摘要
目的:通过对儿童难治性肾病综合征的临床证候分析,初步探讨其证候特征。方法:1.采用德尔菲法进行两轮专家调查,以SPSS16.0统计软件进行统计分析,采用描述性分析等方法,筛选、整理专家意见的集中程度、协调程度,总结本病证候特点。2.运用回顾性研究方法,收集临床资料,采用SPSS16.0统计软件进行描述性分析等方法,总结本病临床证候特点。3.对比两种方法的结果,初步探讨本病中医证候特点。结果:1.调查问卷:提示肺脾气虚证、脾肾阳虚证、肝肾阴虚证、气阴两虚证、水湿内泛证等为临床常见证型。2.临床研究:①根据证型标准能明确辨证的病例中湿热内蒸证出现频率最高,其次是风水相搏证、肝肾阴虚证;病程中症状记录不详细,不能根据证型标准进行辨证而以方测证病例中湿热内蒸证出现频率最高,其次是肝肾阴虚证、气阴两虚证和瘀血内阻证。②根据激素应用阶段,其中足量激素治疗阶段辨证频率居前两位的证型为湿热内蒸证和肝肾阴虚证;激素减量阶段辨证频率居前两位的为湿热内蒸证和气阴两虚证。结论:本病以肺脾气虚证、脾肾阳虚证、肝肾阴虚证、气阴两虚证本虚为主,标实以湿热内蒸证、瘀血内阻证居多;各证型分类与应用激素治疗有一定关系:足量激素治疗阶段以湿热内蒸证和肝肾阴虚证居多,激素减量阶段以湿热内蒸证和气阴两虚证居多。
Objective:to probe syndrome characteristics of children intractable nephrotic syndrome through analysing clinical symptoms. Methods:1.Two turns of expert investigation were managed by using delphi method. Statistical analyse were made by way of software of SPSS16.0. Methods such as descriptive analysis were adopted. Concentrative degree, coordination degree of expert opinions were selected and arranged. Syndrome characteristics of this disease were summarized. 2. Clinical data were collected by using retrospective study method. Methods such as descriptive analysis were applied by using software SPSS16.0 and clinical syndrome characteristics were concluded. 3.The results got through the two methods mentioned above were contrasted. The syndrome characteristics of children intractable nephrotic syndrome were discussed.
Results: 1. Spleen and lung qi deficiency, spleen and kidney yang deficiency, liver and kidney yin deficiency, qi and yin deficiency, dampness syndrome were studied as the most commonly seen syndromes in questionnaire survey. 2. Clinical research:①The frequency of dampness-heat syndrome was thought as the highest one in the cases that the syndromes could be differentiated according to the standard of syndromes. Edema caused by pathogenic wind syndrome, liver and kidney yin deficiency were the next. The frequency of dampness-heat syndrome were thought as highest in the cases that having no detailed clinical symptoms records and syndromes could not be differentiated as the standard of syndromes but using the method of differentiating syndromes through elucidating mechanism of Chinese formula.②The first two rank of syndromes in the therapeutic phase of using sufficient hormone were dampness-heat syndrome and liver and kidney deficiency. The first two rank of syndromes in the therapeutic phase of hormone reduction were dampness-heat syndrome, qi and yin deficiency syndrome.Conclusions: lung and spleen qi deficiency, spleen and kidney yang deficiency, liver and kidney yin deficiency, qi and yin deficiency are the main syndromes of children intractable nephrotic
syndrome for the root deficiency aspect. Dampness-heat syndrome, blood stasis syndrome are the main syndromes for the branch deficiency aspect. The classification of syndromes has close relationship with hormone application. Dampness-heat syndrome, liver and kidney yin deficiency are the main syndrome in the sufficient hormone therapeutic phase. Dampness-heat syndrome, yin and yin deficiency syndrome are main syndromes in hormone reduction phase.
