【作者】 陈伟涛；

【导师】 任可；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 临床上将高血压造成的肾脏结构和功能的改变,称为高血压性肾损害,主要为小动脉性肾硬化。据美国1998年初的一项临床调查结果显示,在回顾过去的10年发现,在终末期肾病患者中,高血压造成ESRD的患病率高达28.5%,仅次于糖尿病肾病(34%)。我国一项针对终末期肾衰竭肾脏替代治疗患者的调查显示,在我国,良性小动脉性肾硬化症在终末肾衰竭腹膜透析及血液透析患者的病因中,分别占第2位(14.8%)及第3位(8.9%)。高血压肾损害在中医的文献中并无确切的病名与之相对应,目前对于原发性高血压导致肾损害的中医理论及治疗也报道甚少,高血压肾损害的中医证型究竟呈现什么样的分布规律,至今尚缺乏系统的研究。目的:本课题通过对195例高血压肾损害患者的中医学症状进行观察统计,旨在总结高血压肾损害的中医证候学特点及分布规律,为我们对提高该病中医辨证规律的认识,更好的应用中医辨证手段有针对性地改善患者症状,提供理论依据。方法:制定高血压肾损害中医临床证候调查量表,对每个入选病例均填写该证候调查量表;以搜集到的北京地区多家医院195例高血压肾损害患者的临床资料为依据,运用因子分析方法,对高血压肾损害患者的中医证候特点及分布规律进行了初步探讨。结果:1.运用因子分析的方法得到9个高血压肾损害的中医临床类证候分类;2.患者性别在11个公因子上的分布在统计学上无显著差异(P=0.627>0.05);患者的年龄及病史在11个公因子上的分布是否有差异尚有待进一步研究。结论:1.在所研究的高血压肾损害病例中类脾肾两虚,瘀血阻络证所占比例较最大,其次为类痰湿壅盛证及类瘀血证,提示高血压肾损害与脾肾亏虚及瘀血、痰湿等因素密切相关,为临床上制定相关治则提供一定的参考依据;2.在所研究的病例中正气不足以脾虚、肾虚最为多见,邪实因素主要涉及瘀血、痰湿,故该研究认为高血压肾损害为本虚标实之证,本虚主要为脾肾两虚,标实主要涉及瘀血和痰湿,其主要病位在脾、肾,涉及心、肝两脏,主要的病机可归纳为脾肾两虚,痰瘀阻络;3.高血压肾损害患者的中医类证侯与性别无关,与年龄及高血压病史是否有关尚有待进一步研究。更多还原

【Abstract】 Study on the traditional Chinese medical syndrome of hypertension nephrosclerosis (HN)Hypertension nephrosclerosis(HN) refers to the change of kidney structure and function caused by hypertension in clinical,mainly for renal arteriolar sclerosis. To review the past 10 years,the results of the United States’s clinical survey in 1998 showed that,the prevalence rate of ESRD caused by hyperrension was as high as 28.5 percent,only inferior to diabetic nephropathy (34%),in patients with end-stage renal disease.According to a investigate aimed at the patients with renal replacement therapy of ESRD in china,benign arteriolar nephrosclerosis due to primary hypertention is the second(14.8%) and the third(8.9%) reason for hemodialysis and peritoneal dialysis in ESRD. Hypertension nephrosclerosis have no precise Name Correspondingly in the traditional Chinese medicine,The theory of traditional Chinese medicine and treatment about the kidney damage caused by pryhypertension are reported little,and there is no systematicly study on what’s the distribution laws of hypertension nephrosclerosis’s Chinese medicine syndrome .Objective: In this research,according to Observe and statistic the TCM symptom about 195 cases of hypertension nephrosclerosis(HN),we try to Summarize the Characteristic and distributed rule of the TCM Syndrome of the hypertension nephrosclerosis,it can provides the theory basis to improve the understanding for this disease at the aspect of Chinese medicine dialectical rules and for a better use of Chinese medicine dialectical method to improves the patient symptom with target-oriented.Method: Enacting the hypertension nephrosclerosis’s TCM Syndromes scale questionnaire,and each of the selected cases were filled out the questionnaire; In accordance with 195 hypertension nephrosclerosis patients’clinic data provided by many hospitals in Beijing and using the factor analysis method,this study probes into the TCM syndrome pattern and distribution of hypertension nephrosclerosis.Results: 1. Using the factor analysis method,9 TCM syndromes of hypertension nephrosclerosis were found;2. There is no significant statistical difference in sex over the distribution of the 11 common factors (P=0.627>0.05); Whether significant statistical difference in age and the course of disease over the distribution of the 11 common factors,there is remains to be further studied. Conclusions: 1. In all the HN cases,the first syndrome of the distributon is the syndrome of spleen and kidney deficiency and the obstruction of the collateral vessel by static blood,followed by static blood syndromes and phlegm-dampness syndromes.The results of the pattens means HN has something to do with spleen and kidney deficiency,static blood and phlegm-dampness. 2.In all the deficiency cases,spleen deficiency and kidney deficiency rank the first two place,while in excess cases,the most syndromes are static blood、phlegm-dampness.So HN is a disease that the primary is deficient and the secondary is excessive,the primary deficiency is dual deficiency of the spleen and kidney,the secondary excesses are static blood syndromes and phlegm-dampness. The locations of disease are mainly spleen and kidney,and also have relation with heart and liver.The mechanism of disease is dual deficiency of the spleen and kidney and the obstruction of the collateral vessel by phlegm and static blood;3. The TCM syndromes of hypertension nephrosclerosis patients have nothing to do with sex,whether it is related to age and the course of disease yet to be studied further.更多还原