摘要
目的:分析综合性医院慢性肾脏病中医证型分布规律及其与临床分期、生化指标、生活质量指数的关系,为慢性肾脏病中西医结合规范化诊治提供依据。方法:采用多中心横断面现场调查方法,在上海地区7家三级综合性医院收集322例慢性肾脏病患者的人口学、中医证候学、实验室检查资料以及生活质量指数SF-36量表,探讨慢性肾脏病中医证型的分布规律及中医证型与临床生化指标、生活质量指数的关系。结果:共调查成年患者322例,其中男169例(52.4%),女153例(47.6%),男女比为1.1:1;年龄21~80(54.8±13.2)岁;原发性肾小球疾病182例(56.5%),高血压肾损害82例(25.5%),糖尿病肾病25例(7.8%);其他病因33例(10.2%);倦怠乏力、畏寒肢冷、口干目涩、大便不实、失眠多梦等症状是慢性肾脏病患者较常见的临床症状;中医证候分布以脾肾气虚证最多见(42.8%),其次为脾肾气阴两虚证(18.6%)及阴阳两虚证(18.6%),而在兼证中以湿热证最常见(12.9%);中医主证分布情况在不同慢性肾脏病分期差异有统计学意义(P<0.01),随着疾病进展,脾肾气虚、阴阳两虚证有上升趋势,脾肾阳虚、脾肾气阴两虚、肝肾阴虚呈下降趋势;而中医兼证分布在不同慢性肾脏病分期差异无统计学意义(P>0.05);脾肾气虚证的eGFR-EPI值显著低于脾肾阳虚、脾肾气阴两虚及肝肾阴虚证,均P<0.05,阴阳两虚证的eGFR-EPI值显著低于肝肾阴虚证;脾肾气虚证的血红蛋白水平显著低于脾肾阳虚、脾肾气阴两虚、肝肾阴虚,分别为P<0.05、P<0.05、P<0.01,阴阳两虚证的血红蛋白水平显著低于肝肾阴虚证,P<0.01;脾肾气虚证的舒张压水平显著低于脾肾阳虚、脾肾气阴两虚、肝肾阴虚、阴阳两虚证,分别为P<0.01、P<0.05、P<0.05、P<0.01;脾肾气虚证的高密度脂蛋白显著低于脾肾气阴两虚及肝肾阴虚证,分别为P<0.01、P<0.05;从生活质量指数来看,脾肾气虚及阴阳两虚证患者的总分显著低于其他证型(P<0.01)。结论:慢性肾脏病患者中医证型分布与疾病进展可能相关,脾肾气虚、阴阳两虚证有上升趋势,中医证型与尿蛋白、血红蛋白、肾功能损害、生活质量指数等指标密切相关。
Objective:To analyze the distribution pattern of TCM syndrome types of chronic kidney disease in general hospitals and its relationship with clinical stage,biochemical index and quality of life index,and to provide evidence for the standardized diagnosis and treatment of chronic kidney disease.Methods:Demographic,TCM syndrome,laboratory data and quality of life index SF-36 were collected from 322 patients with chronic kidney disease in seven tertiary general hospitals in Shanghai using a multi-center cross-sectional field survey.To explore the distribution of TCM syndrome types of chronic kidney disease and the relationship between TCM syndrome types and clinical biochemical indicators and quality of life index.Results:A total of 322 adult patients were investigated,including 169 males(52.4%)and 153 females(47.6%).The male to female ratio was 1.1:1;age 21-80(54.8±13.2)years;primary glomerular disease 182 cases(56.5%),82 cases(25.5%)with hypertensive renal damage,25(7.8%)with diabetic nephropathy;33 cases(10.2%)with other causes;fatigue,cold,cold limbs,dry mouth,and stool Symptoms such as insomnia and insomnia are common clinical symptoms in patients with chronic kidney disease;the distribution of TCM syndromes is most common in spleen and kidney qi deficiency syndrome(42.8%),followed by spleen and kidney qi and yin deficiency syndrome(18.6%)and yin and yang Deficiency syndrome(18.6%),and the most common in the syndrome of dampness and heat syndrome(12.9%);the distribution of TCM syndromes was significantly different in different stages of chronic kidney disease(P<0.01),with disease progression,spleen and kidney Qi deficiency,yin and yang deficiency syndrome have an upward trend,spleen and kidney yang deficiency,spleen and kidney qi and yin deficiency,liver and kidney yin deficiency showed a downward trend;while Chinese medicine and syndrome distribution were not significantly different in different chronic kidney disease stages(P>0.05)The eGFR-EPI value of spleen and kidney qi deficiency syndrome is significantly lower than spleen and kidney yang deficiency,spleen and kidney qi and yin deficiency and liver and kidney yin deficiency,P<0.05,the eGFR-EPI value of yin and yang deficiency syndrome was significantly lower than that of liver and kidney yin deficiency syndrome;the hemoglobin level of spleen and kidney qi deficiency syndrome was significantly lower than that of spleen and kidney yang deficiency,spleen and kidney qi and yin deficiency,liver and kidney yin deficiency P<0.05,P<0.05,P<0.01,the hemoglobin level of yin and yang deficiency syndrome was significantly lower than that of liver and kidney yin deficiency syndrome,P<0.01;the diastolic blood pressure level of spleen and kidney qi deficiency syndrome was significantly lower than that of spleen and kidney yang deficiency.,spleen and kidney qi and yin deficiency,liver and kidney yin deficiency,yin and yang deficiency syndrome,respectively,P<0.01,P<0.05,P<0.05,P<0.01;high density lipoprotein of spleen and kidney qi deficiency syndrome is significantly lower than spleen and kidney Qi and yin deficiency and liver and kidney yin deficiency syndrome were P<0.01 and P<0.05 respectively.From the quality of life index,the total scores of spleen and kidney qi deficiency and yin and yang deficiency syndrome were significantly lower than other syndrome types(P<0.01).Conclusion:The distribution of TCM syndromes in patients with chronic kidney disease may be related to disease progression.The spleen and kidney qi deficiency and yin and yang deficiency syndromes have an upward trend.TCM syndromes are closely related to urinary protein,hemoglobin,renal dysfunction and quality of life index.
出处
《中国中西医结合肾病杂志》
2019年第11期959-963,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市卫计委中西医结合重点项目(No.ZHYY-ZXYJHZX-1-02)
上海市中西医临床协作试点建设项目(No.ZY(2018-2020)-FWTX-1001)
关键词
慢性肾脏病
中医证候
生化指标
生活质量
Chronic kidney disease
TCM syndrome
Biochemical index
Quality of life
