基于多元统计分析的慢性肾小球肾炎中医证候学研究
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摘要
慢性肾小球肾炎(Chronic glomerulonephritis)系指各种病因引起的不同病理类型的双侧肾小球弥漫性或局灶性炎症改变,以起病隐匿,病程冗长,病情发展缓慢为特点的一组原发性肾小球疾病的总称。其通常以蛋白尿、血尿、水肿、高血压等为主要临床表现。本病有可能发展成终末期肾衰竭(End stage renal failure, ESRF),从而给卫生财政带来沉重的负担,因此积极早期防治极为重要。
中医运用其独特的辨证论治方法在慢性肾小球肾炎的治疗中具有某种优势,在疗效上目前也得到西医同行一定程度上的认可。本课题在中医理论指导下,通过文献研究结合临床流行病学调研,运用多元统计方法,初步探讨了慢性肾小球肾炎证候分布特征,并分析了其病因病机,力图为规范中医临床辨证治疗提供某种可能的参考依据。
本文包括理论研究、文献研究和临床研究三部分。
第一部分理论研究两篇,第一篇总结慢性肾小球肾炎与中医病名的相关性、病因病机；第二篇首先回顾慢性肾小球肾炎的历次学术会议辨证分型标准,并着重介绍中医证候研究现状,及证候与现代理化指标的研究进展等。
第二部分为文献研究,主要从近11年的文献入手,总结现代文献中有关慢性肾小球肾炎的常见症状、中医证候分布情况,并提取慢性肾小球肾炎的证候要素,为临床流行病学调查表的制订提供参考,也为下一步临床辨证分型标准的研究提供某种可供参考的依据。
第三部分为临床研究,本研究观察289例慢性肾小球肾炎患者的病例资料,从一般资料、实验室检查及四诊信息入手,运用多元统计分析方法,研究慢性肾小球肾炎常见证候分布特征及病因病机。
研究结果：(1)本研究提示以中青年患病率较高；女性略高于男性,患者男女比例为0.9：1。289例患者中年龄最大79岁,年龄最小18岁。(2)从一般检测指标看,慢性肾小球肾炎患者血压情况普遍控制不理想,血氯、血尿酸、胆固醇和甘油三酯升高者比较多,这些因素往往使原有疾病病情加重。(3)临床研究表明本病常见症状是疲乏无力、水肿、五心烦热、腰痛、腰膝酸软、头晕、咽干、夜尿多、口干、食欲不振、口粘腻等。文献研究表明常见症状为疲乏无力、水肿、腰膝酸软、食欲不振、脘腹胀满、便溏、口干、五心烦热、咽干、畏寒肢冷等,两者研究结果大体一致,都主要表现为脾胃系症状及肾系症状。(4)文献研究发现,多数文献辨证分型是自拟标准,或在文章中未提及辨证标准。目前辨证分型相对混乱,慢性肾小球肾炎的辨证分型迫切需要一个具有相对共识的统一的标准。(5)临床研究,通过收集患者病例资料,建立四诊信息数据库,采用多元统计分析方法,对本病的证候分布特征进行了研究。由聚类分析得知,本病可能的病位证素为肾、脾、肝,病性病邪证素是虚、湿、热、血瘀；通过因子分析得知,慢性肾小球肾炎的主病位证素为脾、肾,次病位证素是肝、肺,病性病邪证素主要是虚、水湿、热、血瘀；因子分析中还总结了慢性肾小球肾炎基本的证候组合。(6)通过文献研究得出,本病病位类证素频数排前4位的分别是肾、脾、肝、肺。病性病邪类证素频数排前4位的分别是气虚、阴虚、湿、血瘀。(7)通过多种检测指标与中医证候的相关性分析得出：F1(以湿热为主证)与X6(周围血白细胞计数)及X10(外周血中性粒细胞百分比)正相关,F2(以阳虚为主证)与X10(中性粒细胞百分比)负相关。
结论：(1)通过探索性的因子分析和聚类分析对慢性肾小球肾炎临床四诊信息的研究,从统计学角度说明了其主病位证素是脾、肾,次病位证素是肝、肺,病性证素主要是气虚、阴虚、阳虚,病邪证素主要是水湿、热和血瘀。其中虚证在本病中普遍存在,纯实证少见,故而总括地讲,“虚”为本病的第一病性总要素。在标实的统计中,“湿”所占的百分比最高,因而是本病的第一重要的病邪证素。(2)本研究发现湿热证与外周血白细胞计数及中性粒细胞百分比正相关、阳虚与中性粒细胞百分比负相关,提示我们这两项实验室指标似可作为本病临床辨证的重要参考依据。(3)运用统计分析方法中的降维思想研究中医证候,与传统辨证方法相比,更有利于证候研究中客观证据与人的专业技术相结合,使证素构成更加清晰,共识度提高,有利于弥补传统辨证方法中主观性太强的缺陷,是证候规范化研究的可行途径之一,值得进一步深入探讨。
Chronic glomerulonephritis refers to diffuse or focal inflammation changes, caused by different pathological type bilateral glomerular, and it's insidious onset, the course of length, slow development condition for a set of characteristics of the floorboard of glomerular disease. The clinical manifestations of glomerular disease are hematuria, proteinuria, hypertension, edema, referred to as chronic nephritis. The diseases can develop end stage renal failure, a heavy burden, so the positive early prevention is extremely important to the health finance.
