对比剂相关早期肾损伤患者的中医证候研究

Study on traditional Chinese medicine syndromes in patients with early renal injury after coronary angiography

关键词:  对比剂急性肾损伤  对比剂相关早期肾损伤  中医证候

Key words:  contrast-induced acute kidney injury  contrast-related early kidney injury  traditional Chinese medicine syndrome

摘要:

[目的] 总结对比剂相关早期肾损伤患者的中医证候特点，为进一步运用中医药临床干预对比剂相关早期肾损伤奠定基础。[方法] 选择2020年9—12月在阜外华中心血管病医院冠状动脉粥样硬化性心脏病病区拟行冠状动脉造影且肾小球、肾小管功能正常的住院患者172例。根据患者冠状动脉造影后24 h内肾小球、肾小管功能是否出现损伤，将172例患者分为损伤组（33例）与非损伤组（139例）。对两组患者的一般资料及中医证候进行研究，归纳总结对比剂相关早期肾损伤患者的基本特征及中医证候特点。[结果] 1）两组患者在性别及合并糖尿病、高脂血症方面比较，差异无统计学意义（P>0.05）；损伤组患者的年龄及合并高血压病数量高于非损伤组（P<0.05）。2）病性比较方面，两组患者差异无统计学意义（P>0.05）；在实证的证候分布方面，损伤组血瘀证占比最高（46.43%）；在虚证的证候分布方面，损伤组的气虚证占比最高（69.57%）；在两组患者基本证候的比较中，损伤组的气虚证和血瘀证的占比均高于非损伤组（P<0.05）；两组患者在血虚、阴虚、阳虚、火热、痰湿、水停等证候分布上的差异无统计学意义（P>0.05）。[结论] 1）老年患者及合并高血压病的患者在冠状动脉造影后更易发生对比剂相关早期肾损伤。2）虚实夹杂证在对比剂相关早期肾损伤的患者中较为多见；气虚证和血瘀证是对比剂相关早期肾损伤患者中占比较高的证候。临床中关于对比剂相关早期肾损伤的治法应以活血化瘀为主，兼顾益气养阴、行水化痰。

Abstract:

[Objective] This study aimed to summarize the characteristics of traditional Chinese medicine（TCM） syndromes in patients with early renal injury caused by contrast agents，laying a foundation for the further use of TCM clinical interventions in contrast agent-related renal injury，and provide syndrome reference ideas for preventing CI-AKI. [Methods] One hundred and seventy-two inpatients with normal glomerular tubule function who underwent coronary angiography were selected from September 2020 to December 2020 in Fuwai Central China Cardiovascular Hospital. According to whether the glomerular tubule function was impaired within 24 h after coronary angiography，the 172 patients were divided into injury group with 33 cases and the non-injury group with 139 cases. Then，this study comparedthe demographic characteristics，concomitant underlying diseases，and TCM syndrome distribution between the two groups. Finally，the basic characteristics and TCM syndrome characteristics of patients with early renal injury caused by contrast agents were summarized. [Results] 1）In terms of gender and combined diabetes and hyperlipidemia，there was statistically significant discrepancy between the two groups（P>0.05），the patients of the injury group were more advanced than those of the non-injury group and there were more patients with hypertension in the injury group（P<0.05）. 2）In the comparison of disease characters including pure deficiency syndrome，pure empirical syndrome，and syndrome of mixed void and solid，the discrepancies between the two groups were not statistically significant（P>0.05）. Among the empirical syndrome elements，blood stasis syndrome accounted for the highest proportion in the injury group（46.43%），in terms of deficiency syndrome，the injury group had the highest proportion of qi deficiency syndrome（69.57%）. In the comparison of the basic syndromes in patients of the two groups，the proportions of qi deficiency syndrome and blood stasis syndrome in the injury groupwere larger than that of the non-injury group（P<0.05），the differences between the two groups with respect to the distribution of syndromes such as blood deficiency，yin deficiency，yang deficiency，fever，phlegm dampness，and water stagnation were not statistically significant（P>0.05）. [Conclusion] 1）Patients with advanced age and high blood pressure are more likely to develop early renal injury caused by contrast media. 2）The pathogenesis of early renal injury caused by contrast agent is more complicated，which includes pure deficiency syndrome，pure empirical syndrome，and syndrome of mixed void and solid. Qi deficiency and blood stasis are the more common syndrome factors in patients with renal injury within 24 h after coronary angiography. In clinical practice，the treatment of early kidney injury caused by contrast agents should be based on promoting blood circulation and removing blood stasis，while replenishing qi and nourishing yin，and promoting hydration and phlegm.