基于真實(shí)世界的CKD3-4期中醫(yī)證型分布及療效研究
發(fā)布時(shí)間：2018-11-15 16:49
【摘要】：目的:探討真實(shí)世界慢性腎臟病(Chronic kidney disease,CKD)3-4期證候分布特點(diǎn)及臨床用藥的療效。方法:符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)220例CKD3-4期患者按臨床實(shí)際用藥的真實(shí)情況非隨機(jī)分為中藥+中成藥+基礎(chǔ)治療組、中藥+基礎(chǔ)治療組、中成藥+基礎(chǔ)治療組、中藥+中成藥組、中藥組、中成藥組、西藥組,依次對應(yīng)為A組、B組、C組、D組、E組、F組、G組。入組時(shí)參照中醫(yī)證候診斷標(biāo)準(zhǔn)進(jìn)行辯證分型,CKD3期患者每12周監(jiān)測1次尿素氮(BUN)、血肌酐(Scr)、腎小球?yàn)V過率(eGFR),CKD4期患者每8周監(jiān)測1次尿素氮(BUN)、血肌酐(Scr)、腎小球?yàn)V過率(eGFR),24周時(shí)進(jìn)行治療前后中醫(yī)證候評分比較,并對治療前0周及治療后24周尿素氮(BUN)、血肌酐(Scr)、腎小球?yàn)V過率(eGFR)進(jìn)行比較。結(jié)果:(1)220例CKD3-4期患者中,本虛證以脾腎氣虛證最多,共123例(55.9%);其次為脾腎陽虛證53例(24.1%);肝腎陰虛證17例(7.7%);肺腎氣虛證及氣陰兩虛證相對較少,分別為16例(7.3%)和11例(5.0%);兼有實(shí)證共163例(74.1%),其中以瘀血證居多,83例(50.9%);依次為濕濁證48例(29.5%);濕熱證32例(19.6%);CKD3期與CKD4期的虛證分布有差異性(P0.05),CKD4期脾腎氣虛證相對CKD3期所占比例下降,其脾腎陽虛證相對CKD3期所占比例升高;(2)中醫(yī)證候積分比較發(fā)現(xiàn):A組、B組、C組與治療前相比證候積分明顯下降(P0.05);治療后組間比較發(fā)現(xiàn),A組與B組無明顯差異(P0.05);A組與B組在改善證候積分方面均明顯優(yōu)于C組(P0.05);臨床療效分析:A組總有效率86.21%,B組總有效率86.74%,C組總有效率78.33%,A組與B組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);A組與C組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);B組與C組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);A組與B組在臨床療效方面明顯優(yōu)于C組(P0.05)。(3)A組、B組、C組治療后均能有效增加eGFR、降低Scr水平(P0.05);A組與B組治療后組間比較eGFR、Scr水平無統(tǒng)計(jì)學(xué)意義(P0.05);A組與B組在增加eGFR、降低Scr水平方面均優(yōu)于C組(P0.05);A組、B組、C組BUN水平與治療前相比無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、CKD3-4期患者本證以脾腎氣虛最多見,標(biāo)證以瘀血證居多。隨著CKD3期進(jìn)展至CKD4期,脾腎氣虛有發(fā)展為脾腎陽虛的趨勢。2、中藥+中成藥+基礎(chǔ)治療組與中藥+基礎(chǔ)治療組在改善患者臨床癥狀方面均優(yōu)于中成藥+基礎(chǔ)治療組。3、中藥+基礎(chǔ)治療組及中成藥+基礎(chǔ)治療組均能有效增加eGFR、降低Scr水平。
[Abstract]:Objective: to investigate the distribution of phase 3-4 syndromes of real world chronic kidney disease (Chronic kidney disease,CKD) and its clinical efficacy. Methods: 220 patients with CKD3-4 according to the inclusion criteria and exclusion criteria were not randomly divided into two groups according to the actual clinical conditions. Group A, group B, group C, group D, group E, group F and group G respectively. According to the diagnostic criteria of TCM syndromes, urea nitrogen, (BUN), creatinine, (Scr), glomerular filtration rate were monitored once every 12 weeks in patients with CKD3. (BUN), was monitored once every 8 weeks in patients with (eGFR), CKD4. The glomerular filtration rate (eGFR),) of serum creatinine (Scr),) was compared before and after treatment with TCM syndrome scores before and after 24 weeks of treatment, and the glomerular filtration rate (eGFR) of (BUN), serum creatinine (Scr), was compared at 0 weeks before treatment and 24 weeks after treatment. Results: (1) in 220patients with CKD3-4, the deficiency of spleen and kidney qi was the most common syndrome (55.9%), followed by the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of liver and kidney yin in 17 patients (7.7%), the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of spleen and kidney qi in 17 patients (5.7%). There were 16 cases (7.3%) and 11 cases (5.0%) with deficiency of qi and kidney qi, 163 cases (74.1%) with both syndrome and 83 cases with blood stasis syndrome (50.9%). There were 48 cases (29.5%) of dampness and heat syndrome, 32 cases (19.6%) of damp-heat syndrome. The distribution of deficiency syndrome in CKD3 phase and CKD4 phase was different (P0.05). The proportion of spleen and kidney qi deficiency syndrome relative to CKD3 phase decreased in CKD4 phase, and the proportion of spleen and kidney yang deficiency syndrome relative to CKD3 phase increased. (2) the syndromes scores of group A, group B and group C were significantly lower than those of before treatment (P0.05), but there was no significant difference between group A and group B after treatment (P0.05). Group A and group B were significantly better than group C in improving syndromes score (P0.05). Clinical efficacy analysis: the total effective rate of group A was 86.21 and the total effective rate of group B was 86.74 and the total effective rate of group C was 78.33. There was no significant difference between group A and group B (P0.05). There was significant difference between group A and group C (P0.05) between); B group and C group (P0.05). The clinical efficacy of group A and group B was significantly better than that of group C (P0.05). (3). Group B and group C could effectively increase the level of eGFR, and decrease the level of Scr after treatment (P0.05). There was no significant difference in eGFR,Scr level between group A and group B after treatment (P0.05); A group and B group in increasing eGFR, and decreasing Scr level were better than C group (P0.05); The level of BUN in group A, group B and group C had no statistical significance compared