本文選題：慢性腎臟病5期 + 透析�。� 參考：《南京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：調(diào)查CKD5期透析伴心血管鈣化患者的中醫(yī)證素,總結(jié)其中醫(yī)病機特點,為中醫(yī)藥防治心血管鈣化提供參考。方法：收集符合納入條件的HD和PD患者,通過影像學(xué)檢查篩選出伴有心血管鈣化的病例。在同等條件下采集血標(biāo)本；采用中醫(yī)傳統(tǒng)四診方法,采集臨床資料,將獲得臨床信息錄入調(diào)查表；對照《證素辨證學(xué)》進行證素判別；分析病位、病性分布及其影響因素,總結(jié)病機特點,比較HD與PD中醫(yī)證素的差別。結(jié)果：(1)一般資料：共收集病例63例,53例檢查提示伴心血管鈣化,占84.1%；其中HD30例(56.6%),PD23例(43.4%)；男性29例(54.7%),女性24例(45.3%)；年齡最小36歲,最大85歲,平均年齡(62.51±13.13)歲；透析齡最小0.25個月,最大300個月,中位透析齡39(11,62)個月。50例透析患者表現(xiàn)為冠狀動脈鈣化,其CACs值最小0.41分,最大12055.72分,中位CACs值為62.45(262.12,879.04)分；另外3例分別表現(xiàn)為二尖瓣鈣化、腹主動脈鈣化及髂總動脈鈣化,未計鈣化值。原發(fā)�。郝阅I炎15例(28.3%),糖尿病腎病9例(17.0%),IgA腎病2例(3.8%),梗阻性腎病、膜性腎病、腎結(jié)石各1例(1.9%),其他24例(45.3%)。合并疾�。焊哐獕�49例(94.3%)、糖尿病19例(35.8%)、心腦血管疾病史24例(45.3%)。(2)透析伴心血管鈣化患者病情分析：50歲以上患者CACs中位數(shù)值較高,但差異無統(tǒng)計學(xué)意義(P0.05)；透析齡60個月(5年)患者的CACs中位數(shù)值升高,但差異無統(tǒng)計學(xué)意義(P0.05)；PD發(fā)生心血管鈣化的比例高于HD,PD組CACs中位數(shù)值高于HD組,但差異無統(tǒng)計學(xué)意義(P0.05)；有心腦血管并發(fā)癥組的CACs中位數(shù)值顯著升高,組間比較差別有統(tǒng)計學(xué)意義(P0.05),提示CACs高者易發(fā)生心腦血管事件。(3)中醫(yī)病位、病性證素分布：53例透析伴心血管鈣化患者,病位證素出現(xiàn)頻數(shù)由高到低依次是：腎、脾、心、肺、肌膚、肝、心神、筋骨、經(jīng)絡(luò)、胃,提示主要病位在腎、脾,涉及心、肺、肌膚等。病性證素出現(xiàn)頻數(shù)由高到低依次是：氣虛、血虛、陽虛、陰虛、痰、濕、氣滯、血瘀、精虧、燥、飲、水停,提示主要本虛病性為氣虛、血虛、陽虛、陰虛；主要標(biāo)實病性為痰、濕,涉及氣滯、血瘀等。病位證素中,僅有腎、肺出現(xiàn)嚴(yán)重病變,其中腎的嚴(yán)重病變出現(xiàn)頻數(shù)最高。本虛病性中氣虛、血虛、陽虛、陰虛均出現(xiàn)了嚴(yán)重病變,尤以血虛、氣虛為著；標(biāo)實病性中僅痰、濕出現(xiàn)了嚴(yán)重病變。提示病位腎、肺及病性氣虛、血虛、陽虛、陰虛、痰、濕的證候表現(xiàn)明顯,病隋較重。病位證素以單個病位、兩個病位相兼最為常見；病性證素以三個、四個、五個病位相兼常見；虛實夾雜證多見,占3/4,其次是純虛證,占1/4,未見單純實證。提示透析患者的病位、病性證素繁多,常同時存在,相兼復(fù)雜。各病位、病性證素的分布與冠狀動脈鈣化程度無明顯關(guān)系,組間比較無統(tǒng)計學(xué)意義(P0.05)。病位腎、肺及病性陽虛的輕重與年齡有關(guān),組間比較有統(tǒng)計學(xué)意義(P0.05)。組間兩兩比較,病位腎在(51-60)歲組的嚴(yán)重程度較50歲組重,較61-70歲組、71歲組輕,差別有統(tǒng)計學(xué)意義(P0.05),提示50歲以后。腎的證候表現(xiàn)明顯；病位肺、病性陽虛隨年齡增長,癥候表現(xiàn)也加重,但差異無統(tǒng)計學(xué)意義(P0.05),提示病位肺、病性陽虛可能與年齡有關(guān)。病性痰的輕重在各透析齡組間差別有統(tǒng)計學(xué)意義(P0.05)。組間兩兩比較,雖然隨著透析齡增長,病性痰證素的癥候表現(xiàn)也加重,但差異無統(tǒng)計學(xué)意義(P0.05),提示病性痰證候的輕重與透析齡可能有關(guān)。PD病位脾、病性血虛的證候較HD明顯,組間比較有統(tǒng)計學(xué)意義(P0.05)。提示PD患者臨床更易出現(xiàn)脾與血虛的證候。病位、病性病變程度與各指標(biāo)的關(guān)系：肺與TC負相關(guān)；肌膚與Ca正相關(guān),與PTH負相關(guān)；氣虛與TG正相關(guān),與Alb負相關(guān)：血虛與Hb負相關(guān),與Hs-CRP正相關(guān)：痰與血Hcy正相關(guān)。結(jié)論：(1)CACs高者更易發(fā)生心腦血管事件；(2)PD較HD有較高的心血管鈣化發(fā)生比例,且冠脈鈣化程度較HD嚴(yán)重,推測與PD對鈣磷離子、氧化因子、炎癥因子的清除不如H13充分有關(guān)。(3)透析伴心血管鈣化的病位主要在腎、脾,涉及心、肺、肌膚：本虛病性突出,表現(xiàn)為氣虛、血虛、陰虛、陽虛；標(biāo)實病性以痰、濕、瘀、氣滯為主；病位、病性證素相兼復(fù)雜。(4)透析伴心血管鈣化患者的病性為本虛標(biāo)實,主要病理因素為痰、瘀,治療當(dāng)在益氣養(yǎng)陰、養(yǎng)血通脈的基礎(chǔ)上,注重化痰行瘀。(5)PD患者的血虛、脾病證素較HD患者表現(xiàn)明顯。
[Abstract]:Objective: To investigate the TCM Syndromes of patients with CKD5 dialysis with cardiovascular calcification, to summarize the characteristics of TCM pathogenesis, and to provide reference for the prevention and treatment of cardiovascular calcification by traditional Chinese medicine. Methods: to collect HD and PD patients conforming to the conditions, and to select the cases with cardiovascular calcification through imaging examination. Traditional methods of medical treatment, collect clinical information, obtain clinical information entry questionnaire, compare syndrome differentiation and syndrome differentiation, analyze disease location, disease distribution and influencing factors, summarize the characteristics of disease machine, compare the difference between HD and PD TCM syndrome. (1) general data: a total of 63 cases were collected, 53 cases were cue with cardiovascular. Calcification, accounting for 84.1%, was 