基于不同虚证分型的ESRD血透患者透析前后的营养状态变化研究

Study on the changes of nutritional state of ESRD patients before and after hemodialysis based on different types of deficiency syndrome

关键词:  终末期肾病  中医虚证分型  营养状态  血液透析

Key words:  end-stage renal disease  TCM deficiency syndrome classification  nutritional status  hemodialysis

摘要:

[目的]调查不同虚证分型的终末期肾病（ESRD）者透析前后的营养状况变化，在治疗疾病的同时，调整不同的营养方案。[方法]连续采集2012年10月—2016年10月在天津中医药大学第一附属医院及第二附属医院透析中心最新确诊ESRD患者201例，并将本证虚证组分为脾肾气虚证（32例）、脾肾阳虚证（59例）、肝肾阴虚证（50例）、阴阳两虚证（35例）、气阴两虚证（25例），并随机选取同时期在天津中医药大学第二附属院体检中心体检的健康人群50例作为本研究的对照组。检测尿素氮及肌酐，电解质、血脂、蛋白、血色素等水平，计算肌酐清除率，体重指数，分析不同虚证分型的ESRD患者透析前后营养状态变化情况。[结果]透析后钾、磷及镁离子、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）较前有所下降，钠、氯及钙离子、总蛋白（TP）、白蛋白（ALB）、血红蛋白（Hb）、红细胞（RBC）和高密度脂蛋白胆固醇（HDL-C）较前有所上升。钾离子在肝肾阴虚、阴阳两虚及气阴两虚组较透析前下降明显，钠离子在脾肾阳虚及阴阳两虚组较前明显升高，各组钙离子均较透析前明显升高，磷离子在阴阳两虚组较透析前明显降低，镁离子在肝肾阴虚组、阴阳两虚组及气阴两虚组均明显降低，TC在脾肾阳虚及气阴两虚组透析后较透析前明显下降，LDL-C在肝肾阴虚、阴阳两虚及气阴两虚组均明显下降。[结论]血液透析能够改善ESRD患者的营养不良情况，但在不同虚证患者中改善程度不一，可以针对不同证型的营养指标，给予更精细化的管理，在辨证论治的同时，调整患者的营养及一些具有类似作用的中西医药物，真正发挥中西医结合的优势。

Abstract:

[Objective] To investigate the changes of nutritional status in patients with end-stage renal disease with different deficiency syndrome types before and after dialysis,in order to adjust different nutrition programs while treating diseases.[Methods] A total of 201 ESRD patients who underwent hemodialysis and were willing to cooperate were selected from October 2012 to October 2016 at the First and Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. The 201 cases of patients were divided into different study groups according to the diagnosis of chronic renal failure,syndrome differentiation and efficacy evaluation:diagnostic criteria of TCM symptoms:The deficiency syndromes were divided into spleen-kidney qi deficiency syndrome,spleen-kidney yang deficiency syndrome,liver-kidney yin deficiency syndrome,yin-yang deficiency syndrome,qi-yin deficiency syndrome. At the same time,urea nitrogen and creatinine were measured,creatinine clearance rate and body mass index were calculated. The changes of nutritional status with different types of deficiency syndrome was analyzed before and after dialysis.[Results] After dialysis,the levels of K⁺,P^3-,Mg²⁺,TC,TG and LDL-C were decreased,and the levels of Na⁺,Cl^-,Ca²⁺,TP,ALB,Hb,RBC and HDL-C were increased. Potassium ions decreased significantly in liver and kidney yin deficiency,yin and yang deficiency and qi and yin deficiency groups. Sodium ions in the deficiency of spleen and kidney yang and yin and yang deficiency group were significantly higher than before. Calcium ions were significantly higher than those before dialysis in each group. Phosphorus ion was significantly lower in yin and yang deficiency group. Magnesium ions decreased significantly in liver-kidney yin deficiency group,yin and yang deficiency group and qi yin deficiency group. TC decreased significantly in patients with deficiency of spleen and kidney yang and deficiency of qi and yin. LDL-C decreased significantly in liver-kidney yin deficiency,yin and yang deficiency and qi and yin deficiency groups.[Conclusion] Hemodialysis can improve malnutrition in patients with ESRD,however,the degree of improvement is different among the patients with different deficiency syndrome. We can give more meticulous management to the nutritional index of different syndrome types. We may adjust the nutrition of patients and some Chinese and western medicine with similar effect at the same time of syndrome differentiation and treatment,in order to give full play to the advantages of integrating traditional Chinese and Western medicine.