本文關(guān)鍵詞： 慢性腎臟病 中醫(yī)證候 分布規(guī)律　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的對(duì)102例慢性腎臟病(Chronic Kidney Disease,CKD)3-5期非透析患者的中醫(yī)證候進(jìn)行辨證分析,并結(jié)合臨床指標(biāo)進(jìn)行相關(guān)分析,探討其中醫(yī)證候分布特點(diǎn)及其與相關(guān)因素的關(guān)系,為臨床中醫(yī)藥防治慢性腎臟病提供理論依據(jù),并為相關(guān)研究提供借鑒。方法本研究以來自湖北省中醫(yī)院腎病門診及住院部的102例慢性腎臟病3-5期非透析患者作為對(duì)象,采用統(tǒng)一問卷調(diào)查方式收集其臨床資料,包括一般情況如姓名、性別、年齡、體重、基礎(chǔ)病因、病程等,實(shí)驗(yàn)室指標(biāo)包括血紅蛋白、24小時(shí)尿蛋白定量、血肌酐、尿素氮、血清白蛋白、血尿酸、總膽固醇、甘油三酯、甲狀旁腺激素等。根據(jù)中醫(yī)證候診斷標(biāo)準(zhǔn)進(jìn)行辨證分析,對(duì)各證型出現(xiàn)的頻率及百分比予以統(tǒng)計(jì),并與一般情況及臨床生化指標(biāo)進(jìn)行相關(guān)統(tǒng)計(jì)學(xué)分析,探討CKD3-5期非透析患者的中醫(yī)證候特征以及與相關(guān)影響因素之間的聯(lián)系。結(jié)果1.一般資料情況:102例CKD3-5非透析患者中男性有56例,占54.90%;女性有46例,占45.1%,男女比率為1.22:1。年齡為20~84歲,其中18-44歲18例(17.64%);45-59歲47例(46.07%);60-74歲30例(29.41%);75-89歲7例(6.87%);平均51.4歲。2.原發(fā)病中,慢性腎小球腎炎33例,占32.35%;糖尿病腎病21例,占20.59%;高血壓腎損害17例,占16.67%;尿酸性腎病9例,占8.82%;慢性腎盂腎炎5例,占4.90%;其他疾病等共17例,占16.67%。數(shù)據(jù)顯示,慢性腎臟病患者原發(fā)病因復(fù)雜,以慢性腎小球腎炎、糖尿病腎病、高血壓腎損害為主。3.中醫(yī)癥狀出現(xiàn)頻率:前10位的癥狀依次為倦怠乏力、腰膝酸軟、夜尿頻多、氣短懶言、食少納呆、脘腹脹滿、肢體困重、大便不實(shí)、五心煩熱、口干咽燥等,以正虛癥狀居多,亦兼夾邪實(shí)癥狀,表明慢性腎衰竭是以本虛為主,多虛實(shí)夾雜,符合本虛標(biāo)實(shí)的中醫(yī)病理學(xué)特點(diǎn)。4.中醫(yī)證型分布情況:102例患者本虛證中脾腎氣虛證49例,脾腎陽虛證13例,氣陰兩虛證28例,肝腎陰虛證10例,陰陽俱虛證2例;邪實(shí)證中濕熱證36例,濕濁證21例,瘀血證27例,水氣證8例,熱毒證4例。本虛證中脾腎氣虛證最多,占48.02%,明顯高于其他證型,余為氣陰兩虛證脾腎陽虛證肝腎陰虛證陰陽俱虛證,標(biāo)實(shí)證中以濕熱證、瘀血證、濕濁證為主,分布占35.29%,27.45%,20.59%,而水氣證,濁毒證較少。本虛與標(biāo)實(shí)兼夾中,脾腎氣虛證、氣陰兩虛證與各邪實(shí)證均可兼夾,以與濕熱證、瘀血證相兼夾為主,其次為濕濁證,亦可無邪實(shí)證。而肝腎陰虛證多與瘀血證相兼夾�？傮w來看,多兼夾濕熱、濕濁及瘀血等實(shí)邪為主。5.性別的不同對(duì)患者本虛證、邪實(shí)證的分布均無相關(guān)影響;而年齡段的不同只對(duì)邪實(shí)證分布有影響,對(duì)本虛證的分布無影響;表現(xiàn)為青年人多見于濕熱證,余證均較少;中年人亦以濕熱證為主,占絕大部分,瘀血證、濕濁證也常見,而濁毒、水濕證居少;年輕老年人以瘀血證居多,濕熱證其次,水濕證、濁毒亦較少,老年人在各邪實(shí)證上分布無明顯差異。6.不同分期證型分布情況:102例患者3期有40人,占39.22%,4期有43人,占42.16%,5期有19人,占18.62%。以4期人數(shù)最多,依次為3期、5期。本虛證中3期、4期患者以脾腎氣虛證最為多見,其次為氣陰兩虛證,而脾腎陽虛證,肝腎陰虛證隨腎功能進(jìn)展逐漸增多,以5期最為多見。邪實(shí)證中3期,4期患者以濕熱證,瘀血證多見,濁毒證,水氣證較少,5期以濕濁證,瘀血證多見,水氣證最少。7.臨床指標(biāo)與證型關(guān)系:本虛證中,肝腎陰虛證、脾腎陽虛證患者血肌酐、尿素氮、甲狀旁腺激素水平均明顯高于脾腎氣虛證、氣陰兩虛證患者,而脾腎陽虛證患者血紅蛋白水平明顯低于其他3證的患者,說明脾腎陽虛證、肝腎陰虛證在腎功能損害較重的患者中多見,且血清PTH水平較高,脾腎陽虛證患者多貧血,且較重。邪實(shí)證中,濕濁證患者血尿素氮、血肌酐水平較高,血紅蛋白水平相應(yīng)低,水氣證患者血清白蛋白水平低,腎功能相對(duì)較差,濕熱證患者尿蛋白表現(xiàn)突出。結(jié)論1.102例CKD3-5期非透析患者中男性多于女性,以中年人為主。原發(fā)病以慢性腎小球腎炎最常見,糖尿病腎病、高血壓腎損害居多。2.患者最常見癥狀為怠倦乏力,本虛證以脾腎氣虛證最多,氣陰兩虛證其次,脾腎陽虛證、肝腎陰虛證、陰陽俱虛證較少且隨CKD進(jìn)展而逐增。邪實(shí)證以濕熱證、瘀血證多見,濕濁證、濁毒證多見于后期。兼證以脾腎氣虛兼濕熱證最多,脾腎氣虛兼瘀血證、氣陰兩虛兼濕熱證、肝腎陰虛兼瘀血較多。3.不同性別對(duì)中醫(yī)證型分布未見明顯影響,不同年齡段對(duì)本虛證分布無明顯影響,對(duì)邪實(shí)證有一定影響。4.血紅蛋白、血清白蛋白、血清尿素氮、血肌酐、甲狀旁腺激素等與中醫(yī)證型分布有關(guān)系,水氣證患者多伴低白蛋白血癥,濕熱證多見于蛋白尿患者,脾腎陽虛證患者多伴有貧血。
