CKD4期中医本虚证型特征及其与实验室指标的相关性分析

发布时间：2019-05-22 21:59

【摘要】：目的：本课题试图探讨CKD4期的中医本虚证证型的分布特征,并以此为基础分析主要的证型与主要实验室指标的相关关系,以期能够为CKD4期中医证候诊断进一步的标准化以及中医药临床治疗的规范化提供一定的参考,以助于发挥中医药在推迟、预防治疗终末期肾病期中的优势,相对减轻患者与社会的负担。方法：本文采用流行病学回顾性调查方法,一共收集123例患者中医症状、证候以及和有关的实验室指标等相关资料,并通过统计分析的方法分析CKD4期中医本虚证型的分布特征,分析主要证型与主要实验室指标的相关关系。其中,主要的观察及分析的实验室指标包括血中肌酐、尿素、尿酸、胆固醇、甘油三酯、LDL-C、24小时尿蛋白定量、尿蛋白／肌酐比值(ACR)。结果：在收集的123例慢性肾脏病4期患者中,具有脾肾气虚证的临床特征的共有44例(34.38%),诊断为脾肾气阴两虚证的患者共有34例(27.64%),脾肾阳虚者19例、肝肾阴虚者18例、脾肾阴阳两虚者7例、湿热证者1例。统计学分析提示在慢性肾脏病4期患者中脾肾气虚证和脾肾气阴两虚证二者的实验室测量值分布不具有统计学意义。脾肾气虚+脾肾气阴两虚证组与非脾肾气虚、脾肾气阴两虚证组中患者的血尿酸值均数具有统计学意义(P0.1),且前组尿酸水平高于后组(P0.05,D0)；血总胆固醇指标分布差异具有显著统计学意义(P0.05),且前组总胆固醇水平低于后组(P0.05, D0);ACR指标分布差异具有显著统计学意义(P0.05),且前组ACR低于后组(P0.05,D0)。在分析脾肾气虚+脾肾气阴两虚组与非脾肾气虚、脾肾气阴两虚组患者的LDL-C、肌酐、尿素、甘油三酯、24小时尿蛋白均数时,发现均不具有统计学意义。结论：在收集的123例慢性肾脏病4期患者中,脾肾气虚证、脾肾气阴两虚证为中医本虚证的主要证型,脾肾二脏的亏虚是为CKD4期的基本病机。在脾肾气虚证和脾肾气阴两虚证两个证型之间,本次研究中尚没有发现此二证与主要观察的实验室指标之间的相关关系,仍需进一步的大样本、多中心的统计分析,在客观指标无法提示证候分布特征的情况下,中医的辨证论治在区分慢性。肾脏病4期患者脾肾气虚证和脾肾气阴两虚证的诊断与治疗中更为重要。在CKD4期中,四诊合参,可以将明显升高的尿酸值视为CKD4期患者诊断脾肾气虚证、脾肾气阴两虚证的相关参考指标。ACR及总胆固醇的明显升高可以视为诊断CKD4期患者肝肾阴虚证、脾肾阳虚证、阴阳两虚的相关参考指标。
[Abstract]:Objective: to explore the distribution characteristics of deficiency syndrome in traditional Chinese medicine (TCM) in CKD4 stage, and to analyze the relationship between the main syndrome types and the main laboratory indexes. In order to provide some reference for the further standardization of TCM syndrome diagnosis in CKD4 stage and the standardization of clinical treatment of traditional Chinese medicine, so as to give full play to the advantages of traditional Chinese medicine in delaying and preventing the treatment of end-stage kidney disease. Relatively lighten the burden on patients and society. Methods: a total of 123 patients with TCM symptoms, syndromes and related laboratory indexes were collected by epidemiological retrospective investigation, and the distribution characteristics of TCM deficiency syndrome in CKD4 stage were analyzed by statistical analysis. The correlation between the main syndrome types and the main laboratory indexes was analyzed. Among them, the main laboratory indexes of observation and analysis include serum creatinine, urea, uric acid, cholesterol, TG, LDL-C,24 hourly urine protein quantity, urine protein / creatine ratio (ACR). Results: of the 123 patients with chronic kidney disease in stage 4, 44 (34.38%) had the clinical characteristics of spleen and kidney qi deficiency syndrome, 34 cases (27.64%) were diagnosed as deficiency of spleen and kidney qi and yin, and 19 cases were deficiency of spleen and kidney yang. There were 18 cases of deficiency of yin of liver and kidney, 7 cases of deficiency of yin and yang of spleen and kidney, and 1 case of syndrome of dampness and heat. Statistical analysis showed that the distribution of laboratory measurements of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome was not statistically significant in stage 4 patients with chronic kidney disease. The mean value of uric acid in spleen and kidney qi deficiency syndrome group and non-spleen and kidney qi deficiency syndrome group and spleen and kidney qi yin deficiency syndrome group was statistically significant (P0.1), and the level of uric acid in the former group was higher than that in the latter group (P0.05, D0). There was significant difference in the distribution of blood total cholesterol (P0.05), and the level of total cholesterol in the former group was lower than that in the latter group (P0.05, D0). The distribution of ACR index was significantly different (P 0.05), and the ACR of the former group was lower than that of the latter group (P0.05, D0). It was found that there was no significant difference in LDL-C, creatinine, urea, TG and 24-hour urinary protein between spleen and kidney qi deficiency group and non-spleen and kidney qi deficiency group and spleen and kidney qi yin deficiency group. The results showed that there was no significant difference between spleen and kidney qi deficiency group and non-spleen and kidney qi deficiency group and spleen and kidney qi yin deficiency group. Conclusion: among 123 patients with chronic kidney disease in stage 4, spleen and kidney qi deficiency syndrome and spleen kidney qi yin deficiency syndrome are the main syndromes of TCM deficiency syndrome, and deficiency of spleen and kidney deficiency is the basic pathogenesis of CKD4 stage. Between spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome, there is no correlation between these two syndromes and the main laboratory indexes in this study, and further large samples and multicenter statistical analysis are still needed. Under the condition that the objective index can not indicate the distribution characteristics of syndromes, the syndrome differentiation and treatment of traditional Chinese medicine is to distinguish chronic. The diagnosis and treatment of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome are more important in stage 4 kidney disease. In CKD4 stage, the significantly increased uric acid value can be regarded as the relevant reference index for the diagnosis of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome in patients with CKD4 stage. The obvious increase of ACR and total cholesterol can be regarded as the diagnosis of liver and kidney yin deficiency syndrome in CKD4 stage. Spleen and kidney yang deficiency syndrome, yin and yang deficiency related reference indicators.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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