TCM was used to its unique diagnosis and treatment methods had an advantage in the treatment of the Chronic Nephritis in the Western counterparts to some extent, the recognition on the efficacy. This topic under the guidance of the TCM theory, basing on literature research combined with clinical epidemiological research and objective multivariate statistical methods, discussed the Chronic Nephritis syndrome distribution characteristics, and analyzed its etiology and pathogenesis machine, to provide a basis for possible clinical syndrome treatment attempts to standardize Chinese medicine.
There are three parts in the article, including theoretical research, literature research and clinical studies.
There are two parts in the first part. The first summarizes the Chronic Nephritis related concepts and the etiology and pathogenesis; The second first reviews the previous Syndrome standard of Chronic Nephritis, and then introduces research status of TCM syndrome, and syndrome with modern physical and chemical indicators.
The second part is the literature research, mainly from the literature of the past 11 years, summarized up the common symptoms of chronic nephritis in the modern literature, and TCM syndrome distribution and extraction of Chronic Nephritis syndrome factor and clinical epidemiology of the questionnaire provided a reference.
The third part is the clinical studies, this study observed 289 cases with Chronic Nephritis in patients with clinical data, from general information,laboratory tests and diagnostic message. Use of multivariate statistical analysis method of the common syndrome of chronic nephritis distribution characteristics and pathogenesis machine.
Results:(1)The higher prevalence was of middle-aged and young; Women slightly higher than men, men and women with a ratio of 0.9:1. Patient age were from 79 and 18 years old. (2) In term of the general test index for, patients with Chronic Nephritis, blood pressure control was not ideal, the rise of CL, UA, CHO and TG is more, which often aggravate the original disease. (3) Clinical research showed that the common symptoms were fatigue, weakness, edema, five upset hot, low back pain, weak knees, dizziness, dry throat, nocturia, dry mouth, loss of appetite, sticky mouth slimy and etc. Common symptoms were the literature research exhaustion, edema, lumbar debility, loss of appetite, wan abdominal distension and fullness, loose stools, dry mouth, five upset hot, dry throat, chills limb cold and etc. The research results were basically the same, which main performance for the Spleen and Stomach symptoms and Shen symptoms. (4) The literature research finds that most of the syndrome type is the self, or not mentioned in the article Diagnostic Criteria.At present the confusion of syndrome standard, Chronic Nephritis syndrome differentiation of parting urgently need a relatively uniform standard. (5)The clinical research part,collecting cases material, established the four diagnostic information database, used multivariate statistical analysis methods to research the distribution characteristics of the syndrome. By clustering analysis, we can conclude that the disease could a syndrome factor kidney, liver, spleen, sexual disease syndrome factor is wet, heat, deficiency, blood stasis; Through the factor analysis shows that the disease the Chronic Nephritis syndrome factor may be in the kidney, spleen, ill sex syndrome factor mainly is empty, wet, blood stasis; Factor analysis also summarizes the basic chronic nephritis syndrome combination. (6)Through the literature research, the disease of syndrome factor frequency row of the top three were the kidney, spleen, the liver. Disease syndrome factor frequency row four were before qi, Yin deficiency, wet, blood stasis. (7)Through a variety of detection index and syndromes typical related analysis:F1 (mainly to hot and humid) and X6 (blood around white blood count) and X10 (neutrophils percentage) were related, F2 (mainly to Yang deficiency) and X10 (neutrophils percentage) negative correlation.
Conclusions:(1) Through the exploratory factor analysis and cluster analysis to chronic glomerulonephr it is four diagnostic informat ion research clinic, from the Angle of statistics that its main disease syndrome factors are Spleen and Kidney, time sickness syndrome factors are Liver, Lungs, disease syndrome factors mainly were Qi deficiency, Yin deficiency and Yang deficiency, and disease syndrome factors mainly were dampness, heat and blood stasis. (2) The study finded that the hot and humid syndrome with peripheral white blood cell and neutrophils percentage was related, and Yang deficiency syndrome and neutrophils percentage was negatively related.It Suggested that these two laboratory parameters can be used as the basis of the clinical differentiation syndrome of the disease. (3)Used statistical analysis methods of dimension reduction thought to study TCM syndrome, and traditional method than the syndrome differentiation, is more advantageous to the syndrome in the research objective evidence of professional technology and combine to make the syndrome factor constitute more clear, consensus degree increase, and it can make up for the traditional methods of syndrome differentiation of subjectivity is too strong defects. It's the study of standardization of syndrome, one of the feasible way, which is worth further further discussed.
