【作者】 林颖；

【导师】 毛炜；

【作者基本信息】 广州中医药大学 ， 中医学（专业学位）， 2015， 硕士

【摘要】 目的分析2型糖尿病肾病患者的四诊资料,探讨2型糖尿病肾病的中医证候特点及证型分类；探讨糖尿病肾病的风险因素,为指导临床采取有针对性的防治措施提供参考。方法1.采取回顾性病例对照的研究设计,从病案室检索2013年12月至2014年12月在广东省中医院总院内分泌科、肾内科的糖尿病患者和糖尿病肾病住院患者信息,并建立《糖尿病住院患者一览表》及《糖尿病肾病住院患者一览表》。从电子病历中逐份调阅《糖尿病肾病住院患者一览表》中的住院病历,筛选出符合纳入条件的糖尿病肾病患者作为病例组,建立《糖尿病肾病患者信息表》,内容包括入院时的一般人口学资料、病程、病史、症状、体征、舌脉、中医辨证分型、生化指标检测结果的临床信息,运用Excel建立相关数据库,并对本组住院患者的年龄、性别分布情况进行初步分析。2.以患者性别和年龄作为匹配因素,从《糖尿病住院患者一览表》中筛选与纳入的糖尿病肾病患者相匹配的糖尿病住院患者作为对照组,并建立《糖尿病患者信息表》,所采集的临床信息与糖尿病肾病患者相同,将所采集的信息用Excel建立数据库。3.统计分析方法：建立数据库,使用spss19.0进行统计分析。中医证候特点方面,先得出糖尿病和糖尿病肾病患者各症状出现的频数,再采用K-均值聚类分析筛选中医证候群,结合文献研究及病例主治医生意见,总结出关于2型糖尿病及糖尿病肾病的中医证型；风险因素方面,先使用t检验或χ2检验对各组资料进行相关性分析,再将有统计学意义的指标进一步引入多因素logistic回归分析中得出糖尿病肾病的风险因素。结果1.一般人口学资料：对照组纳入200例,男104人,女96人,平均年龄为61.2±11.25岁；病例组纳入200例,男104人,女96人,平均年龄为62.5±12.19岁。分析结果显示,两组在性别、年龄方面具有可比性(P>0.05)；2.中医证候特点方面：剔除频数在7%以下的变量后,对照组得到29项指标,结果显示：口干、多饮、精神疲倦、视力模糊、舌暗、舌红、苔白、苔腻、脉弦、脉滑出现频率最高,达50%以上。病例组得到33项指标,其中出现频率高于50%的是口干、多饮、精神疲倦、视力模糊、肢体疼痛、肢体麻木、舌暗、舌红、苔腻、苔白、脉弦。中医证型方面,2型糖尿病可分为五类：第一类湿热瘀阻；第二类肝肾阴虚,湿热瘀阻；第三类气阴两虚血瘀；第四类阴虚血瘀；第五类脾虚湿瘀证。糖尿病肾病可分为五类：第一类脾肾气虚,痰湿瘀阻；第二类脾肾阳虚夹瘀；第三类气阴两虚,湿热瘀阻；第四类肝肾阴虚,湿热瘀阻；第五类阴阳两虚,水湿瘀阻；3.经过t检验分析发现,与2型糖尿病相比,糖尿病肾病患者病程更长、BMI、收缩压、舒张压、血甘油三酯、血肌酐、血清尿酸水平均更高(P<0.05,P<0.01)；χ2检验表明,与2型糖尿病患者相比,糖尿病肾病患者中发生高血压病、糖尿病视网膜病变及高尿酸血症的人数更多(P<0.05,P<0.01)；进一步经多因素Logistic回归分析表明BMI、收缩压、舒张压、糖尿病周视网膜病变以及血肌酐、LDL-C、血尿酸水平升高是糖尿病肾病的风险因素。结论1.2型糖尿病和糖尿病肾病均以气阴两虚为主,湿瘀贯穿糖尿病肾病整个病程；2型糖尿病临床主要证型为湿热瘀阻、肝肾阴虚,湿热瘀阻、气阴两虚血瘀、阴虚血瘀、脾虚湿瘀证。糖尿病肾病临床常见证型为脾肾气虚,痰湿瘀阻、脾肾阳虚夹瘀、气阴两虚,湿热瘀阻、肝肾阴虚,湿热瘀阻、阴阳两虚,水湿瘀阻；2.多种因素参与了糖尿病肾病的发生与进展,病程、BMI、收缩压、舒张压、高血压病史、糖尿病视网膜病变、高尿酸血症、甘油三酯、肌酐、尿酸与糖尿病肾病的发生发展相关；其中BMI、收缩压、舒张压、糖尿病周视网膜病变、血肌酐、LDL-C、血尿酸是糖尿病肾病的风险因素。更多还原

