基于真实世界的CKD3-4期中医证型分布及疗效研究
发布时间：2018-11-15 16:49
【摘要】：目的:探讨真实世界慢性肾脏病(Chronic kidney disease,CKD)3-4期证候分布特点及临床用药的疗效。方法:符合纳入标准及排除标准220例CKD3-4期患者按临床实际用药的真实情况非随机分为中药+中成药+基础治疗组、中药+基础治疗组、中成药+基础治疗组、中药+中成药组、中药组、中成药组、西药组,依次对应为A组、B组、C组、D组、E组、F组、G组。入组时参照中医证候诊断标准进行辩证分型,CKD3期患者每12周监测1次尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(eGFR),CKD4期患者每8周监测1次尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(eGFR),24周时进行治疗前后中医证候评分比较,并对治疗前0周及治疗后24周尿素氮(BUN)、血肌酐(Scr)、肾小球滤过率(eGFR)进行比较。结果:(1)220例CKD3-4期患者中,本虚证以脾肾气虚证最多,共123例(55.9%);其次为脾肾阳虚证53例(24.1%);肝肾阴虚证17例(7.7%);肺肾气虚证及气阴两虚证相对较少,分别为16例(7.3%)和11例(5.0%);兼有实证共163例(74.1%),其中以瘀血证居多,83例(50.9%);依次为湿浊证48例(29.5%);湿热证32例(19.6%);CKD3期与CKD4期的虚证分布有差异性(P0.05),CKD4期脾肾气虚证相对CKD3期所占比例下降,其脾肾阳虚证相对CKD3期所占比例升高;(2)中医证候积分比较发现:A组、B组、C组与治疗前相比证候积分明显下降(P0.05);治疗后组间比较发现,A组与B组无明显差异(P0.05);A组与B组在改善证候积分方面均明显优于C组(P0.05);临床疗效分析:A组总有效率86.21%,B组总有效率86.74%,C组总有效率78.33%,A组与B组比较差异无统计学意义(P0.05);A组与C组比较差异有统计学意义(P0.05);B组与C组比较差异有统计学意义(P0.05);A组与B组在临床疗效方面明显优于C组(P0.05)。(3)A组、B组、C组治疗后均能有效增加eGFR、降低Scr水平(P0.05);A组与B组治疗后组间比较eGFR、Scr水平无统计学意义(P0.05);A组与B组在增加eGFR、降低Scr水平方面均优于C组(P0.05);A组、B组、C组BUN水平与治疗前相比无统计学意义(P0.05)。结论:1、CKD3-4期患者本证以脾肾气虚最多见,标证以瘀血证居多。随着CKD3期进展至CKD4期,脾肾气虚有发展为脾肾阳虚的趋势。2、中药+中成药+基础治疗组与中药+基础治疗组在改善患者临床症状方面均优于中成药+基础治疗组。3、中药+基础治疗组及中成药+基础治疗组均能有效增加eGFR、降低Scr水平。
[Abstract]:Objective: to investigate the distribution of phase 3-4 syndromes of real world chronic kidney disease (Chronic kidney disease,CKD) and its clinical efficacy. Methods: 220 patients with CKD3-4 according to the inclusion criteria and exclusion criteria were not randomly divided into two groups according to the actual clinical conditions. Group A, group B, group C, group D, group E, group F and group G respectively. According to the diagnostic criteria of TCM syndromes, urea nitrogen, (BUN), creatinine, (Scr), glomerular filtration rate were monitored once every 12 weeks in patients with CKD3. (BUN), was monitored once every 8 weeks in patients with (eGFR), CKD4. The glomerular filtration rate (eGFR),) of serum creatinine (Scr),) was compared before and after treatment with TCM syndrome scores before and after 24 weeks of treatment, and the glomerular filtration rate (eGFR) of (BUN), serum creatinine (Scr), was compared at 0 weeks before treatment and 24 weeks after treatment. Results: (1) in 220patients with CKD3-4, the deficiency of spleen and kidney qi was the most common syndrome (55.9%), followed by the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of liver and kidney yin in 17 patients (7.7%), the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of spleen and kidney qi in 17 patients (5.7%). There were 16 cases (7.3%) and 11 cases (5.0%) with deficiency of qi and kidney qi, 163 cases (74.1%) with both syndrome and 83 cases with blood stasis syndrome (50.9%). There were 48 cases (29.5%) of dampness and heat syndrome, 32 cases (19.6%) of damp-heat syndrome. The distribution of deficiency syndrome in CKD3 phase and CKD4 phase was different (P0.05). The proportion of spleen and kidney qi deficiency syndrome relative to CKD3 phase decreased in CKD4 phase, and the proportion of spleen and kidney yang deficiency syndrome relative to CKD3 phase increased. (2) the syndromes scores of group A, group B and group C were significantly lower than those of before treatment (P0.05), but there was no significant difference between group A and group B after treatment (P0.05). Group A and group B were significantly better than group C in improving syndromes score (P0.05). Clinical efficacy analysis: the total effective rate of group A was 86.21 and the total effective rate of group B was 86.74 and the total effective rate of group C was 78.33. There was no significant difference between group A and group B (P0.05). There was significant difference between group A and group C (P0.05) between); B group and C group (P0.05). The clinical efficacy of group A and group B was significantly better than that of group C (P0.05). (3). Group B and group C could effectively increase the level of eGFR, and decrease the level of Scr after treatment (P0.05). There was no significant difference in eGFR,Scr level between group A and group B after treatment (P0.05); A group and B group in increasing eGFR, and decreasing Scr level were better than C group (P0.05); The level of BUN in group A, group B and group C had no statistical significance compared with that before treatment (P0.05). Conclusion: (1) deficiency of spleen and kidney qi is the most common syndrome in CKD 3-4 patients, and blood stasis syndrome is the most common syndrome. With the development of CKD3 to CKD4, the deficiency of spleen and kidney qi developed into deficiency of spleen and kidney yang. 2. The basic treatment group of traditional Chinese medicine and the basic treatment group of traditional Chinese medicine were superior to the traditional Chinese patent medicine group in improving the clinical symptoms of the patients. Both the basic Chinese medicine treatment group and the traditional Chinese patent medicine treatment group can effectively increase eGFR, and reduce the level of Scr.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5