84.1% (56.6%), PD23 (43.4%), 29 men (54.7%) and 24 women (45.3%); the minimum age 36, the maximum age of 85, the average age (62.51 + 13.13), the minimum dialysis age 0.25 months, the maximum 300 months, and the middle dialysate age (11,62) months (11,62) for.50 patients with coronary artery calcification, and the minimum CACs value. The maximum 12055.72 points and median CACs value were 62.45 (262.12879.04); the other 3 cases were mitral valve calcification, abdominal aortic calcification and total iliac artery calcification, without calcification. The primary disease was chronic nephritis in 15 cases (28.3%), diabetic nephropathy in 9 cases (17%), IgA nephropathy in 2 cases (3.8%), obstructive nephropathy, membranous nephropathy, and 1 renal calculi (1.9%). He had 24 cases (45.3%), combined disease: 49 cases of hypertension (94.3%), 19 cases of diabetes (35.8%), and 24 cases of cardiovascular and cerebrovascular disease (45.3%). (2) analysis of the condition of patients with dialysis with cardiovascular calcification: the median value of CACs was higher in patients over 50 years old, but the difference was not statistically significant (P0.05); the median value of CACs in patients with dialysis age 60 months (5) was higher, but the difference was different There was no statistical significance (P0.05); the proportion of cardiovascular calcification in PD was higher than that of HD, and the median value of CACs in group PD was higher than that in group HD, but the difference was not statistically significant (P0.05); there was a significant increase in the median of CACs in the group of cardiovascular and cerebrovascular complications, and there was a significant difference between groups (P0.05), suggesting that those with high CACs were prone to cardio cerebral vascular events. (3) TCM disease. 53 cases of dialysis with cardiovascular calcification in patients with cardiovascular calcification, the frequency from high to low is the following: kidney, spleen, heart, lung, skin, liver, heart, muscles, meridians, stomach, indicating the main disease location in the kidney, spleen, involving the heart, lung, skin and so on. The frequency of the disease syndrome appears from high to low in turn: Qi deficiency, blood deficiency, Yang deficiency, yin asthenia, phlegm, dampness, Qi stagnation, blood stasis, deficiency, dryness, drinking and water stop, suggesting that the main deficiency of the disease is Qi deficiency, blood deficiency, Yang deficiency and yin deficiency. The main symptoms are phlegm and damp, involving qi stagnation, blood stasis and so on. Change, especially blood deficiency, Qi deficiency, only phlegm and dampness appeared in the disease. It suggested that the disease position kidney, lung and disease Qi deficiency, blood deficiency, Yang deficiency, yin deficiency, phlegm, wet syndrome were obvious, and the disease was more serious in the Sui Dynasty. The disease position syndrome was single disease position, two disease phase and most common; the disease syndrome was three, four, five diseases in phase and common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency syndrome was common; deficiency of five diseases common; deficiency The syndrome of solid inclusion was common, accounting for 3/4, followed by pure deficiency syndrome, accounting for 1/4, and no simple demonstration. It indicated that the disease location of the dialysis patients was various, often existed at the same time and complex. There was no significant relationship between the distribution of the disease level and the degree of coronary artery calcification, and there was no statistical significance between the groups (P0.05). Age related, the comparison between groups was statistically significant (P0.05). 