[Abstract]:The purpose of 102 cases of chronic kidney disease (Chronic Kidney, Disease, CKD) 3-5 non dialysis patients with TCM syndrome differentiation and analysis, combined with clinical indicators of correlation analysis, to explore the relationship between the distribution of TCM syndrome and its related factors, and provide a theoretical basis for clinical prevention and treatment of TCM of chronic kidney disease, and to provide reference for the related studies. Methods 102 cases of chronic kidney disease in this study from Hubei Provincial Traditional Chinese Medical Hospital outpatient and inpatient department of nephropathy stage 3-5 non dialysis patients as the object, using the clinical data collection questionnaire survey, including the general situation such as name, gender, age, weight, basic course, etiology, laboratory indexes including hemoglobin, 24 hours urine protein, serum creatinine, urea nitrogen, serum albumin, serum uric acid, total cholesterol, triglyceride, parathyroid hormone syndrome. According to TCM syndrome diagnostic criteria Analysis of frequency and percentage of each type of statistics, and statistical analysis was performed with the general condition and clinical biochemical indicators between the factors of CKD3-5 non dialysis patients with the characteristics of TCM syndromes and related effects of contact. Results of the 1. general information: 102 cases of CKD3-5 in non dialysis patients with male 56 cases women, accounting for 54.90%; 46 cases, accounting for 45.1%, the ratio of male to female is 1.22:1. age 20~84 years, 18-44 years old in 18 cases (17.64%); 45-59 47 cases (46.07%); 60-74 30 cases (29.41%); 75-89 7 cases (6.87%); the average age of 51.4.2. in the pathogenesis of chronic glomerular. In 33 cases, accounting for 32.35%; 21 cases of diabetic nephropathy, accounted for 20.59%; 17 cases of hypertensive renal injury accounted for 16.67%; uric acid nephropathy in 9 cases, accounting for 8.82%; 5 cases of chronic pyelonephritis, other diseases accounted for 4.90%; a total of 17 cases, accounting for 16.67%. data show that patients with chronic kidney disease etiology complex, chronic kidney 灝忕悆鑲劇値,緋栧翱鐥呰偩鐥，

本文編號(hào)：1454611