本文選題：慢性腎炎 + 氣陰兩虛證�。� 參考：《南京中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：探討慢性腎小球腎炎(簡稱慢性腎炎,CGN)氣陰兩虛證的證候臨床特點(diǎn),為此病證的臨床中醫(yī)辨證提供參考和依據(jù)。方法：從2015年3月1日-11月31日期間在江蘇省中醫(yī)院腎內(nèi)科住院的病患中,收集符合納入標(biāo)準(zhǔn)的182例病患,回顧性研究這些病例的臨床資料,運(yùn)用Excel軟件進(jìn)行氣陰兩虛證候積分計(jì)算,觀察、分析其證候積分、一般資料(年齡、性別、病程、病理類型)、血液指標(biāo)(血尿素氮、血肌酐、血尿酸、血清白蛋白、血總膽固醇、血甘油三酯、血鉀、血鈣、血磷、血二氧化碳結(jié)合力)、尿液指標(biāo)(尿蛋白、尿隱血、尿白細(xì)胞、尿紅細(xì)胞、24小時(shí)尿蛋白定量)等客觀指標(biāo)的臨床特點(diǎn),并對以上數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理。根據(jù)統(tǒng)計(jì)結(jié)果總結(jié)慢性腎炎氣陰兩虛證的證候臨床特點(diǎn),為臨床預(yù)防、診斷及治療此病證提供辨證依憑和根據(jù)。結(jié)果：年齡分布特點(diǎn)：(1)年齡分布于18-83歲。(2)患者平均年齡49.25±15.02歲,女病患的平均年齡大于男病患。(3)人數(shù)分布：青年組中年組老年組。(4)年齡組的不同對證候積分產(chǎn)生的影響不明顯(P0.05)。性別分布特點(diǎn)：(1)病患男女比為1：1.84。(2)各年齡組上女病患人數(shù)均較男病患多。男病患人數(shù)分布：青年組老年組中年組,女病患人數(shù)分布：中年組青年組老年組。(3)不同性別的病患在各年齡組上的分布無明顯差別(P0.05),性別對證候積分產(chǎn)生的影響不明顯(P0.05)。病程分布特點(diǎn)：(1)病程分布于3月-480月。(2)人數(shù)分布：病程大于24個(gè)月者病程在12個(gè)月以下者病程在13～24個(gè)月者。(3)患者平均病程58.73±92.53月。女性病患的平均病程大于男性病患。女性病患人數(shù)在所有病程組中均多于男性。(4)男病患在病程12月以下者人數(shù)最多,女病患在病程大于24個(gè)月者人數(shù)最多。(5)不同性別病患在各病程組上的分布差異不顯著(P0.05)。氣陰兩虛證候積分均值：病程在13-24個(gè)月者病程在12個(gè)月以下者病程在24個(gè)月以上者。(6)可認(rèn)為病程的不同對氣陰兩虛證候積分產(chǎn)生了明顯影響(P0.05)。病理類型分布特點(diǎn)：(1)患者中行腎穿活檢者和未行者人數(shù)比為1：2.71。(2)分布人數(shù)：IgA腎病患者膜性腎病患者系膜增生性腎炎(非IgA腎炎)患者膜增殖性腎炎者、局灶或節(jié)段性腎小球硬化者微小病變型腎炎患者。(3)男性與女性均在IgA腎病中患病人數(shù)最多,膜性腎病患病人數(shù)緊隨其后。氣陰兩虛證候積分均值：膜性腎病患者局灶或節(jié)段性腎小球硬化組IgA腎病組和系膜增生性腎炎(非IgA腎炎)組膜增殖性腎炎組微小病變型腎炎組。(4)可以認(rèn)為病患的病理類型對氣陰兩虛證候積分的影響顯著(P0.01)。血液指標(biāo)特點(diǎn)：(1)ALB、Ca2+、TC與氣陰兩虛證候積分顯著相關(guān)(P0.05),此三者水平異常者證候積分均值高于水平正常者。其中ALB、Ca2+是否異常對證候積分的影響顯著(P0.01)。BUN、Scr、UA、TG、K+、P3+、CO2CP與證候積分比較無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)所有血液指標(biāo)中,ALB同氣陰兩虛證候積分相關(guān)性最密切,其次是Ca2+,Scr與此病證證候積分相關(guān)性最不密切。尿液指標(biāo)特點(diǎn)：(1)人數(shù)分布：尿蛋白陰性者尿蛋白+者尿蛋白++者尿蛋白+-者尿蛋白+++者：隱血陰性者尿隱血+++者尿隱血+者尿隱血++者尿隱血+-者尿隱血+++·者。(2)氣陰兩虛證候積分均值分布：尿蛋白為+++者尿蛋白為++者尿蛋白+者尿蛋白-+者尿蛋白陰性者；尿隱血為+++者尿隱血陰性者尿隱血為++++者尿隱血為+者尿隱血為-+者尿隱血++者。尿蛋白的不同等級定性對證候積分影響顯著(P0.01)。尿隱血的等級定性指標(biāo)對證候積分的影響不顯著(P0.05)。(3)UTP與證候積分顯著正相關(guān)(P0.01)；尿白細(xì)胞、尿紅細(xì)胞與證候積分相比較皆無統(tǒng)計(jì)學(xué)意義(P0.05)。UTP與證候積分的相關(guān)性最密切,其次為白細(xì)胞,紅細(xì)胞與證候積分的相關(guān)性最不密切。結(jié)論：(1)慢性腎炎氣陰兩虛證患者病程較長。(2)膜性腎病的氣陰兩虛證候特點(diǎn)最明顯,微小病變型腎炎組最不明顯。(3)在血液指標(biāo)中,ALB、Ca2+與氣陰兩虛證候積分呈負(fù)相關(guān),TC與證候積分呈正相關(guān)。(4)尿液指標(biāo)中,氣陰兩虛證候積分均值與尿蛋白呈正相關(guān),尿蛋白等級越高,患者氣陰兩虛癥狀越重；UTP與氣陰兩虛證候積分顯著正相關(guān)。(5)年齡、性別、血BUN、Scr、UA、TG、K+、P3+、CO2CP、尿隱血、尿白細(xì)胞、尿紅細(xì)胞均與氣陰兩虛證候無關(guān)。提示氣陰兩虛證候與年齡、性別、腎功能進(jìn)展等因素?zé)o相關(guān)性。
[Abstract]:Objective: To explore the clinical characteristics of syndrome of chronic glomerulonephritis (chronic nephritis, CGN) syndrome of deficiency of Qi and Yin, and to provide reference and basis for clinical TCM Syndrome Differentiation for this disease. Methods: to collect 182 patients in the hospitalized patients in the Department of Nephrology of Jiangsu Province Traditional Chinese Medicine Hospital during the period of 31 -11 of March 1, 2015, and to review the retrospective study. To investigate the clinical data of these cases, Excel software was used to calculate the syndrome score of Qi and yin deficiency