with that before treatment (P0.05). Conclusion: (1) deficiency of spleen and kidney qi is the most common syndrome in CKD 3-4 patients, and blood stasis syndrome is the most common syndrome. With the development of CKD3 to CKD4, the deficiency of spleen and kidney qi developed into deficiency of spleen and kidney yang. 2. The basic treatment group of traditional Chinese medicine and the basic treatment group of traditional Chinese medicine were superior to the traditional Chinese patent medicine group in improving the clinical symptoms of the patients. Both the basic Chinese medicine treatment group and the traditional Chinese patent medicine treatment group can effectively increase eGFR, and reduce the level of Scr.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5
本文編號：2333865
[Abstract]:Objective: to investigate the distribution of phase 3-4 syndromes of real world chronic kidney disease (Chronic kidney disease,CKD) and its clinical efficacy. Methods: 220 patients with CKD3-4 according to the inclusion criteria and exclusion criteria were not randomly divided into two groups according to the actual clinical conditions. Group A, group B, group C, group D, group E, group F and group G respectively. According to the diagnostic criteria of TCM syndromes, urea nitrogen, (BUN), creatinine, (Scr), glomerular filtration rate were monitored once every 12 weeks in patients with CKD3. (BUN), was monitored once every 8 weeks in patients with (eGFR), CKD4. The glomerular filtration rate (eGFR),) of serum creatinine (Scr),) was compared before and after treatment with TCM syndrome scores before and after 24 weeks of treatment, and the glomerular filtration rate (eGFR) of (BUN), serum creatinine (Scr), was compared at 0 weeks before treatment and 24 weeks after treatment. Results: (1) in 220patients with CKD3-4, the deficiency of spleen and kidney qi was the most common syndrome (55.9%), followed by the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of liver and kidney yin in 17 patients (7.7%), the deficiency of spleen and kidney yang in 53 patients (24.1%), the deficiency of spleen and kidney qi in 17 patients (5.7%). There were 16 cases (7.3%) and 11 cases (5.0%) with deficiency of qi and kidney qi, 163 cases (74.1%) with both syndrome and 83 cases with blood stasis syndrome (50.9%). There were 48 cases (29.5%) of dampness and heat syndrome, 32 cases (19.6%) of damp-heat syndrome. The distribution of deficiency syndrome in CKD3 phase and CKD4 phase was different (P0.05). The proportion of spleen and kidney qi deficiency syndrome relative to CKD3 phase decreased in CKD4 phase, and the proportion of spleen and kidney yang deficiency syndrome relative to CKD3 phase increased. (2) the syndromes scores of group A, group B and group C were significantly lower than those of before treatment (P0.05), but there was no significant difference between group A and group B after treatment (P0.05). Group A and group B were significantly better than group C in improving syndromes score (P0.05). Clinical efficacy analysis: the total effective rate of group A was 86.21 and the total effective rate of group B was 86.74 and the total effective rate of group C was 78.33. There was no significant difference between group A and group B (P0.05). There was significant difference between group A and group C (P0.05) between); B group and C group (P0.05). The clinical efficacy of group A and group B was significantly better than that of group C (P0.05). (3). Group B and group C could effectively increase the level of eGFR, and decrease the level of Scr after treatment (P0.05). There was no significant difference in eGFR,Scr level between group A and group B after treatment (P0.05); A group and B group in increasing eGFR, and decreasing Scr level were better than C group (P0.05); The level of BUN in group A, group B and group C had no statistical significance compared with that before treatment (P0.05). Conclusion: (1) deficiency of spleen and kidney qi is the most common syndrome in CKD 3-4 patients, and blood stasis syndrome is the most common syndrome. With the development of CKD3 to CKD4, the deficiency of spleen and kidney qi developed into deficiency of spleen and kidney yang. 2. The basic treatment group of traditional Chinese medicine and the basic treatment group of traditional Chinese medicine were superior to the traditional Chinese patent medicine group in improving the clinical symptoms of the patients. Both the basic Chinese medicine treatment group and the traditional Chinese patent medicine treatment group can effectively increase eGFR, and reduce the level of Scr.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5
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