本文選題：糖尿病腎病　切入點(diǎn)：中醫(yī)證型　出處：《大連醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:對(duì)大連醫(yī)科大學(xué)附屬第二醫(yī)院住院的2型糖尿病患者及糖尿病腎病(diabetic nephropathy,DN)患者的病歷資料進(jìn)行回顧性分析,研究2型糖尿病患者并發(fā)DN的危險(xiǎn)因素,并探討糖尿病腎病中醫(yī)證型與相關(guān)指標(biāo)之間的內(nèi)在聯(lián)系,從而為糖尿病腎病的預(yù)防干預(yù)提供思路,為糖尿病腎病臨床辨證提供參考。方法:隨機(jī)選擇2014年3月到2015年10月在大連醫(yī)科大學(xué)附屬第二醫(yī)院內(nèi)分泌科、腎內(nèi)科、中醫(yī)科確診為2型糖尿病的患者共183例,其中伴有糖尿病腎病的有96例,分為DN組;不伴有糖尿病腎病的有87例,分為NDN(non diabetic nephropathy)組。將糖尿病腎病患者分為陰虛燥熱型、氣陰兩虛型、脾腎氣虛型、陰陽(yáng)兩虛型4個(gè)中醫(yī)證型。對(duì)所有患者的性別、年齡、病程、體質(zhì)指數(shù)、血脂(膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白)、血壓(收縮壓、舒張壓、脈壓差)、血糖(空腹血糖、餐后2h血糖)、糖化血紅蛋白、空腹胰島素、胰島素敏感指數(shù)、胱抑素C、尿蛋白/肌酐比值進(jìn)行統(tǒng)計(jì)。分析2型糖尿病并發(fā)DN的危險(xiǎn)因素,探討糖尿病腎病各證型與上述各個(gè)指標(biāo)間的相關(guān)性。觀察結(jié)果用SPSS13.0進(jìn)行統(tǒng)計(jì)學(xué)分析,所有計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(sx?)表示,符合正態(tài)分布的采用成組t檢驗(yàn),不符合正態(tài)分布的采用秩和檢驗(yàn),多組間比較采用方差分析;計(jì)數(shù)資料以百分率(%)表示,采用χ2卡方檢驗(yàn);用Logistic回歸分析分析相關(guān)危險(xiǎn)因素。結(jié)果:1.DN組與NDN組在吸煙史、年齡、病程方面差異具有統(tǒng)計(jì)學(xué)意義(P0.05),DN組較NDN組吸煙患者更多,年齡更大,病程更長(zhǎng)。兩組間在性別、飲酒史、糖尿病家族史、體質(zhì)指數(shù)方面差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.DN組與NDN組的收縮壓、脈壓差差異具有統(tǒng)計(jì)學(xué)意義(P0.05),DN組患者收縮壓和脈壓差水平高于NDN組;而兩組間舒張壓、血脂水平差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.DN組空腹血糖、空腹胰島素、胱抑素C水平高于NDN組,DN組胰島素敏感指數(shù)低于NDN組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),兩組間餐后2h血糖、糖化血紅蛋白差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.為明確DN發(fā)生的相關(guān)危險(xiǎn)因素,將上述與DN發(fā)生具有顯著性差異的相關(guān)因素進(jìn)行Logistic回歸分析,結(jié)果顯示:病程(OR=1.083,P=0.006)、胱抑素C(OR=2.427,P=0.037)、空腹血糖(OR=1.131,P=0.011)、空腹胰島素(OR=1.021,P=0.044)是糖尿病腎病的危險(xiǎn)因素。5.DN各證型組間病程、胱抑素C、尿蛋白/肌酐并不完全相等(P0.05),兩兩比較結(jié)果得出,在病程方面,脾腎氣虛組和陰陽(yáng)兩虛組均與陰虛燥熱組有統(tǒng)計(jì)學(xué)差異(P0.05),脾腎氣虛組和陰陽(yáng)兩虛組患者病程均長(zhǎng)于陰虛燥熱組患者;陰陽(yáng)兩虛組在胱抑素C和尿蛋白/肌酐方面均較其他三個(gè)證型組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。DN各證型組間性別、年齡、BMI、血壓、血脂、吸煙史、飲酒史、糖尿病家族史、空腹血糖、餐后2h血糖、糖化血紅蛋白、胰島素敏感指數(shù)、胱抑素C、尿蛋白/肌酐比的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.年齡、病程、吸煙史、收縮壓、脈壓差、胱抑素C、空腹血糖、空腹胰島素、胰島素敏感指數(shù)與糖尿病腎病的發(fā)病有關(guān),其中病程、空腹血糖、胱抑素C、空腹胰島素是糖尿病腎病的危險(xiǎn)因素。病程越長(zhǎng)、空腹血糖越高、空腹胰島素越高、胱抑素C越高,越容易并發(fā)糖尿病腎病。2.病程、胱抑素C、尿蛋白/肌酐與糖尿病腎病的中醫(yī)分型存在聯(lián)系:脾腎氣虛組和陰陽(yáng)兩虛組患者病程均長(zhǎng)于陰虛燥熱組患者;陰陽(yáng)兩虛組胱抑素C、尿蛋白/肌酐比值均較其余三個(gè)證型組高,提示了陰陽(yáng)兩虛型是糖尿病腎病的終末證型。
[Abstract]:Objective: to patients with type 2 diabetes and diabetic nephropathy in Second Affiliated Hospital of Dalian Medical University (diabetic nephropathy, DN) were analyzed retrospectively. The risk factors of DN in patients with type 2 diabetes mellitus, and to explore the relationship between TCM Syndromes of diabetic nephropathy and related indicators, so as to provide ideas for the prevention and intervention of diabetes mellitus kidney disease, to provide reference for the clinical diagnosis of diabetic nephropathy. Methods: randomly selected from March 2014 to October 2015 in the Second Affiliated Hospital of Dalian Medical University, Department of Endocrinology, Department of traditional Chinese medicine, Department of Nephrology, diagnosed with type 2 diabetes patients with a total of 183 cases with diabetic nephropathy in 96 cases, divided into the DN group; not associated with diabetic nephropathy in 87 cases, divided NDN (non diabetic nephropathy) group. The patients with diabetic nephropathy were divided into yin deficiency, Qi Yin deficiency, spleen qi deficiency, yin and yang two The 4 type of deficiency syndromes. All patients gender, age, duration, body mass index, blood lipids (cholesterol, triglycerides, high density lipoprotein, low density lipoprotein), blood pressure (systolic blood pressure, diastolic blood pressure, pulse pressure), blood glucose (fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin, 2H) fasting insulin, insulin sensitivity index, Cystatin C, urinary protein / creatinine