本文编号：2333865
[Abstract]:Objective: to investigate the distribution of phase 3-4 syndromes of real world chronic kidney disease (Chronic kidney disease,CKD) and its clinical efficacy. Methods: 220 patients with CKD3-4 according to the inclusion criteria and exclusion criteria were not randomly divided into two groups according to the actual clinical conditions. Group A, group B, group C, group D, group E, group F and group G respectively. According to the diagnostic criteria of TCM syndromes, urea nitrogen, (BUN), creatinine, (Scr), glomerular filtration rate were monitored once every 12 weeks in patients with CKD3. (BUN), was monitored once every 8 weeks in patients with (eGFR), CKD4. The glomerular filtration rate (eGFR),) of serum creatinine (Scr),) was compared before and after treatment with TCM syndrome scores before and after 24 weeks of treatment, and the glomerular filtration rate (eGFR) of (BUN), serum creatinine (Scr), was compared at 0 weeks before treatment and 24 weeks after treatment. Results: (1) in 220patients with CKD3-4, the deficiency of spleen and kidney qi was the most common syndrome (55.9%), followed by the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of liver and kidney yin in 17 patients (7.7%), the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of spleen and kidney qi in 17 patients (5.7%). There were 16 cases (7.3%) and 11 cases (5.0%) with deficiency of qi and kidney qi, 163 cases (74.1%) with both syndrome and 83 cases with blood stasis syndrome (50.9%). There were 48 cases (29.5%) of dampness and heat syndrome, 32 cases (19.6%) of damp-heat syndrome. The distribution of deficiency syndrome in CKD3 phase and CKD4 phase was different (P0.05). The proportion of spleen and kidney qi deficiency syndrome relative to CKD3 phase decreased in CKD4 phase, and the proportion of spleen and kidney yang deficiency syndrome relative to CKD3 phase increased. (2) the syndromes scores of group A, group B and group C were significantly lower than those of before treatment (P0.05), but there was no significant difference between group A and group B after treatment (P0.05). Group A and group B were significantly better than group C in improving syndromes score (P0.05). Clinical efficacy analysis: the total effective rate of group A was 86.21 and the total effective rate of group B was 86.74 and the total effective rate of group C was 78.33. There was no significant difference between group A and group B (P0.05). There was significant difference between group A and group C (P0.05) between); B group and C group (P0.05). The clinical efficacy of group A and group B was significantly better than that of group C (P0.05). (3). Group B and group C could effectively increase the level of eGFR, and decrease the level of Scr after treatment (P0.05). There was no significant difference in eGFR,Scr level between group A and group B after treatment (P0.05); A group and B group in increasing eGFR, and decreasing Scr level were better than C group (P0.05); The level of BUN in group A, group B and group C had no statistical significance compared with that before treatment (P0.05). Conclusion: (1) deficiency of spleen and kidney qi is the most common syndrome in CKD 3-4 patients, and blood stasis syndrome is the most common syndrome. With the development of CKD3 to CKD4, the deficiency of spleen and kidney qi developed into deficiency of spleen and kidney yang. 2. The basic treatment group of traditional Chinese medicine and the basic treatment group of traditional Chinese medicine were superior to the traditional Chinese patent medicine group in improving the clinical symptoms of the patients. Both the basic Chinese medicine treatment group and the traditional Chinese patent medicine treatment group can effectively increase eGFR, and reduce the level of Scr.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5
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