摘要
目的:探索慢性肾脏病5期(CKD G5)血液透析患者的典型证型及其高诊断价值症状、体征。方法:采集100例CKD G5血液透析患者的中医四诊信息资料,运用潜在类别分析(LCA)得出患者主要中医证型,在此证型基础上分析症状、体征并构建二元Logistic回归模型,确定其具有高诊断价值的症状、体征。结果:100例CKD G5血液透析患者涉及症状、体征总计338个,出现频次共2 790次;提取证素35项,总频次728次,其中频次≥30次的有11项(536次),包括病性证素气虚(63次)、阴虚(58次)、阳虚(55次)、湿(53次)、热(46次)、痰(44次)、血虚(44次)、气滞(31次);病位证素肾(57次)、肝(44次)、脾(41次)。LCA根据证素将84例可判定证素的CKD G5血液透析患者分成2类人群,区分两类人群的证素特征为气虚、阴虚,组合形成主要证型气阴两虚证。基于气阴两虚证筛选出9个高频症状、体征,分别为舌苔腻(42次)、脉沉(41次)、舌苔黄白相兼(39次)、脉细(38次)、口渴(34次)、失眠(34次)、尺脉弱(30次)、脉弦(30次)、睡眠不实(30次)。进一步将这9个症状、体征结合LCA分类结果开展二元Logistic回归分析,结果显示舌苔腻、口渴、失眠和睡眠不实具有统计学意义(P<0.05)。结论:CKD G5血液透析患者以气阴两虚证为主要证型,舌苔腻、口渴、失眠、睡眠不实为诊断CKD G5血液透析气阴两虚证患者的典型相关症状、体征。
Objective:To explore the typical traditional Chinese medicine(TCM)syndrome patterns and their highly diagnostic symptoms and signs in patients with chronic kidney disease stage 5(CKD G5)undergoing hemodialysis.Methods:TCM four-diagnostic data were collected from 100 CKD G5 hemodialysis patients.Latent class analysis(LCA)was employed to identify the major TCM syndrome patterns.Based on these patterns,relevant symptoms and signs were analyzed,and binary logistic regression models were constructed to determine those with high diagnostic value.Results:Among the l00 CKD G5hemodialysis patients,a total of 338 symptoms and signs were recorded,with 2790 occurrences.Thirty-five syndrome elements were extracted,with a cumulative frequency of 728.Among them,11 elements appeared≥30 times(totaling 536 occurrences),including pathological nature elements suchas Qi deficiency(n=63),Yin deficiency(n=58),Yang deficiency(n=55),dampness(n=53),heat(n=46),phlegm(n=44),blood deficiency(n=44),and Qi stagnation(n=31),and pathological location elements including the kidney(n=57),liver(n=44),and spleen(n=41).LCA classified 84 CKD G5 hemodialysis patients with identifiable syndrome elements into two groups,with Qi deficiency and Yin deficiency as the distinguishing features,forming the predominant syndrome pattern of Qi-Yin deficiency.Based on the Qi-Yin deficiency syndrome,nine high-frequency symptoms and signs were identified,including greasy tongue coating(n=42),deep pulse(n=41),yellow-white mixed tongue coating(n=39),thready pulse(n=38),thirst(n=34),insomnia(n=34),weak Chi pulse(n=30),wiry pulse(n=30),and poor sleep quality(n=30).Further binary logistic regression analysis combining these nine features with the LCA classification results showed that greasy tongue coating,thirst,insomnia,and poor sleep quality were statistically significant(P<0.05).Conclusion:The predominant TCM syndrome among CKD G5 hemodialysis patients is Qi-Yin deficiency.Greasy tongue coating,thirst,insomnia,and poor sleep quality are typical symptoms and signs strongly associated with the diagnosis of Qi-Yin deficiency in this population.
作者
乔雪
刘鹏
闫二萍
李晓娟
唐棠
籍嫱
王湛
孙平平
邱模炎
栾洁
QIAO Xue;LIU Peng;YAN Erping;LI Xiaojuan;TANG Tang;JI Qiang;WANG Zhan;SUN Pingping;QIU Moyan;LUAN Jie(Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Blood Purification Center,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)
出处
《中国实验方剂学杂志》
北大核心
2025年第23期146-153,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家重点研发计划项目(2023YFC3503003)
中医临床应用专家共识项目(20250102-GS-CACM)。
关键词
慢性肾脏病5期
血液透析
证候
证型
证素
潜在类别分析
横断面研究
气阴两虚证
chronic kidney disease stage 5
hemodialysis
syndrome
syndrome pattern
syndrome element
latent class analysis
cross-sectional study
Qi-Yin deficiency syndrome