ratio statistics. Analysis of type 2 diabetes risk factors associated with DN, to investigate the correlation between diabetic nephropathy syndrome type with the indexes. Results were statistically analyzed using SPSS13.0 standard deviation for all measurement data (SX?) said that accord with normal distribution using t test, does not meet the normal distribution using the rank sum test, analysis of variance was used to compare between groups; count data by percentage (%), with 2 chi square test; analysis of the related risk factors with Logistic regression analysis. Results: 1.DN group and NDN group in the history of smoking, age, course of disease was statistically significant difference (P0.05), DN group compared with NDN group, smoking patients had more older, longer duration. Between the two groups in gender, drinking history, family history of diabetes, there was no significant difference on body mass index (P0.05) of.2.DN group with the NDN group of systolic blood pressure, pulse pressure difference was statistically significant (P0.05), DN group of patients with systolic pressure and pulse pressure levels higher than the NDN group; and two groups of diastolic pressure, no significant difference of serum lipid levels (P0.05) in group.3.DN, fasting blood glucose, fasting insulin, serum cystatin C levels higher than the NDN group, DN group the insulin sensitivity index was lower than the NDN group, the difference was statistically significant between the two groups (P0.05), 2h postprandial blood glucose, no statistically significant difference in glycated hemoglobin (P0.05) specific.4. related risk factors of DN, DN and the related factors with significant difference Logistic regression analysis results showed that duration (OR=1.083, P=0.006), Cystatin C (OR=2.427, P=0.037), fasting blood glucose (OR=1.131, P=0.011), fasting insulin (OR=1.021, P=0.044).5.DN is a risk factor for diabetic nephropathy syndromes group course of cystatin C, urinary protein / creatinine (P0.05 is not completely equal 22), the results showed that in the course of disease, both spleen and kidney qi deficiency group and Yin and yang deficiency group had significant difference with the two yinxuzaore group (P0.05), spleen and kidney qi deficiency group and Yin and Yang of the two virtual group patients were longer than those of yin asthenia and heat group patients; two of yin and yang deficiency group in cystatin C and urine protein / creatinine compared with other three groups, the difference was statistically significant (P0.05.DN) the syndrome group between gender, age, BMI, blood pressure, blood fat, smoking history, drinking history, family history of diabetes, fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin, insulin sensitive index, inhibition of cystine C, urine protein / creatinine ratio differences were not statistically significant (P0.05). Conclusion: 1. age, disease duration, smoking history, systolic blood pressure, pulse pressure, Cystatin C, fasting blood glucose, fasting insulin, insulin sensitivity index, the incidence of diabetic nephropathy with the course of disease, fasting blood glucose, fasting serum cystatin C insulin is a risk factor for diabetic nephropathy. The longer the duration, the higher the fasting blood glucose, fasting insulin is higher, Cystatin C is higher, more prone to diabetic nephropathy in the course of.2., Cystatin C, urinary protein / creatinine and diabetic nephropathy in TCM are linked: spleen kidney qi deficiency group and Yin and yang deficiency patients were two course longer than yinxuzaore group patients; two of yin and yang deficiency group of cystatin C, urinary protein / creatinine ratio was better than the other three groups, suggesting that the two type is the end of yin and yang deficiency syndrome of diabetic nephropathy.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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