【Abstract】 ObjectiveAnalyze and summarize general information, clinical symptoms, tongue and pulse of the diabetic nephropathy to explore the syndromes characteristics;Identify related factors of diabetic nephropathy, in order to prevent or delay the development of diabetic nephropathy.Methods1. The study choosed type 2 diabetes and type 2 diabetic nephropathy patients diagnosed by Guangdong provincial hospital. The four methods of examination information of Chinese Traditional Medicine were collected. Firstly, inputted these datas to excel, and then imputed to spss19.0 for statistical analysis. Use of K-Means Cluster to analyze the type of symptoms about TCM of DN and DM, combined with the literature and visiting staff opinions to determine the representatives syndromes of each type.2. A Retrospective hospital - based case control study of gender and age matching was conducted in the Guangdong provincial hospital during December 2013 to December 2014.200 DN Patients and 200 DM Patients were selected as case group and control group respectively. All the information was collected by questionnaire. Compare the indexes belong to the 2 groups by T test or Chi-Square test. Then use the multivariate logistic regression to detect the relevant factors about the DN.Results1.The study got 29 terms after deleting variables whose frequency less than 7% by frequency statistics of the information for 200 DM patients. The results showed that the following symptoms frequency were the highest (more than 50%), including oropharyngeal drying, drinking water increased, fatigue, blurred vision, limb numbness,dark tongue,red tongue, white coating, greasy coating, string pulse, slippery pulse. The study got 33 terms of 200 DN patients. The most common symptoms were oropharyngeal drying, drinking water increased, fatigue, blurred vision, limb numbness, physical pain, dark tongue, red tongue, white coating, greasy coating, string pulse. The symptoms of DM can be classified into five groups, which represents four syndromes of each type. The first class is moist heat and blood stasis, the second is liver-kidney-yin deficiency with damp-heat stasis, the third one is qi-yin deficiency with blood stasis, and then is yin deficiency with blood stasis, last one is spleen-deficiency with Dampness and blood stasis. The symptoms of DN can be classified into five groups.The first class is spleen-kidney-qi deficiency with dampness and blood stasis,the second is spleen-kidney-yang deficiency with blood stasis, the third one is qi-yin deficiency with damp-heat stasis, and then is liver-kidney-yin deficiency with damp-heat stasis, the last one is yin-yang deficiency with water and blood stagnation.2. The study showed the DN group was significant different with the DM group in disease course (P=0.008), BMI (P=0.000), SBP(P=0.000), DBP (P=0.000), history of hypertension(P=0.001), DR(P=0.000), hyperuricemia(P=0.000), TG (P=0.000),SCr(P=0.000), UA (P=0.000). And the Logistic regression analysis showed that BMI, SDP, DBP, DR, Cr, LDL-C, UA are related with the occurrence of DN.Conclusion1.The main clinical syndrome symptoms of DM were moist heat and blood stasis, liver-kidney-yin deficiency with damp-heat stasis, qi-yin deficiency with blood stasis, yin deficiency with blood stasis, spleen-deficiency with Dampness and blood stasis. The symptoms of DN were spleen-kidney-qi deficiency with dampness and blood stasis, spleen-kidney-yang deficiency with blood stasis, qi-yin deficiency with damp-heat stasis, liver-kidney-yin deficiency with damp-heat stasis, yin-yang deficiency with water and blood stagnation.2. The occurrence of DN is the result of the multifactor, disease course, BMI, SBP, DBP, history of hypertension, DR, hyperuricemia, LDL-C, TG, SCr, UA are the relevant factors about the DN.更多还原