發(fā)布時(shí)間：2018-03-13 18:30

  本文選題：核心方藥　切入點(diǎn)：療效評價(jià)　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的本研究通過對仝小林教授門診病例資料的分析,挖掘中藥治療糖尿病合并慢性腎衰竭患者的人口學(xué)特征(性別、年齡、地址等)、就診信息(就診頻次、就診時(shí)間、隨診頻次、隨診時(shí)間等)、疾病診斷情況(并發(fā)癥及合并癥)、主要癥狀體征(乏力、眠差、水腫等)、檢驗(yàn)指標(biāo)(血肌酐、血尿素氮、腎小球?yàn)V過率等)等信息,并研究其治療本病的核心方藥及用藥規(guī)律(使用頻次、配伍應(yīng)用等),評價(jià)中藥治療本病的臨床療效。通過對這些數(shù)據(jù)的分析總結(jié)、驗(yàn)證仝小林教授治療糖尿病合并慢性腎衰竭的臨床辨證、用藥經(jīng)驗(yàn)。研究方法采用仝小林教授門診病歷系統(tǒng)錄入糖尿病合并慢性腎衰竭的患者。利用數(shù)據(jù)挖掘方法,將無尺度復(fù)雜網(wǎng)絡(luò)分析方法用于挖掘治療本病的核心方藥,以趨勢圖研究各相關(guān)指標(biāo)療效趨勢,用卡方檢驗(yàn)比較藥物有效率。研究結(jié)果(1)基本信息:本研究納入了 2005年至2015年3月期間于仝小林教授門診就診的糖尿病合并慢性腎衰竭患者160例,共1433次診次。其中男性患者共106例,女性患者共54例。一年中二月份患者就診次數(shù)最少,僅90次,三月份就診次數(shù)最多,為146次�；颊吣挲g段主要集中于40-70歲,以中老年人群為主。(2)疾病類型:160例患者中1型糖尿病3人,剩余為2型糖尿病157人。糖尿病并發(fā)癥最多的分別是糖尿病視網(wǎng)膜病變、糖尿病周圍神經(jīng)病變及糖尿病自主神經(jīng)病變。合并癥最多的疾病類別依次為內(nèi)分泌系統(tǒng)及營養(yǎng)代謝性疾病、循環(huán)系統(tǒng)疾病及消化系統(tǒng)疾病,單一疾病中,最常見的五種疾病分別是高血壓、血脂異常、高尿酸血癥、代謝綜合征及脂肪肝。(3)癥狀及體征:最常見癥狀依次為乏力、水腫、便溏、眠差、肢體麻木、便秘、肢體疼痛、小便泡沫、視物模糊、口干。最常見的舌、脈診依次為脈弦、苔膩、苔黃、脈沉、苔厚、脈滑、脈數(shù)、舌紅、底絡(luò)瘀、脈硬。(4)證素:證型的多樣性及復(fù)合性不適合利用計(jì)算機(jī)進(jìn)行統(tǒng)計(jì)分析,需要相互獨(dú)立而又能準(zhǔn)確表達(dá)證型含義的"最小單位"對中醫(yī)辨證進(jìn)行描述,因此本研究參考朱文鋒教授提出的"證素"概念,對患者的中醫(yī)辨證進(jìn)行統(tǒng)計(jì)。其中最常見的3個(gè)病位證素分別是經(jīng)絡(luò)、脾胃、大腸,最常見的2個(gè)病性證素是血疲和濁毒,其次為火熱、痰、氣滯、氣虛、陰虛。(5)方藥:仝小林教授方中用藥少則3味,多則30味,以8-9味最為常用。其處方總劑量最少45g,最多870g,平均每方總劑量為230.5±91.2g。治療糖尿病合并慢性腎衰竭常用中藥依次為大黃、黃芪、水蛭、丹參、黃連、生姜、茯苓、附子、紅曲、威靈仙。本病的核心藥物為大黃,核心藥對為大黃、黃芪,核心方劑為大黃、黃芪、水蛭。(6)療效與有效藥物挖掘:血肌酐總體呈下降趨勢,有效藥物為附子、黃芪、丹參、水蛭、生姜、大黃;血尿素氮總體呈波動(dòng)性下降趨勢,有效藥物為黃連;腎小球?yàn)V過率總體保持平穩(wěn),有效藥物為半夏、淫羊藿、生姜、黃連、益母草、丹參;血尿酸總體保持水平,有效藥物為威靈仙與丹參;24小時(shí)尿蛋白定量總體呈下降趨勢,有效藥物為水蛭和大黃;糖化血紅蛋白總體呈下降趨勢,有效藥物為知母;空腹血糖總體呈下降趨勢,未見有統(tǒng)計(jì)學(xué)意義的有效單藥;收縮壓總體呈輕微下降趨勢,舒張壓總體保持水平,兩者有效藥物均為水蛭;膽固醇總體呈下降趨勢,未見有統(tǒng)計(jì)學(xué)意義的有效單藥;甘油三酯總體呈下降趨勢,有效藥物為黃芪;低密度脂蛋白膽固醇總體呈下降趨勢,未見有統(tǒng)計(jì)學(xué)意義的有效單藥。結(jié)論糖尿病合并慢性腎衰竭病機(jī)主要以絡(luò)脈瘀阻、濁毒內(nèi)蘊(yùn)為主,臨床常見癥狀為乏力、水腫、便溏、眠差、肢體麻木等,常見舌、脈體征為脈弦、苔膩、苔黃、脈沉、苔厚等。治療本病的核心方藥為大黃、黃芪、水蛭。經(jīng)過對門診數(shù)據(jù)的分析,發(fā)現(xiàn)在治療本病時(shí),附子、黃芪、丹參、水蛭、生姜、大黃對血肌酐,黃連對血尿素氮,半夏、淫羊藿、生姜、黃連、益母草、丹參對腎小球?yàn)V過率,威靈仙、丹參對血尿酸,水蛭、大黃對24小時(shí)尿蛋白定量,知母對糖化血紅蛋白,水蛭對血壓(尤其是收縮壓),黃芪對甘油三酯,以上藥物對相關(guān)檢驗(yàn)指標(biāo)可能存在較好的改善作用。
[Abstract]:This study through the analysis of Professor Tong Xiao Lin outpatient data, mining the demographic characteristics of patients with chronic renal failure combined with traditional Chinese medicine for treating diabetes (gender, age, address, etc.), medical information (treatment frequency, treatment time and frequency of follow-up, follow-up time), disease diagnosis (complications) and the main symptoms (fatigue, poor sleep, edema), test indicators (serum creatinine, blood urea nitrogen, glomerular filtration rate, etc.) and other information, and to