【摘要】 目的:探讨慢性肾功能衰竭(chronic renal failure,CRF)中医证型分布规律及并发胃肠功能障碍的影响因素。方法:选取2022年7月至2024年10月信阳市中心医院收治的100例CRF患者，均未行透析治疗，分析CRF在中医证型中的分布规律及消化道症状分级量表(gastrointestinal symptom rating scale,GSRS)评分，并依据是否发生胃肠功能障碍分为发生组(60例)和未发生组(40例)，采用多因素Logistic回归分析CRF患者胃肠功能障碍的相关影响因素。结果:CRF患者中医主证在男女构成、平均年龄、不同年龄段例数方面比较，差异无统计学意义(P > 0.05)。CRF患者兼证以湿热证(16.00%)、血瘀证(21.00%)最常见，且兼证在不同中医主证间分布比较，差异无统计学意义(P > 0.05)。CRF患者中医主证在CKD 3—5期分布情况比较，差异有统计学意义(P<0.05)，脾肾气虚证的GSRS评分高于肝肾阴虚证、脾肾阳虚证、气阴两虚证、阴阳两虚证，差异有统计学意义(P<0.05)。CRF患者中医兼证在CKD 3—5期分布情况比较差异无统计学意义(P > 0.05)，湿浊证的GSRS评分高于湿热证、血瘀证、溺毒证、水湿证，差异有统计学意义(P<0.05)。CRF患者发生胃肠道症状60例(60%)，其GSRS评分为(12.85±2.76)分。发生组血钾、血肌酐、尿素氮、胃泌素水平较未发生组高，差异有统计学意义(P<0.05)，其余指标与未发生组比较，差异无统计学意义(P > 0.05)。血钾、血肌酐、尿素氮、胃泌素是影响CRF患者胃肠功能障碍的危险因素，差异有统计学意义(P<0.05)。结论:CRF患者中医主证演变过程基本符合脾肾气虚-气阴两虚-脾肾阳虚-阴阳两虚的规律，尿毒素积蓄、胃肠激素代谢障碍是CRF患者并发胃肠功能障碍的影响因素。更多还原

【Abstract】 Objective: To investigate the distribution laws of TCM syndromes in chronic renal failure( CRF) and the influencing factors for concurrent gastrointestinal dysfunction. Methods: A total of 100 patients with CRF,who were admitted to Xinyang Central Hospital from July 2022 to October 2024 and had not undergone dialysis treatment,were selected. The distribution laws of TCM syndromes in CRF and the scores on the Chinese version of the gastrointestinal symptom rating scale( GSRS) were analyzed. Based on the presence or absence of gastrointestinal dysfunction,patients were divided into the occurrence group( 60 cases) and the non-occurrence group( 40 cases). Multivariate Logistic regression analysis was used to identify factors influencing gastrointestinal dysfunction in CRF patients. Results: No statistically significant differences were observed in the distribution of primary TCM syndromes among CRF patients when comparing gender composition,mean age,and the number of cases in different age groups( P > 0. 05). The most common secondary TCM syndromes in CRF patients were dampness-heat syndrome( 16. 00%) and blood stasis syndrome( 21. 00%),and there was no statistically significant difference in the distribution of secondary syndromes among different primary TCM syndromes( P > 0. 05). A statistically significant difference was found in the distribution of primary TCM syndromes across CKD stages 3-5( P < 0. 05). The GSRS score for the spleen-kidney qi deficiency syndrome was significantly higher than those for liver-kidney yin deficiency syndrome,spleenkidney yang deficiency syndrome,qi-yin deficiency syndrome,and yin-yang deficiency syndrome( P < 0. 05). No statistically significant difference was observed in the distribution of secondary TCM syndromes across CKD stages 3-5( P > 0. 05). The GSRS score for the turbid-dampness syndrome was significantly higher than those for dampness-heat syndrome,blood stasis syndrome,uremic toxin syndrome,and water-dampness syndrome( P < 0. 05). Gastrointestinal symptoms occurred in 60 CRF patients( 60%),with a GSRS score of 12. 85 ± 2. 76. The levels of serum potassium,serum creatinine,blood urea nitrogen,and gastrin in the occurrence group were significantly higher than those in the non-occurrence group. No significant differences were found in other indicators between the two groups( P > 0. 05). Serum potassium,serum creatinine,blood urea nitrogen,and gastrin were identified as risk factors for gastrointestinal dysfunction in CRF patients( P < 0. 05). Conclusion: The evolutionary process of primary TCM syndromes in CRF patients generally follows the following pattern: from spleen-kidney qi deficiency to qi-yin deficiency to spleen-kidney yang deficiency to yin-yang deficiency. Furthermore,the accumulation of uremic toxins and metabolic disorder of gastrointestinal hormone are influencing factors for the development of gastrointestinal dysfunction in patients with CRF.更多还原