引文
[1]中华医学会儿科学分会肾脏病学组.小儿肾小球疾病的临床分类、诊断及治疗[J].中华儿科杂志,2001,39(8):746-749
[2]四川省简阳县中医医院翻印.中医儿科病证诊断疗效标准[M].四川:四川省简阳县中医医院翻印,1986,第一辑(试行本):15-16
[3]国家中医药管理局.中医病症诊断疗效标准[M].南京:南京大学出版社,1994,1版:40-41
[4]汪受传.中医儿科学[M].北京:中国中医药出版社,2007,2版:161-165
[5]陈凯,姜春燕.中药减轻糖皮质激素副作用的研究[J].中华中医药杂志,2005,20(10):636
[6]冯天保.谢桂权教授治疗难治性肾病综合征经验撷菁[J].中医药学刊,2005,(9):1574-1575
[7]第二次全国中医肾病专题学术讨论会.慢性原发性肾小球疾病中医辨证分型试行方案.陕西中医,1998,9(1):封4
[8]彭玉.黄建业教授治疗小儿肾病综合征的经验浅析[J].陕西中医,2004,25(11):1013-1014
[9]罗世杰.小儿难治性肾病辨证论治初探[J].中医儿科杂志,2008,3,4(2):32-33
[10]莫穗林,李俊彪,伍新林.中药配合激素冲击疗法治疗小儿原发性肾病综合征的临床观察[J].中药材,2005,1O,28(1O):965-967
[11]李向峰.丁樱教授治疗小儿难治性肾病经验介绍[J].新中医,2008,5,40(5):11-12
[12]彭世桥.中医辨证治疗难治性肾病综合征的思路与方法[J].光明中医,2009,7,24(7):1308-1310
[13]王琳.陈以平教授“微观辨证”学术思想在膜性肾病中的应用[J].上海中医药大学学报,2006,20(3):30
[14]吴力群,丁樱.益气滋肾活血方辅治小儿难治性肾病综合征45例临床观察[J].山西中医学院学报,2002,3(3)
[15]任臻,刘尚智.中西医结合治疗儿童难治性肾病37例疗效观察[J].World Health Digest,2007,6,4(6):22-24
[1]罗雪冰,李良,刘南梅.辨证治疗难治性肾病综合征136例疗效观察[J].河南中医,2007,27(6):38-39
[2]秦骥,侯立维.辨证分型治疗小儿难治性肾病102例效果观察[J].中国基层医药,2005,12(3):353
[3]周玲娟等.潘月丽教授治疗儿童难治性肾病综合征经验简介[J].国医论坛,2008,9,23(5):11-12
[4]潘海英,盛丽先.健脾益气法治疗小儿频繁复发型单纯性肾病综合征17例[J].中国中医药信息杂志,2002,2,9(2):52-63
[5]冯天保.谢桂权教授治疗难治性肾病综合征经验撷菁[J].中医药学刊,2005,9(9):1574-1575
[6]张朝霞.分期辨治小儿肾病综合征体会[J].河南中医,2008,2(2):36
[7]李向峰.丁樱教授治疗小儿难治性肾病经验介绍[J].新中医,2008,5, 40(5):11-12
[8]刘清亮.对激素副反应的认识与用药心得[J].中医药信息,2002,19(1):1
[9]罗世杰.小儿难治性肾病辨证论治初探[J].中医儿科杂志,2008,3,4(2):32-33
[10]莫穗林,李俊彪,伍新林.中药配合激素冲击疗法治疗小儿原发性肾病综合征的临床观察[J].中药材,2005,1O,28(1O):965-967
[11]翁端怡,曾章超.小儿频复发性肾病综合征中医临床证治剖析[J].中国中西医结合肾病杂志,2005,5,6,(5):298-299
[12]马剑颖,马垂宪.中医药配合糖皮质激素治疗肾病综合征的思路探讨[J].黑龙江中医药,2002,3:5
[13]黄伟.小儿肾病综合征激素应用不同阶段的中医辨证论治[J].中医儿科杂志,2008,9,4(5):4-6
[14]董飞侠.儿童频复发性肾病的中西结合治疗思路探要[J].中医药学刊,2003,3,21(3):464-465
[15]袁斌,刘光陵,孙轶秋,夏正坤,高远赋,樊忠民,现国,任辉杰.中药合环磷酰胺冲击治疗小儿难治性肾病疗效观察[J].辽宁中医杂志,2007,34(8):1101-1102
[16]王智.辨证论治难治性肾病综合征80例[J].医学信息,2009,22(lO)