study the treatment of this disease core prescription and drug laws (use frequency, application compatibility etc.), evaluation of clinical curative effect of traditional Chinese medicine in the treatment of this disease. Through the analysis of these data summary, the clinical syndrome, chronic renal failure to verify Professor Xiaolin Tong in treatment of diabetes combined with medication experience. Research methods by Professor Tong Xiaolin outpatient medical records system entry of diabetes complicated with chronic renal failure patients using the number. According to the mining method, the scale-free complex network analysis method for mining the core prescription in the treatment of this disease, the curative effect of the trend trend related indicators, comparison of drug efficiency by chi square test. Results (1) basic information: This study included 160 cases of patients with chronic renal failure complicated with diabetes in Professor Tong Xiao Lin clinic during the period from 2005 to March 2015, a total of 1433 visits. The male patients with a total of 106 cases of female patients with a total of 54 cases a year. In February the least number of patients, only 90 times in March, most times, for 146 times. The patients age mainly concentrated at the age of 40-70, in the elderly population. (2) the type of disease: 160 patients with type 1 diabetes, 3 people, 157 people remaining for type 2 diabetes. Diabetic complications are the most lesions of diabetic retinopathy, diabetic peripheral neuropathy and diabetic autonomic combined. In most of the categories of diseases in endocrine and nutritional and metabolic diseases, diseases of the circulatory system and digestive system diseases, single disease, the five most common diseases were hypertension, dyslipidemia, hyperuricemia, metabolic syndrome and fatty liver (3). Symptoms and signs are the most common symptoms were fatigue, edema, loose stools, poor sleep, limb numbness, limb pain, constipation, urine bubble, blurred vision, dry mouth. The most common tongue, pulse in pulse string, greasy moss, moss yellow, thick moss, pulse, slippery pulse, pulse, red tongue, bottom collaterals, hard veins (4). The syndrome: the syndrome type of diversity and compound are not suitable for statistical analysis by computer, need to be independent and be able to express the meaning of the card type "the smallest unit" of TCM is described, therefore this study proposes reference to Professor Zhu Wenfeng's "syndrome" concept, the statistics of the TCM syndrome patients. In the 3 most common disease syndrome factor are meridian, spleen and stomach, large intestine, the 2 most common disease syndrome of blood exhaustion and Zhuodu, followed by heat, phlegm, qi stagnation, Qi