syndrome, and to observe the syndrome integral, the general data (age, sex, course of disease, pathological type), blood indexes (blood urea nitrogen, serum creatinine, serum albumin, total cholesterol, triglyceride, potassium, blood calcium, blood phosphorus, blood carbon dioxide binding) The clinical characteristics of the objective indexes, such as urine protein, urine occult blood, urinalysis, urine red blood cell, urine red blood cell, 24 hour urine protein, etc., and carry out statistical processing on the above data. According to the statistical results, the clinical characteristics of syndrome of Qi and yin deficiency syndrome of chronic nephritis are summarized, and the basis of syndrome differentiation and basis for clinical prevention, diagnosis and treatment of this disease is provided. Results: the characteristics of age distribution: (1) the age distribution was 18-83 years old. (2) the average age of the patients was 49.25 + 15.02 years, the average age of the female patients was greater than that of the male patients. (3) the number distribution: the age group of the young group. (4) the influence of the age group was not obvious (P0.05). (1) the ratio of men and women to the disease was 1:1.84 (2) the number of female patients in each age group was more than that of the male patients. The distribution of the number of male patients: the distribution of the middle-aged group in the young group, the distribution of the number of women in the middle-aged group. (3) there was no obvious difference in the distribution of the different sexes in all age groups (P0.05), and the influence of gender on the syndrome score was not obvious (P0.05). Points: (1) the course of disease was distributed in March -480 month. (2) the number distribution: the course of disease was more than 24 months in 13~24 months. (3) the average course of disease was 58.73 + 92.53 months. The average course of female patients was greater than that of male patients. The number of female patients was more than that of men in all course of disease. (4) male patients were under the course of illness under the course of December. The number of patients was the most, and the number of female patients in the course of disease was more than 24 months. (5) there was no significant difference in the distribution of different sexes in the course group (P0.05). The mean value of Qi and yin deficiency syndrome score: the course of disease in 13-24 months was below 12 months for more than 24 months. (6) the difference between the disease course and the Qi and yin deficiency syndrome score was considered. There were significant effects (P0.05). The distribution of pathological types: (1) the number of renal biopsy and non traveler was 1:2.71. (2) in patients with membranous glomerulonephritis (non IgA nephritis) with membranous proliferative glomerulonephritis in patients with membranous nephropathy in IgA nephropathy, and in patients with focal or segmental glomerulosclerosis. (3 The number of men and women in IgA nephropathy was the most, and the number of patients with membranous nephropathy was