尿毒症腹膜透析伴血管钙化患者中医证候特征研究

Study on characteristics of TCM syndrome in uremia patients with peritoneal dialysis complicated with vascular calcification

关键词:  腹膜透析  血管钙化  证候特征

Key words:  peritoneal dialysis  vascular calcification  syndrome characteristics

摘要:

[目的] 探究尿毒症腹膜透析患者血管钙化的发病情况及其中医证候特点，为中医药辨治尿毒症血管钙化提供临床依据。[方法] 回顾性分析单中心421例腹膜透析患者血管钙化发生率，并详细分析其中125例合并血管钙化患者的性别、年龄、临床要素及中医证候信息，总结其证候规律，并进一步探讨患者临床特征与证候分布规律的相关性。[结果] 本腹膜透析中心患者中血管钙化发生率为29.7%。其中以单纯心脏瓣膜钙化患者居多（80.0%）。中医证候中本虚证以脾肾阳虚证为主（48.0%），其次为气阴两虚证（20.0%）、脾肾气虚证（17.6%）、肝肾阴虚证（8.0%）和阴阳两虚证（6.4%）；标实证以湿热证为主（49.5%），其次为湿浊证（26.6%）、血瘀证（15.6%）、水气证（7.3%）。不同年龄和透析龄患者的本虚证、标实证构成比分布均存在统计学差异（本虚证P<0.01；标实证P<0.05）。年龄大、透析龄越长者脾肾阳虚证占比越多（P<0.01）；性别对中医证型分布无明显影响；血肌酐水平对本虚证辨别有影响，血肌酐较高的患者脾肾阳虚证居多（P<0.01）；血钾水平影响标实证辨证（P<0.01），血红蛋白和血浆白蛋白水平对本虚和标实证分布都有显著影响。[结论] 尿毒症腹膜透析合并血管钙化患者本虚证以脾肾阳虚证为主，标实证以湿热证为主；年龄、透析龄影响尿毒症血管钙化患者中医证型分布。临床辨证亦应考虑实验室指标对证候分型的影响，患者营养状况对临床辨证有重要参考意义。

Abstract:

[Objective] To investigate the incidence and the characteristics of traditional Chinese medicine (TCM) syndromes in vascular calcification patients with peritoneal dialysis due to uremia,in order to provide evidence for the TCM treatment for peritoneal dialysis with vascular calcification.[Methods] The incidence of vascular calcification in 421 peritoneal dialysis patients were retrospectively analyzed. By collecting information on gender,age,clinical elements,calcification and TCM syndromes of 125 patients with peritoneal dialysis and vascular calcification. Diagnosis and classification of syndromes,summarize and analyze the laws of syndromes,and further explore the correlation between gender,age,clinical elements and the distribution of syndromes.[Results] The incidence of vascular calcification in the dialysis center was 29.7%. Among them,patients with simple heart valve calcification were the majority (80.0%). The analysis of the law of TCM syndromes showed that the distribution law of the deficiency of the spleen and kidney was as follows:spleen-kidney yang deficiency syndrome (48.0%),followed by qi-yin deficiency syndrome (20.0%),spleen-kidney qi deficiency syndrome (17.6%),liver-kidney yin deficiency syndrome (8.0%),yin-yang deficiency syndrome (6.4%);The main standard positivity were dampness-heat syndrome (49.5%),followed by dampness and turbidity syndrome (26.6%),blood stasis syndrome (15.6%),and moisture and gas syndrome (7.3%). In addition,there were statistical differences in the distribution of the composition ratio of the original deficiency syndrome and standard positivity of patients of different ages and dialysis ages (the original deficiency syndrome P<0.01;the standard empirical syndrome P<0.05). The proportion of spleen-kidney yang deficiency syndrome increased with the older age and the older dialysis age (P<0.01). Gender had no obvious influence on the distribution of TCM syndromes. The serum creatinine level had a significant effect on the identification of this deficiency syndrome,and the patients with higher serum creatinine were more likely to have spleen-kidney yang deficiency syndrome (P<0.01). The level of serum potassium affected the differentiation of the standard positivity syndrome (P<0.01),and the levels of hemoglobin and plasma albumin significantly affected the distribution of both the standard positivity and the deficiency syndrome of spleen-kidney yang,which was more obvious in patients with poor nutritional status.[Conclusion] In uremic patients with peritoneal dialysis complicated with vascular calcification,the main syndrome was spleen-kidney yang deficiency and damp-heat syndrome. Age and dialysis age are factors which affects the distribution of TCM syndromes. The influence of laboratory examination on syndrome typing should also be considered in clinical syndrome differentiation. The nutritional status of patients has important reference for clinical syndrome differentiation.