deficiency, yin deficiency. (5) recipe: Professor Xiaolin Tong Fang Zhong medication at least 3 taste, many 30, to 8-9 kinds of most commonly used. The total dose of the prescription of at least 45g, up to 870g, the average total dose was 230.5 + 91.2g. for treatment of diabetes mellitus complicated with chronic renal failure in traditional Chinese medicine rhubarb, astragalus root, leech, salvia, Rhizoma Coptidis, ginger, Poria, aconite, Monascus, Weilingxian. The core of this disease drug as the core of medicine Astragalus rhubarb, rhubarb, rhubarb, astragalus, as the core of prescription, leech. (6) effect and effective drug Mining: serum creatinine declined overall, effective drug for aconite, Radix Astragali, Salvia miltiorrhiza, leech, ginger, rhubarb; blood urea nitrogen showed a decreasing trend, effective drug for Coptis; glomerular filtration rate maintained Stable and effective drug for ginger, pinellia, epimedium, Coptis chinensis, Herba Leonuri, Salvia miltiorrhiza; serum uric acid level is maintained, effective drug Weilingxian and Salvia miltiorrhiza; 24 hours urine protein decreased, effective drug for leech and Rhubarb; glycated hemoglobin decreased, effective drug for Rhizoma Anemarrhenae; fasting blood glucose declined in general the trend, effective single drug is no statistic significance; systolic blood pressure showed a slight downward trend, the overall level of diastolic blood pressure, both drugs were effective for leech; cholesterol decreased, the effective single drug is no statistic significance; triglyceride declined overall, effective drug for astragalus; low density lipoprotein cholesterol in general decreased, effective monotherapy was statistically significant. No conclusion diabetic patients with chronic renal failure and pathogenesis mainly luomaiyuzu, Zhuodu connotation, clinical often Common symptoms were fatigue, edema, diarrhea, poor sleep, limb numbness, common tongue, pulse signs for string pulse, greasy moss, moss yellow, pulse, and so on. Thick moss core agent for the treatment of this disease as rhubarb, astragalus, leech. After analyzing the clinic data, found in the treatment of diseases attached, sub, astragalus, Danshen, leech, ginger, rhubarb on serum creatinine, blood urea nitrogen of Coptis, pinellia, epimedium, ginger, Coptis, motherwort, Clematis Salvia miltiorrhiza on glomerular filtration rate, and Salvia miltiorrhiza on blood uric acid, leech, rhubarb on 24 hour urinary protein, Zhimu on glycosylated hemoglobin, leech on blood pressure (especially systolic), Huangqi on triglyceride, above drugs might have good effect on the test indicators.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259;R277.5

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