followed. The mean value of Qi and yin deficiency syndrome score: IgA nephropathy group and mesangial proliferative glomerulonephritis (non IgA nephritis) group of membranous nephrotic patients with membranous glomerulonephritis group and the group of small disease type nephritis in the group of proliferative nephritis (non IgA nephritis). (4) it can be considered as a patient. The pathological type has significant influence on the syndrome score of Qi and yin deficiency syndrome (P0.01). (1) ALB, Ca2+, TC and Qi and yin deficiency syndrome score is significantly correlated (P0.05), and the mean value of the syndrome score of the three persons with abnormal level is higher than that of the normal ones. Among them, ALB, Ca2+ has a significant influence on the syndrome score (P0.01).BUN, Scr, UA, TG There was no statistical significance between CP and syndrome score (P0.05). (2) in all blood indexes, the correlation of ALB and Qi Yin two deficiency syndrome was most closely related, followed by Ca2+, and Scr was not closely related to the syndrome score of this disease. (1) the distribution of urine protein negative urine protein + urine protein + + urine protein + + + person Occult blood + + + + + + urinary occult blood + urinary occult blood + + + + + + + +. (2) urinary protein + + + + urine protein + urine protein + urine protein negative; urinary occult blood is + + + + + + + + + + + urine occult blood occult blood Urinary occult blood + +. The different grades of urine protein have significant influence on syndrome score (P0.01). The qualitative index of urinary occult blood has no significant influence on syndrome score (P0.05). (3) there is significant positive correlation between UTP and syndrome score (P0.01), and there is no statistical significance (P0.05).UTP and syndrome product in urinocyte, urine red cell and syndrome product The correlation is the most closely related, followed by white blood cells, the correlation of red blood cells and syndrome integral is the most closely related. (1) chronic nephritis Qi Yin two deficiency syndrome patients have a longer course of disease. (2) the characteristics of Qi and yin deficiency syndrome of membranous nephropathy are the most obvious, and the minimal disease variant nephritis group is the most obvious. (3) in the blood index, ALB, Ca2+ and Qi Yin deficiency syndrome integral Negative correlation, TC and syndrome score positive correlation. (4) in urine indicators, the mean value of Qi and yin deficiency syndrome is positively correlated with urine protein, the higher the level of urine protein, the more severe symptoms of deficiency of Qi and Yin, UTP and Qi and yin deficiency syndrome score significant positive correlation. (5) age, sex, BUN, Scr, UA, TG, K+, P3+, CO2CP, urine occult blood, urinal cells, urine red thin All the cells were not related to deficiency syndrome of Qi and Yin, suggesting that there was no correlation between Qi Yin deficiency syndrome and age, sex, renal function progress and so on.
【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】：R277.5

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