿蛋白阴性者尿蛋白+者尿蛋白++者尿蛋白+-者尿蛋白+++者：隐血阴性者尿隐血+++者尿隐血+者尿隐血++者尿隐血+-者尿隐血+++·者。(2)气阴两虚证候积分均值分布：尿蛋白为+++者尿蛋白为++者尿蛋白+者尿蛋白-+者尿蛋白阴性者；尿隐血为+++者尿隐血阴性者尿隐血为++++者尿隐血为+者尿隐血为-+者尿隐血++者。尿蛋白的不同等级定性对证候积分影响显著(P0.01)。尿隐血的等级定性指标对证候积分的影响不显著(P0.05)。(3)UTP与证候积分显著正相关(P0.01)；尿白细胞、尿红细胞与证候积分相比较皆无统计学意义(P0.05)。UTP与证候积分的相关性最密切,其次为白细胞,红细胞与证候积分的相关性最不密切。结论：(1)慢性肾炎气阴两虚证患者病程较长。(2)膜性肾病的气阴两虚证候特点最明显,微小病变型肾炎组最不明显。(3)在血液指标中,ALB、Ca2+与气阴两虚证候积分呈负相关,TC与证候积分呈正相关。(4)尿液指标中,气阴两虚证候积分均值与尿蛋白呈正相关,尿蛋白等级越高,患者气阴两虚症状越重；UTP与气阴两虚证候积分显著正相关。(5)年龄、性别、血BUN、Scr、UA、TG、K+、P3+、CO2CP、尿隐血、尿白细胞、尿红细胞均与气阴两虚证候无关。提示气阴两虚证候与年龄、性别、肾功能进展等因素无相关性。
[Abstract]:Objective: To explore the clinical characteristics of syndrome of chronic glomerulonephritis (chronic nephritis, CGN) syndrome of deficiency of Qi and Yin, and to provide reference and basis for clinical TCM Syndrome Differentiation for this disease. Methods: to collect 182 patients in the hospitalized patients in the Department of Nephrology of Jiangsu Province Traditional Chinese Medicine Hospital during the period of 31 -11 of March 1, 2015, and to review the retrospective study. To investigate the clinical data of these cases, Excel software was used to calculate the syndrome score of Qi and yin deficiency syndrome, and to observe the syndrome integral, the general data (age, sex, course of disease, pathological type), blood indexes (blood urea nitrogen, serum creatinine, serum albumin, total cholesterol, triglyceride, potassium, blood calcium, blood phosphorus, blood carbon dioxide binding) The clinical characteristics of the objective indexes, such as urine protein, urine occult blood, urinalysis, urine red blood cell, urine red blood cell, 24 hour urine protein, etc., and carry out statistical processing on the above data. According to the statistical results, the clinical characteristics of syndrome of Qi and yin deficiency syndrome of chronic nephritis are summarized, and the basis of syndrome differentiation and basis for clinical prevention, diagnosis and treatment of this disease is provided. Results: the characteristics of age distribution: (1) the age distribution was 18-83 years old. (2) the average age of the patients was 49.25 + 15.02 years, the average age of the female patients was greater than that of the male patients. (3) the number distribution: the age group of the young group. (4) the influence of the age group was not obvious (P0.05). (1) the ratio of men and women to the disease was 1:1.84 (2) the number of female patients in each age group was more than that of the male patients. The distribution of the number of male patients: the distribution of the middle-aged group in the young group, the distribution of the number of women in the middle-aged group. (3) there was no obvious difference in the distribution of the different sexes in all age groups (P0.05), and the influence of gender on the syndrome score was not obvious (P0.05). Points: (1) the course of disease was distributed in March -480 month. (2) the number distribution: the course of disease was more than 24 months in 13~24 months. (3) the average course of disease was 58.73 + 92.53 months. The average course of female patients was greater than that of male patients. The number of female patients was more than that of men in all course of disease. (4) male patients were under the course of illness under the course of December. The number of patients was the most, and the number of female patients in the course of disease was more than 24 months. (5) there was no significant difference in the distribution of different sexes in the course group (P0.05). The mean value of Qi and yin deficiency syndrome score: the course of disease in 13-24 months was below 12 months for more than 24 months. (6) the difference between the disease course and the Qi and yin deficiency syndrome score was considered. There were significant effects (P0.05). The distribution of pathological types: (1) the number of renal biopsy and non traveler was 1:2.71. (2) in patients with membranous glomerulonephritis (non IgA nephritis) with membranous proliferative glomerulonephritis in patients with membranous nephropathy in IgA nephropathy, and in patients with focal or segmental glomerulosclerosis. (3 The number of men and women in IgA nephropathy was the most, and the number of patients with membranous nephropathy was followed. The mean value of Qi and yin deficiency syndrome score: IgA nephropathy group and mesangial proliferative glomerulonephritis (non IgA nephritis) group of membranous nephrotic patients with membranous glomerulonephritis group and the group of small disease type nephritis in the group of proliferative nephritis (non IgA nephritis). (4) it can be considered as a patient. The pathological type has significant influence on the syndrome score of Qi and yin deficiency syndrome (P0.01). (1) ALB, Ca2+, TC and Qi and yin deficiency syndrome score is significantly correlated (P0.05), and the mean value of the syndrome score of the three persons with abnormal level is higher than that of the normal ones. Among them, ALB, Ca2+ has a significant influence on the syndrome score (P0.01).BUN, Scr, UA, TG There was no statistical significance between CP and syndrome score (P0.05). (2) in all blood indexes, the correlation of ALB and Qi Yin two deficiency syndrome was most closely related, followed by Ca2+, and Scr was not closely related to the syndrome score of this disease. (1) the distribution of urine protein negative urine protein + urine protein + + urine protein + + + person Occult blood + + + + + + urinary occult blood + urinary occult blood + + + + + + + +. (2) urinary protein + + + + urine protein + urine protein + urine protein negative; urinary occult blood is + + + + + + + + + + + urine occult blood occult blood Urinary occult blood + +. The different grades of urine protein have significant influence on syndrome score (P0.01). The qualitative index of urinary occult blood has no significant influence on syndrome score (P0.05). (3) there is significant positive correlation between UTP and syndrome score (P0.01), and there is no statistical significance (P0.05).UTP and syndrome product in urinocyte, urine red cell and syndrome product The correlation is the most closely related, followed by white blood cells, the correlation of red blood cells and syndrome integral is the most closely related. (1) chronic nephritis Qi Yin two deficiency syndrome patients have a longer course of disease. (2) the characteristics of Qi and yin deficiency syndrome of membranous nephropathy are the most obvious, and the minimal disease variant nephritis group is the most obvious. (3) in the blood index, ALB, Ca2+ and Qi Yin deficiency syndrome integral Negative correlation, TC and syndrome score positive correlation. (4) in urine indicators, the mean value of Qi and yin deficiency syndrome is positively correlated with urine protein, the higher the level of urine protein, the more severe symptoms of deficiency of Qi and Yin, UTP and Qi and yin deficiency syndrome score significant positive correlation. (5) age, sex, BUN, Scr, UA, TG, K+, P3+, CO2CP, urine occult blood, urinal cells, urine red thin All the cells were not related to deficiency syndrome of Qi and Yin, suggesting that there was no correlation between Qi Yin deficiency syndrome and age, sex, renal function progress and so on.
【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】：R277.5

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