285例慢性肾脏病病程进展的影响因素及固本泻浊法保护作用分析

发布时间：2018-06-28 12:33

本文选题：固本泻浊法 + 慢性肾脏病　；参考：《中国中医科学院》2017年硕士论文

【摘要】：研究目的:探讨慢性肾脏病(Chronic kidney disease,CKD)病程进展的影响因素,分析固本泻浊法与肾功能进展的关系,在此基础上挖掘张宁教授治疗CKD核心处方,为CKD的临床防治提供理论依据。研究方法:采用回顾性队列研究的方法,选取2014年1月1日至2016年12月31日中国中医科学院望京医院所有就诊病例(包含门诊及住院)实验室指标符合CKD诊断标准(2012KDIGO)的患者670例,最终入组285例。自符合CKD诊断入组开始观察,记录基线项目及随访项目、终点事件发生情况,以影响因素为协变量,生存时间及终点事件作为应变量,进行多元逐步Cox回归模型分析,以探讨CKD病程进展的影响因素,将固本泻浊中药作为影响因素之一,按疗程进行分层进入方程,分析固本泻浊法辨证治疗在延缓CKD进展及减少终点事件发生方面的作用。利用Liquorice软件以同质网络创建关系数据,导入入组患者观察期内所有张宁教授门诊处方信息,挖掘药物之间的核心配伍关系,经张宁教授确认,得到治疗CKD的核心处方。研究结果:1.基线特征:本研究中共纳入研究对象285例,平均基线年龄为68.98岁,其中男性51.6%,中位随访时间为230d,基线eGFR分期情况:CKD3期(41.7%),2 期(19.3%),1 期(16%),4 期(14%),5 期(8.8%),CKD～3 期的研究对象 77.2%。2.终点事件发生情况:285例随访研究对象共57例进入终点事件。其中主要终点事件31例:包括死亡19例,肾脏替代治疗6例,进入CKD5期6例。次要终点事件26例:其中10例为eGFR较基线下降≥25%,且GFR分期改变,16例为ACR分期进展。未观察到CKD快速进展。3.全部终点事件Cox回归分析结果:基于单因素分析结果:年龄,高磷血症、低钠血症、贫血、AKI、AKD(非AKI)是全部终点事件的危险因素,而固本泻浊治疗为保护性因素。而在多因素分析中仍然显著的影响因素是:高磷血症和CKD基础上的AKD(非AKI)。按中药治疗疗程分层,绘制生存曲线,根据生存曲线的结果,服用中药的疗程对患者的近期和远期的生存时间(出现终点事件之前的时间)均有影响,且未服用中药组的生存曲线较低。在近期生存曲线中,未服用中药的患者相比于服用中药的患者,生存时间较短,而服用中药不同疗程的患者中,近期生存时间差别不显著。在远期生存时间中,服用中药半年及以上的患者生存曲线平直,且明显高于其他疗程的患者。4.主要终点事件(死亡+肾替代治疗+进入CKD期)Cox回归分析结果:基于单因素分析结果:基线eGFR分期、贫血、高磷血症、低钠血症、AKI、AKD(非AKI)是主要终点事件的危险因素,固本泻浊治疗仍为保护性因素,但未达到显著性水平。在多因素分析仍然显著的影响因素为:高磷血症和CKD基础上发生AKD(非 AKI)。5.基于复杂网络分析挖掘张宁教授治疗CKD的核心处方为:黄芪、柴胡、石韦、白茅根、茯苓、丹参、生薏苡仁、当归、地龙、白芍、炒酸枣仁,酒大黄。结论:1.高磷血症及AKD是CKD病程进展的独立危险因素。2.固本泻浊法辨证治疗能够在一定程度上延缓CKD病程进展。3.基于复杂网络分析挖掘张宁教授治疗CKD核心处方有助于总结和继承老师治疗CKD的学术思想。
[Abstract]:Objective: To explore the influencing factors of the progression of Chronic kidney disease (CKD), and to analyze the relationship between the method of purging turbid and the progression of renal function. On this basis, we excavate professor Zhang Ning's core prescription for the treatment of CKD and provide a theoretical basis for the clinical prevention and treatment of CKD. Methods of retrospective cohort study were used to select 1 2014. From 1 to December 31, 2016, all the cases (including outpatient and hospitalization) in Wangjing Hospital of China Academy of traditional Chinese medicine (including outpatient and hospitalization) were in accordance with the CKD diagnostic criteria (2012KDIGO), and the final entry group was 285 cases. The baseline and follow-up items were recorded from the CKD diagnosis group. The covariance volume, the survival time and the endpoint event were used as the variable, and the multivariate stepwise Cox regression model was used to analyze the influencing factors of the progress of the course of CKD disease. The traditional Chinese medicine was taken as one of the influencing factors, and the treatment was stratified into the equation according to the course of treatment, and the treatment of syndrome differentiation and treatment was analyzed to delay the progress of CKD and reduce the occurrence of endpoint events. Using the Liquorice software to create the relational data with the homogeneity network, import all Zhang Ning outpatient prescription information in the observation period of the group, excavate the core compatibility between the drugs, and get the core prescription for the treatment of CKD by Professor Zhang Ning. The results of the study: 1. basic line features: this study included 285 cases, average of the research subjects. The baseline age was 68.98 years, of which 51.6% were male, median follow-up time was 230d, and baseline eGFR staging: CKD3 (41.7%), 2 (19.3%), 1 (16%), 4 phase (14%), 5 phase (8.8%), CKD ~ 3, 77.2%.2. terminal events. 19 cases of death, 6 cases of renal replacement therapy, 6 cases of CKD5 stage, 26 cases of secondary end point event: 10 cases of eGFR compared with baseline decrease of 25%, GFR stage change, and 16 cases of ACR staging. The Cox regression analysis of CKD rapid progression.3. terminal event was not observed: Based on single factor analysis, age, hyperphosphatemia, hyponremia, poor, poor, poor Blood, AKI, and AKD (non AKI) are the risk factors of all endpoint events, and the treatment of purging turbid is a protective factor. In the multifactor analysis, the significant factors are the AKD (non AKI) based on hyperphosphatemia and CKD. According to the treatment course of Chinese medicine, the survival curve is drawn. According to the result of the survival curve, the treatment course of Chinese medicine to the patient In the short term survival curve, the patients who did not take Chinese medicine had a shorter survival time than those taking traditional Chinese medicine in the short term survival curve, but the difference of the short-term survival time was not significant in the patients who took traditional Chinese medicine without the same course of treatment. In the long term survival time, the survival curve of patients taking Chinese medicine for half a year or more was straight, and obviously higher than the results of Cox regression analysis of.4. main endpoints (Death + renal replacement therapy + entering CKD) in other courses: Based on single factor analysis, baseline eGFR staging, anemia, hyperphosphatemia, hyponatremia, AKI, and AKD (non AKI) were the main factors The risk factors of endpoint events were still a protective factor, but there was no significant level. The significant factors in multifactor analysis were: hyperphosphatemia and CKD based AKD (non AKI).5. based on the complex network analysis of Professor Zhang Ning's core prescription for the treatment of CKD: Astragalus, bupleurum, shivido, root, porch. Conclusion: 1. hyperphosphatemia and AKD are independent risk factors for the progression of CKD's course of disease,.2. fixation and turbidity method can postpone the progression of CKD to a certain extent.3. based on the complex network analysis of Professor Zhang Ning's treatment of CKD core prescription helps to summarize and inherit The teacher treats the academic thought of CKD.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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