【摘要】：目的：本課題試圖探討CKD4期的中醫(yī)本虛證證型的分布特征,并以此為基礎(chǔ)分析主要的證型與主要實驗室指標(biāo)的相關(guān)關(guān)系,以期能夠為CKD4期中醫(yī)證候診斷進一步的標(biāo)準(zhǔn)化以及中醫(yī)藥臨床治療的規(guī)范化提供一定的參考,以助于發(fā)揮中醫(yī)藥在推遲、預(yù)防治療終末期腎病期中的優(yōu)勢,相對減輕患者與社會的負(fù)擔(dān)。方法：本文采用流行病學(xué)回顧性調(diào)查方法,一共收集123例患者中醫(yī)癥狀、證候以及和有關(guān)的實驗室指標(biāo)等相關(guān)資料,并通過統(tǒng)計分析的方法分析CKD4期中醫(yī)本虛證型的分布特征,分析主要證型與主要實驗室指標(biāo)的相關(guān)關(guān)系。其中,主要的觀察及分析的實驗室指標(biāo)包括血中肌酐、尿素、尿酸、膽固醇、甘油三酯、LDL-C、24小時尿蛋白定量、尿蛋白／肌酐比值(ACR)。結(jié)果：在收集的123例慢性腎臟病4期患者中,具有脾腎氣虛證的臨床特征的共有44例(34.38%),診斷為脾腎氣陰兩虛證的患者共有34例(27.64%),脾腎陽虛者19例、肝腎陰虛者18例、脾腎陰陽兩虛者7例、濕熱證者1例。統(tǒng)計學(xué)分析提示在慢性腎臟病4期患者中脾腎氣虛證和脾腎氣陰兩虛證二者的實驗室測量值分布不具有統(tǒng)計學(xué)意義。脾腎氣虛+脾腎氣陰兩虛證組與非脾腎氣虛、脾腎氣陰兩虛證組中患者的血尿酸值均數(shù)具有統(tǒng)計學(xué)意義(P0.1),且前組尿酸水平高于后組(P0.05,D0)；血總膽固醇指標(biāo)分布差異具有顯著統(tǒng)計學(xué)意義(P0.05),且前組總膽固醇水平低于后組(P0.05, D0);ACR指標(biāo)分布差異具有顯著統(tǒng)計學(xué)意義(P0.05),且前組ACR低于后組(P0.05,D0)。在分析脾腎氣虛+脾腎氣陰兩虛組與非脾腎氣虛、脾腎氣陰兩虛組患者的LDL-C、肌酐、尿素、甘油三酯、24小時尿蛋白均數(shù)時,發(fā)現(xiàn)均不具有統(tǒng)計學(xué)意義。結(jié)論：在收集的123例慢性腎臟病4期患者中,脾腎氣虛證、脾腎氣陰兩虛證為中醫(yī)本虛證的主要證型,脾腎二臟的虧虛是為CKD4期的基本病機。在脾腎氣虛證和脾腎氣陰兩虛證兩個證型之間,本次研究中尚沒有發(fā)現(xiàn)此二證與主要觀察的實驗室指標(biāo)之間的相關(guān)關(guān)系,仍需進一步的大樣本、多中心的統(tǒng)計分析,在客觀指標(biāo)無法提示證候分布特征的情況下,中醫(yī)的辨證論治在區(qū)分慢性。腎臟病4期患者脾腎氣虛證和脾腎氣陰兩虛證的診斷與治療中更為重要。在CKD4期中,四診合參,可以將明顯升高的尿酸值視為CKD4期患者診斷脾腎氣虛證、脾腎氣陰兩虛證的相關(guān)參考指標(biāo)。ACR及總膽固醇的明顯升高可以視為診斷CKD4期患者肝腎陰虛證、脾腎陽虛證、陰陽兩虛的相關(guān)參考指標(biāo)。
[Abstract]:Objective: to explore the distribution characteristics of deficiency syndrome in traditional Chinese medicine (TCM) in CKD4 stage, and to analyze the relationship between the main syndrome types and the main laboratory indexes. In order to provide some reference for the further standardization of TCM syndrome diagnosis in CKD4 stage and the standardization of clinical treatment of traditional Chinese medicine, so as to give full play to the advantages of traditional Chinese medicine in delaying and preventing the treatment of end-stage kidney disease. Relatively lighten the burden on patients and society. Methods: a total of 123 patients with TCM symptoms, syndromes and related laboratory indexes were collected by epidemiological retrospective investigation, and the distribution characteristics of TCM deficiency syndrome in CKD4 stage were analyzed by statistical analysis. The correlation between the main syndrome types and the main laboratory indexes was analyzed. Among them, the main laboratory indexes of observation and analysis include serum creatinine, urea, uric acid, cholesterol, TG, LDL-C,24 hourly urine protein quantity, urine protein / creatine ratio (ACR). Results: of the 123 patients with chronic kidney disease in stage 4, 44 (34.38%) had the clinical characteristics of spleen and kidney qi deficiency syndrome, 34 cases (27.64%) were diagnosed as deficiency of spleen and kidney qi and yin, and 19 cases were deficiency of spleen and kidney yang. There were 18 cases of deficiency of yin of liver and kidney, 7 cases of deficiency of yin and yang of spleen and kidney, and 1 case of syndrome of dampness and heat. Statistical analysis showed that the distribution of laboratory measurements of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome was not statistically significant in stage 4 patients with chronic kidney disease. The mean value of uric acid in spleen and kidney qi deficiency syndrome group and non-spleen and kidney qi deficiency syndrome group and spleen and kidney qi yin deficiency syndrome group was statistically significant (P0.1), and the level of uric acid in the former group was higher than that in the latter group (P0.05, D0). There was significant difference in the distribution of blood total cholesterol (P0.05), and the level of total cholesterol in the former group was lower than that in the latter group (P0.05, D0). The distribution of ACR index was significantly different (P 0.05), and the ACR of the former group was lower than that of the latter group (P0.05, D0). It was found that there was no significant difference in LDL-C, creatinine, urea, TG and 24-hour urinary protein between spleen and kidney qi deficiency group and non-spleen and kidney qi deficiency group and spleen and kidney qi yin deficiency group. The results showed that there was no significant difference between spleen and kidney qi deficiency group and non-spleen and kidney qi deficiency group and spleen and kidney qi yin deficiency group. Conclusion: among 123 patients with chronic kidney disease in stage 4, spleen and kidney qi deficiency syndrome and spleen kidney qi yin deficiency syndrome are the main syndromes of TCM deficiency syndrome, and deficiency of spleen and kidney deficiency is the basic pathogenesis of CKD4 stage. Between spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome, there is no correlation between these two syndromes and the main laboratory indexes in this study, and further large samples and multicenter statistical analysis are still needed. Under the condition that the objective index can not indicate the distribution characteristics of syndromes, the syndrome differentiation and treatment of traditional Chinese medicine is to distinguish chronic. The diagnosis and treatment of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome are more important in stage 4 kidney disease. In CKD4 stage, the significantly increased uric acid value can be regarded as the relevant reference index for the diagnosis of spleen and kidney qi deficiency syndrome and spleen and kidney qi yin deficiency syndrome in patients with CKD4 stage. The obvious increase of ACR and total cholesterol can be regarded as the diagnosis of liver and kidney yin deficiency syndrome in CKD4 stage. Spleen and kidney yang deficiency syndrome, yin and yang deficiency related reference indicators.
【學(xué)位授予單位】：廣州中醫(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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