【摘要】 目的:通过搜集确诊为糖尿病肾病(Diabetic nephropathy,DN)Ⅲ~Ⅴ期的患者病例资料、症状表现及相关的生化指标,以期发现DNⅢ~Ⅴ期中医证候学的特点、临床中医证型的规律及其与生化指标的相关性。方法:以调查问卷的方式收集301例DNⅢ~Ⅴ期患者的病例资料,包括中医证型分布、主要症状表现,并对各中医证型的血肌酐、肾小球滤过滤(Glomerular Filtration Rate,e GFR)、24 h尿蛋白、体重指数、血清白蛋白、血脂、血红蛋白等指标进行统计分析。结果:(1)DNⅢ~Ⅴ期患者中发生率前10位的临床症状为:疲乏、肢体麻木、小便泡沫增多、肢体浮肿、夜尿频多等,以脾肾气虚症状为主要表现。(2)DNⅢ期以气阴两虚型为主(66.7%),DNⅣ期以脾肾气虚为主(67.7%),DNⅤ期仍以脾肾气虚型为主(61.8%),阴阳两虚型明显上升(38.2%)。(3)所有入组患者中脾肾气虚型所占比例最大(56.15%),其次为气阴两虚型(30.23%)、阴阳两虚型(11.63%),阴虚燥热型比例最少(2%);(4)DNⅢ~Ⅴ期中医证型的兼证表现为:阴虚燥热型、气阴两虚型、脾肾气虚型以湿热证、瘀证为主,阴阳两虚型以瘀证、痰瘀证为主,瘀证贯穿始终,占据优势。(5)伴随DN病情的加重,中医证型的转变,患者24 h尿蛋白、血肌酐、血尿酸等均明显上升(P<0.01),而GFR、血清白蛋白、血红蛋白均显著降低(P<0.01)。结论:DNⅢ~Ⅴ期以脾肾气虚型比例最高(56.15%),随着DN病情的进展,兼证的比例逐步增加,其中瘀证在各证型中占据最大比例,DN中医证型与24 h尿蛋白、肾功能、血清白蛋白等预后指标密切相关。更多还原

【Abstract】 Objective:To collect diagnosed as diabetic nephropathyⅢ~Ⅴ of patients with clinical data,symptoms and related biochemical parameters in order to find DNⅢ~Ⅴ of traditional Chinese medicine syndrome characteristics,clinical syndromes type of law and the correlation with biochemical indicators. Methods:A questionnaire collected 301 cases of DNⅢ~Ⅴ patients with clinical data,including the distribution of traditional Chinese medicine,the main symptoms,and various syndromes of serum creatinine,glomerular filtration filter(Glomerular Filtration Rate,e GFR),24-hour urine protein,body mass index,serum albumin,cholesterol,hemoglobin and other indicators for statistical analysis. Results:(1)DNⅢ~Ⅴ incidence of patients before 10 clinical symptoms are:fatigue,numbness,increased urination foam,limb edema,nocturia,etc.,to spleen qi deficiency symptoms as the main performance.(2)DNⅢ based on a Yin deficiency type(66.7%),DNⅣ based on a spleen Qi deficiency(67.7%),DNⅤ of spleen Qi deficiency is still dominated(61.8%),Yin and Yang type significantly rise to(38.2%).(3)All enrolled patients with spleen Qi deficiency largest proportion(56.15%),followed by Yin deficiency type(30.23%),Yin and Yang type(11.63%),Yin hot proportional minimum(2%).(4)DN Ⅲ~Ⅴ traditional Chinese medicine syndromes and certificates as follows:Yin hot type,Yin deficiency type,spleen Qi deficiency with damp-heat syndrome,stasis based,Yin and Yang type in stasis,phlegm stasis mainly stasis throughout,an advantage.(5)DN illness accompanied by a marked increase in aggravated traditional Chinese medicine shift patients 24-hour urine protein,serum creatinine,uric acid etc.(P<0.01),and GFR,serum albumin,hemoglobin were significantly lower(P<0.01). Conclusion:DNⅢ~Ⅴ of spleen Qi deficiency with the highest percentage(56.15%),with the proportion of DN progress of the disease,and permit a gradual increase,which accounted for the largest proportion of stasis in various syndromes,DN syndromes and 24 hour urine protein closely related to renal function,serum albumin and other prognostic factors.更多还原