發(fā)布時(shí)間：2018-05-20 13:22

  本文選題：老年人 + 慢性腎臟病　； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過對(duì)老年慢性腎臟病(CKD)3-5期患者的中醫(yī)辨治的臨床調(diào)查,總結(jié)出其證型分布及中醫(yī)辨證治療特點(diǎn),并進(jìn)一步探討出主要證型與實(shí)驗(yàn)室指標(biāo)間的相關(guān)性,使我科(北京市中西醫(yī)結(jié)合腎內(nèi)科)診治老年CKD3-5期的方案得到進(jìn)一步優(yōu)化,并提出理論及實(shí)踐依據(jù)。方法:本課題采用回顧性研究及實(shí)時(shí)錄入方法,選取2012年01月至2016年12月北京市中西醫(yī)結(jié)合醫(yī)院腎內(nèi)科病房及門診符合標(biāo)準(zhǔn)的122例老年CKD3-5期病例,逐一統(tǒng)計(jì)性別、年齡、原發(fā)病、CKD分期、證型、中醫(yī)用藥及相關(guān)輔助檢查等內(nèi)容。結(jié)果:老年CKD3-5期患者中,糖尿病腎病是慢性腎臟病最為常見的原發(fā)病,總共44例,不明原因?qū)е碌哪I臟病排名第二,有25例,慢性腎小球腎炎18例、高血壓腎損害16例、痛風(fēng)性腎病8例。中醫(yī)證型分布特點(diǎn)中,本虛證出現(xiàn)頻數(shù)最多的是氣陰兩虛證(46例),其次依次為脾腎陽虛證(43例)、脾腎氣虛證(17例)、腎元虧虛證(10例)、肝腎陰虛證(6例)。標(biāo)實(shí)證中,毒瘀互結(jié)證(87例)最多見,水氣證(38例)次之,濕熱證(15例)、血瘀證(13例)則較為少見。臨證常用生黃芪、丹參、川牛膝、白茅根、水蛭、女貞子、白花蛇舌草、黨參等藥物。血肌酐、血清β 2微球蛋白、尿酸在診斷老年CKD脾腎陽虛這一證型上的R0C曲線面積分別為0.681、0.837、0.427。結(jié)論:我科老年CKD3-5期患者本虛證中以氣陰兩虛、脾腎陽虛為多,標(biāo)實(shí)證中以毒瘀互結(jié)證最為常見;在治療過程中抓住核心病機(jī),扶正與祛邪雙管齊下,主要治法為:補(bǔ)脾益腎、活血通絡(luò)、通腑降濁、清熱解毒;補(bǔ)益活血藥常用黃芪、黨參、白術(shù)、淫羊藿、女貞子、丹參、川牛膝、水蛭;通腑解毒藥多選用白茅根、白花蛇舌草、蒲公英、石葦、地榆、大黃。其次,血清β 2微球蛋白水平與老年CKD脾腎陽虛證密切相關(guān),在一定程度上可以預(yù)測(cè)老年CKD脾腎陽虛證的發(fā)生,為中醫(yī)證型的客觀化提供臨床依據(jù),更好的指導(dǎo)了中醫(yī)臨床辨證治療。
[Abstract]:Objective: to summarize the distribution of syndrome types and the characteristics of TCM syndrome differentiation and treatment, and to explore the correlation between the main syndromes and laboratory indexes through the clinical investigation of TCM differentiation and treatment of aged patients with chronic kidney disease (CKD) at stage 3-5. So that our department (Beijing integrated traditional and western medicine nephrology) program for the diagnosis and treatment of elderly CKD3-5 stage was further optimized, and put forward the theoretical and practical basis. Methods: a retrospective study and real-time input method were used to select 122 elderly CKD3-5 patients who met the criteria in the Department of Nephrology and Out-patient Clinic of Beijing Integrated Chinese and Western Medicine Hospital from January 2012 to December 2016. Primary disease CKD staging, syndrome type, Chinese medicine and related auxiliary examination and so on. Results: among the elderly patients with CKD3-5, diabetic nephropathy was the most common primary disease of chronic kidney disease, with 44 cases in total. The unexplained causes of renal disease ranked second, 25 cases, 18 cases of chronic glomerulonephritis, 16 cases of renal damage due to hypertension. 8 cases of gouty nephropathy. In the distribution of TCM syndromes, 46 cases of Qi and Yin deficiency syndrome appeared most frequently, followed by 43 cases of spleen and kidney yang deficiency syndrome, 17 cases of spleen and kidney qi deficiency syndrome, 10 cases of kidney deficiency syndrome and 6 cases of liver and kidney yin deficiency syndrome. In the standard evidence, 87 cases of toxin and blood stasis syndromes were most common, 38 cases of water and qi syndromes), 15 cases of damp-heat syndrome and 13 cases of blood stasis syndrome). Astragalus, Salvia miltiorrhiza, Radix Achyranthes bidentata, Roots, Leech, Ligustrum lucidum, Codonopsis and so on. The R0C curve area of serum creatinine, serum 尾 2 microglobulin and uric acid in the diagnosis of senile CKD syndrome type of deficiency of spleen and kidney yang was 0.681n0.837 ~ 0.427, respectively. Conclusion: the deficiency of qi and yin, deficiency of spleen and kidney and deficiency of spleen and kidney are the most common syndromes in the aged patients with CKD3-5 in our department, and the syndrome of toxin and blood stasis is the most common in the standard demonstration, and in the course of treatment, the core pathogenesis is grasped, the two ways of strengthening the spirit and dispelling evil are combined, the main treatment methods are: invigorating the spleen and nourishing the kidney. Astragalus, Codonopsis, Atractylodes macrocephala, Epimedium, Ligustrum lucidum, Salvia miltiorrhiza, Radix Achyranthes bidentata, leeches, etc. Rhubarb. Secondly, the level of serum 尾 2 microglobulin is closely related to the syndrome of deficiency of spleen and kidney yang in aged CKD, which can predict the occurrence of deficiency of spleen and kidney yang in elderly patients with CKD to a certain extent, and provide the clinical basis for the objectivity of TCM syndrome type. Better guidance of TCM clinical syndrome differentiation treatment.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.5

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