摘要
目的通过调查收集符合纳入标准病例的一般情况、症状、部分体征、舌脉象以及部分实验室检查指标,采用聚类分析等方法,探讨肾移植术后不同阶段患者的症候、证型特点,为肾移植术后的中医辨证分型标准研究及指导临床实践,提供客观、科学的依据。
方法采用横断面调查、流行病学现场调查方法。严格按照入选标准选择2007年11月至2008年3月间在广州中医药大学第一附属医院、广东省第二人民医院、广州军区总医院门诊和病房住院的肾移植术后的患者。收集包括人口学一般情况、自主症状、舌脉象、体征、实验室检查等资料,采用聚类分析等方法分析肾移植术后不同阶段的证型分布,并用方差分析等方法研究实验室指标之间的关系。
结果本研究入选病例共185例,总样本按术后年限分为三个阶段,第一阶段(术后3-12个月)包含54例、第二阶段(术后13-36个月)包含53例、第三阶段(术后大于36个月)包含78例。三个阶段的症候均是虚证的症状出现频率较多。第一阶段的证型分布为血瘀兼气阴虚证、肾阳虚兼血虚证、阴虚证、肾虚证。第二阶段的证型分布为肾阴虚证、阴血虚证、气阴两虚兼湿热证、脾肾两虚兼肺气虚证、脾肾两虚证。第三阶段的证型分布为脾肾两虚兼血瘀证、阴虚证、肾虚兼肝血虚证、心肺气虚兼肾阴虚证、阳虚证。
结论肾移植术后不同阶段症候及证型分布调查研究结果初步显示:
①症候分布特点:从症状分布来看,各个阶段均以虚证症状多见。
②证型分布特点:第一阶段的证型主要是单种虚证、复合虚证、虚实夹杂证,无单种实证。其中单种虚证中以阴虚、肾虚为主:复合虚证以肾阳虚兼血虚为主;虚实夹杂证以血瘀兼气阴虚为主。第二阶段的证型也主要是单种虚证、复合虚证、虚实夹杂证,无单种实证。其中单种虚证中以肾阴虚、阴血虚为主:复合虚证以脾肾两虚证、脾肾两虚兼肺气虚为主;虚实夹杂证以气阴虚两兼湿热为主。第三阶段的证型也主要是单种虚证、复合虚证、虚实夹杂证,无单种实证。其中单种虚证中以阴虚、阳虚为主:复合虚证以肾虚兼肝血虚、心肺气虚兼肾阴虚为主;虚实夹杂证以脾肾两虚兼血瘀证为主。
③实验室检查研究表明:各个阶段患者血红蛋白、血尿素氮、血肌酐值均无明显差异。
Objective
The purpose of this research is using Cluster and other statistical analysis method to evaluate the syndrome and laboratory examinations of the patients after kidney transplantation at different stages,to find out the principle of TCM diagnosis on these patients after kidney transplantation, in order to provide a objective standerd of classification of syndrome for our TCM research as well as the clinic pactice.
Methods
It' s a cross-sectional survey,epidemiology scene investigation methods.According to strict selection criterion,we chose the patients after kidney transplantation from the First Affiliated Hospital of Guangzhou TCM University,the Second People's Hospital of the Guangzhou,the Military Region General Hospital during November 2007 to March 2008..After collection of their demography data,independent syndrome,the picture of the tongue,the pulse condition and laboratory examination results etc.,we put these data into SPSS11.5 software to evaluate their contributions,and then drew out the primary TCM diagnosis on the patients after kidney transplantation at different stages.
Results
This study collected 185 cases in all.According to their postop period,we divided them into 3 classes,the first class(3-12 months)contains 54 cases, the second(13-36 months)contains 53 cases,and the third s(more than 36 months) contains 78 cases.The symptoms of deficiency more frequently in the three stages.In the first stage,the types of syndrome include blood stasis and the deficiency of bothqi and yin,deficiency of blood,deficiency of yin, nephrasthenia syndrome,ln the second stage,the types of syndrome include the syndrome of deficiency of kidney-YIN,syndrome of deficiency of YIN-blood,syndrome of the deficiency of both qi and yin and damp-heat syndrome,syndrome of asthenia of both the spleen and kidney and deficiency of lung-QI,syndrome of asthenia of both the spleen and kidney.In the third stage,the types of syndrome include the syndrome of asthenia of both the spleen and kidney and blood stasis,the syndrome of deficiency of YIN,the syndrome of renal deficiency and deficiency of liver-blood,the syndrome of cardiac and pulmonary deficiency and deficiency of kidney-YIN,the syndrome of deficiency of YANG.
Conclusion
The results of the research show that:
①The distribution of the symptom:deficience is the main character of different stages.
②The distribution of the pattern of Syndrome:In the first stage,the patterns of Syndrome include single deficient syndrome,the combination deficient syndrome,the inclusion syndrome of excess and deficiency,no single sthenia syndrome.The single species deficient syndrome includes deficiency of yin,nephrasthenia syndrome.The inclusion syndrome of excess and deficiency includes blood stasis and the deficiency of both qi and yin.The combination deficient syndrome includes deficiency of kidney-YANG and blood deficiency.
In the second stage,the patterns of Syndrome also include single deficient syndrome,the combination deficient syndrome,the inclusion syndrome of excess and deficiency,no single sthenia syndrome.The single species deficient syndrome includes the syndrome of deficiency of kidney-YIN,syndrome of deficiency of YIN-blood.The combination deficient syndrome includes syndrome of asthenia of both the spleen and kidney and deficiency of lung-QI,syndrome of asthenia of both the spleen and kidney.The inclusion syndrome of excess and deficiency includes syndrome of the deficiency of both qi and and yin damp-heat syndrome.
In the third stage,the pattern s of syndrome also include single deficient syndrome,the combination deficient syndrome,the inclusion syndrome of excess and deficiency,no single sthenia syndrome.Thesingle species deficient syndrome includes the syndrome of deficiency of YIN and the syndrome of deficiency of YANG.The combination deficient syndrome includes the syndrome of renal deficiency and deficiency of liver-blood,the syndrome of cardiac and pulmonary deficiency and deficiency of kidney-YIN.The inclusion syndrome of excess and deficiency includes the syndrome of asthenia of both the spleen and kidney and blood stasis.
③The study of laboratory examination shows that:there are not significant difference among the three stages.
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