糖尿病肾病肾功能不全期中医证候学研究

【作者】 牟新；

【导师】 赵进喜；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2006， 博士

【摘要】 目的为了探索糖尿病肾病肾功能不全期证候规律,以及不同证候和性别、年龄、实验室指标的相关性,对揭示中医证候的本质做有意义的工作。方法本研究是“十五”国家科技攻关计划课题—糖尿病肾病肾功能不全防治优化方案研究的部分内容。本项研究按照课题组统一制定的调查表对糖尿病肾病肾功能不全患者进行调查,采集北京中医药大学东直门医院等10家参研单位符合纳入标准的糖尿病肾病患者的一般情况、中医四诊信息以及相关的实验室检查。录入数据后进行核对保证无误后锁定数据库。采用资料完整的病例进行统计分析。采用聚类分析和探索性因子分析对中医证型的分布规律进行分析和归纳;采用典型相关分析对多项实验室指标与多种中医证型的相关性进行研究和分析,确立公认的、科学的与中医证型相关的现代医学指标群。结果我们对糖尿病肾病肾功能不全期传统证候学研究时发现糖尿病肾病肾功能不全代偿期患者本虚证以气虚和阴虚证为主要表现,标实证中以痰湿、湿浊和血瘀为主要表现;失代偿期患者本虚证以阳虚为主要表现,标实证中以痰湿和血瘀为主要表现。本次研究发现,糖尿病肾病肾功能不全代偿期患者中虚实夹杂证186例,占95.3%;糖尿病肾病肾功能不全失代偿期患者中虚实夹杂证66例,占94.3%。且多为三证以上组合。聚类分析和探索性因子分析结果基本符合证候调查表涉及的7个方面的中医症状,由此从数理学角度反证了气虚证、血虚证、阴虚证、阳虚证、痰湿证和血瘀证是糖尿病肾病肾功能不全期的基本证素。典型相关分析显示痰湿证和体质指数,湿浊证和内生肌酐清除率,阴虚证和糖化血红蛋白有相关性。结论1.糖尿病肾病肾功能不全代偿期患者以气虚证、阳虚证和阴虚证为主要临床表现,而到了该病的后期也就是失代偿期则主要以阳虚证的临床表现为主了;作为标实证候的痰湿证和血瘀证则贯穿在整个疾病的发展过程中,这和传统认为的糖尿病及其并发证的病机是吻合的。该病病机复杂,证候虚实夹杂。由此也验证了吕仁和教授提出的以“正虚定证型,邪实定证候”的辨证思路和“活血化瘀,软坚散结”治法的科学性。2.通过采用探索性因子分析和聚类分析,从数理学角度验证了数位该病研究领域知名专家的临床经验。提示我们根据临床流行病学原理和方法,严格按DME进行设计的证候学研究,将专家经验作为对照的“金标准”进行临床验证是可行的。更多还原

【Abstract】 ObjectiveIn order to discuss the TCM syndrome pattern of diabetic nephropathy renal failure,and the relativity of different TCM syndrome with the sex, age and laboratory indices.This work is meaningfully to open out the character of the TCM syndrome.MethodsThis research is part content of the fifteen national science and technology tackle key problem-the optimize project research of diabetic nephropathy renal failure prevention and cure.The research proceeds the questionary of diabetic nephropathy established according to task group, collecting the Diabetic Nephropathy sufferer came from Dozhimen Hospital of Peking Chinese Medicine University etc.Including commonly instances, four diagnostic methods information of TCM and correlative laboratory indices. Lock up the data-base after checking figures and assurance without any error at last. Adopt the complete case in data proceed statistics analysis.Adoption clustering analysis and factor analysis to analysis and Sum up the distributing of TCM syndrome;Adoption canonical correlation analysis to research and analysis the relativity of the laboratory indices with different TCM syndrome,and establishs the generally accepted, scientific laboratory indices related TCM syndrome.ResultsWe discovers that the sufferer are mostly belong to deficiency of Qi and deficiency of Yin,phlegm and dampness,dampness and turbid,stagnation of blood stasis in repay period of diabetic nephropathy renal failure,deficiency of Yang , phlegm and dampness, stagnation of blood stasis are mostly in lose repay period of diabetic nephropathy renal failure. This research discovers that 186 cases in repay period of diabetic nephropathy renal failure are deficiency syndrome accompanied with excess syndrome, occupying 95.3%;and 66 cases sufferer in lose repay period of diabetic nephropathy renal failure are deficiency syndrome accompanied with excess syndrome,occupying 94.3%.And many of the TCM syndrome are three combination.The results of clustering analysis and factor analysis are basic accord with the 7 groups of TCM syndrome in questionary,and proved that deficiency of Qi, deficiency of Xue, deficiency of Yin, deficiency of Yang, phlegm and dampness,dampness and turbid,stagnation of blood stasis are basic TCM syndrome element in diabetic nephropathy.The results of canonical correlation analysis display that phlegm and dampness and BMI, dampness and turbid and creatinine clearance rate, deficiency of Yin and glycosylated hemoglobin have pertinence.Conclusion1.The mainly TCM syndrome of sufferer in repay period of diabetic nephropathy renal更多还原