糖尿病肾病Ⅲ~Ⅴ期296例中医本虚和标实证型分布特征及临床特点分析

The distribution of syndrome types of traditional Chinese medicine and clinical characteristics in 296 patients with diabetic nephropathy in stage Ⅲ-Ⅴ

关键词:  2型糖尿病肾病  中医证候  临床特点  本虚证  标实证

Key words:  type 2 diabetic nephropathy  traditional Chinese medicine syndrome  clinical feature  deficiency syndrome  excessive pathogen syndrome

摘要:

[目的] 通过探索分析2型糖尿病肾病Ⅲ~Ⅴ期患者的中医证型及其临床特征，为糖尿病肾病"病证症关联"的规范化研究及中医辨证提供参考。[方法] 选取2013年8月-2016年2月就诊于北京中医药大学东直门医院确诊为2型糖尿病肾病Ⅲ~Ⅴ期患者，将患者按证候特征分别分为气虚组、血虚组、阴虚组、阳虚组、气郁组、血瘀组、湿浊组和内热组，对其临床资料进行回顾性分析并统计临床特点。[结果] 随着病情进展，血虚组和阳虚组所占比例逐渐上升，阴虚组和内热组所占比例逐渐下降，其中血虚组、阳虚组和血瘀组病程明显较长（P<0.05）。在临床特点分析中，在本虚证候中，血虚组和阳虚组患者血浆白蛋白较低（P<0.05），24 h尿蛋白定量值较高（P<0.05），血肌酐（Scr）和尿素氮（BUN）较高（P<0.01）；血虚组血红蛋白（Hb）较低（P<0.01）；气虚组糖化血红蛋白（HbA1c）（P<0.05）较高。在标实证候中，气郁和血瘀组患者的Hb显著较低（P<0.05）；血瘀组和内热组的HbAlc较高（P<0.05）；湿浊组Scr和BUN较高（P<0.05或P<0.01），气郁组BUN较高（P<0.01）。[结论] 本病随着病情进展，正气日益亏虚，血虚证、阳虚证所占比例均逐渐增多，内热证占比例均逐渐减少，且与其他证型相比，血虚证和阳虚证患者的血浆白蛋白较低，24 h尿蛋白定量值、血肌酐和尿素氮较高；标实证候中湿浊证可见较高的Scr和BUN。

Abstract:

[Objective] The purpose of this study is to explore and analyze the syndrome types of traditional Chinese medicine (TCM) and clinical characteristics in patients with diabetic nephropathy (stage Ⅲ-V),and to provide reference for the "syndrome association" in diabetic nephropathy and TCM syndrome types.[Methods] From August 2013 to February 2016,patients with stage Ⅲ-V diabetic nephropathy diagnosed in Dongzhimen Hospital of Beijing University of Chinese Medicine were selected. Patients were divided into qi deficiency group,blood deficience group,yin deficiency group,yang deficiency group,qi depression group,blood stasis group,dampness tubid group and heat group by syndiome characteristics. The clinical data were analyzed retrospectively,while the distribution and clinical characteristics of TCM syndromes were analyzed.[Results] With the progress of the disease,the proportion of blood deficiency syndrome and yang deficiency syndrome increased gradually,and the proportion of yin deficiency syndrome and heat syndrome decreased gradually. The course of disease in blood deficiency syndrome,yang deficiency syndrome and blood stasis syndrome were significantly longer (P<0.05). In the analysis of clinical characteristics,the deficiency syndrome groups,plasma albumin was significantly lower (P<0.05),24 h urinary protein quantity (P<0.05),the serum creatinine (Scr) and urea nitrogen (BUN) (P<0.01) were significantly higher in patients with blood deficiency syndrome and yang deficiency syndrome. The hemoglobin (Hb) in the blood deficiency group was lower than that in the other groups (P<0.01). The glycosylated hemoglobin (HbAlc) in qi deficiency group (P<0.05). Among the excessive pathogen syndrome,The Hb in qi depression and blood stasis group was significantly lower (P<0.05). The HbAlc in blood stasis group and heat group was higher (P<0.05). The Scr and BUN were higher in dampness turbid group (P<0.05),and BUN was higher in qi depression group (P<0.01).[Conclusions] With the progress of the disease,the righteous qi is becoming more and more deficient. The proportion of blood deficiency syndrome and yang deficiency syndrome is higher. Among them,blood deficiency syndrome and yang deficiency syndrome are associated with lower plasma albumin,higher 24 h urinary protein quantitative,higher serum creatinine and higher urea nitrogen. The high serum creatinine and urea nitrogen were found in dampness and turbidity syndrome.