22, the severity of the kidney in the (51-60) year group was heavier than that of the 50 year old group, compared with the 61-70 year old group and the 71 year old group. The difference was statistically significant (P0.05). It was suggested that after 50 years of age, the symptoms of the kidney were obvious; the disease in the lung and the disease Yang deficiency increased with age, but the symptom was also aggravated, but the difference was also aggravated, but the difference was also different, but the difference was different, but the difference was different, but the difference was different There was no statistical significance (P0.05), suggesting that the disease level lung may be related to the age of the disease. The severity of the phlegm is statistically significant (P0.05). The symptoms of the phlegm syndrome are also aggravated with the age of dialysis (22), but the difference is not statistically significant (P0.05), suggesting the severity of the phlegm syndrome. The syndrome of.PD disease was more likely to be related to the spleen, and the syndrome of disease sex blood deficiency was more obvious than that of HD (P0.05). It suggested that the symptoms of spleen and blood deficiency were more likely to appear in the patients with PD. The relationship between the degree of disease and the degree of disease and the index of the disease was negatively related to the lung and TC; the skin was positively related to Ca and negatively correlated with PTH; Qi deficiency was positively related to TG and Alb. Negative correlation: negative correlation of blood deficiency with Hb and positive correlation with Hs-CRP: positive correlation between phlegm and blood Hcy. Conclusion: (1) the patients with high CACs are more likely to have cardio cerebral vascular events; (2) PD has a higher proportion of cardiovascular calcification than HD, and the degree of coronary calcification is more severe than HD. It is presumed that the clearance of calcium and phosphorus ions, oxidation factors, and inflammatory factors is not as sufficient as H13 (3). (3 ) dialysis with cardiovascular calcification mainly in the kidney, the spleen, involving the heart, lung, skin: the deficiency of the disease is prominent, manifested as Qi deficiency, blood deficiency, yin deficiency, Yang deficiency; the underlying disease is phlegm, dampness, stasis, qi stagnation. (4) the disease of patients with dialysis with cardiac calcification is a virtual standard, and the main pathological factors are phlegm, stasis, treatment. On the basis of Supplementing Qi and nourishing yin and nourishing blood and promoting blood circulation, we should pay attention to phlegm and blood stasis. (5) blood deficiency of PD patients, spleen disease syndrome is more obvious than HD patients.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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6 張正楊;鉀離子抗血管鈣化的分子機制研究[D];川北醫(yī)學(xué)院;2014年

7 閆鐵昆;終末期腎病患者橈動脈局部醛固酮—鹽皮質(zhì)激素受體活性改變及其與血管鈣化的關(guān)系[D];天津醫(yī)科大學(xué);2009年

8 陳晶晶;C-型利鈉利尿肽抑制血管鈣化的作用及機制研究[D];南華大學(xué);2008年

9 李相;終末期腎臟疾病血管鈣化多因素關(guān)聯(lián)性分析[D];吉林大學(xué);2012年

10 張旭升;血管鈣化大鼠尾加壓素Ⅱ及其受體表達的變化[D];汕頭大學(xué);2008年

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