中医运用其独特的辨证论治方法在慢性肾小球肾炎的治疗中具有某种优势,在疗效上目前也得到西医同行一定程度上的认可。本课题在中医理论指导下,通过文献研究结合临床流行病学调研,运用多元统计方法,初步探讨了慢性肾小球肾炎证候分布特征,并分析了其病因病机,力图为规范中医临床辨证治疗提供某种可能的参考依据。
本文包括理论研究、文献研究和临床研究三部分。
第一部分理论研究两篇,第一篇总结慢性肾小球肾炎与中医病名的相关性、病因病机；第二篇首先回顾慢性肾小球肾炎的历次学术会议辨证分型标准,并着重介绍中医证候研究现状,及证候与现代理化指标的研究进展等。
第二部分为文献研究,主要从近11年的文献入手,总结现代文献中有关慢性肾小球肾炎的常见症状、中医证候分布情况,并提取慢性肾小球肾炎的证候要素,为临床流行病学调查表的制订提供参考,也为下一步临床辨证分型标准的研究提供某种可供参考的依据。
第三部分为临床研究,本研究观察289例慢性肾小球肾炎患者的病例资料,从一般资料、实验室检查及四诊信息入手,运用多元统计分析方法,研究慢性肾小球肾炎常见证候分布特征及病因病机。
研究结果：(1)本研究提示以中青年患病率较高；女性略高于男性,患者男女比例为0.9：1。289例患者中年龄最大79岁,年龄最小18岁。(2)从一般检测指标看,慢性肾小球肾炎患者血压情况普遍控制不理想,血氯、血尿酸、胆固醇和甘油三酯升高者比较多,这些因素往往使原有疾病病情加重。(3)临床研究表明本病常见症状是疲乏无力、水肿、五心烦热、腰痛、腰膝酸软、头晕、咽干、夜尿多、口干、食欲不振、口粘腻等。文献研究表明常见症状为疲乏无力、水肿、腰膝酸软、食欲不振、脘腹胀满、便溏、口干、五心烦热、咽干、畏寒肢冷等,两者研究结果大体一致,都主要表现为脾胃系症状及肾系症状。(4)文献研究发现,多数文献辨证分型是自拟标准,或在文章中未提及辨证标准。目前辨证分型相对混乱,慢性肾小球肾炎的辨证分型迫切需要一个具有相对共识的统一的标准。(5)临床研究,通过收集患者病例资料,建立四诊信息数据库,采用多元统计分析方法,对本病的证候分布特征进行了研究。由聚类分析得知,本病可能的病位证素为肾、脾、肝,病性病邪证素是虚、湿、热、血瘀；通过因子分析得知,慢性肾小球肾炎的主病位证素为脾、肾,次病位证素是肝、肺,病性病邪证素主要是虚、水湿、热、血瘀；因子分析中还总结了慢性肾小球肾炎基本的证候组合。(6)通过文献研究得出,本病病位类证素频数排前4位的分别是肾、脾、肝、肺。病性病邪类证素频数排前4位的分别是气虚、阴虚、湿、血瘀。(7)通过多种检测指标与中医证候的相关性分析得出：F1(以湿热为主证)与X6(周围血白细胞计数)及X10(外周血中性粒细胞百分比)正相关,F2(以阳虚为主证)与X10(中性粒细胞百分比)负相关。
结论：(1)通过探索性的因子分析和聚类分析对慢性肾小球肾炎临床四诊信息的研究,从统计学角度说明了其主病位证素是脾、肾,次病位证素是肝、肺,病性证素主要是气虚、阴虚、阳虚,病邪证素主要是水湿、热和血瘀。其中虚证在本病中普遍存在,纯实证少见,故而总括地讲,“虚”为本病的第一病性总要素。在标实的统计中,“湿”所占的百分比最高,因而是本病的第一重要的病邪证素。(2)本研究发现湿热证与外周血白细胞计数及中性粒细胞百分比正相关、阳虚与中性粒细胞百分比负相关,提示我们这两项实验室指标似可作为本病临床辨证的重要参考依据。(3)运用统计分析方法中的降维思想研究中医证候,与传统辨证方法相比,更有利于证候研究中客观证据与人的专业技术相结合,使证素构成更加清晰,共识度提高,有利于弥补传统辨证方法中主观性太强的缺陷,是证候规范化研究的可行途径之一,值得进一步深入探讨。
Chronic glomerulonephritis refers to diffuse or focal inflammation changes, caused by different pathological type bilateral glomerular, and it's insidious onset, the course of length, slow development condition for a set of characteristics of the floorboard of glomerular disease. The clinical manifestations of glomerular disease are hematuria, proteinuria, hypertension, edema, referred to as chronic nephritis. The diseases can develop end stage renal failure, a heavy burden, so the positive early prevention is extremely important to the health finance.
TCM was used to its unique diagnosis and treatment methods had an advantage in the treatment of the Chronic Nephritis in the Western counterparts to some extent, the recognition on the efficacy. This topic under the guidance of the TCM theory, basing on literature research combined with clinical epidemiological research and objective multivariate statistical methods, discussed the Chronic Nephritis syndrome distribution characteristics, and analyzed its etiology and pathogenesis machine, to provide a basis for possible clinical syndrome treatment attempts to standardize Chinese medicine.
There are three parts in the article, including theoretical research, literature research and clinical studies.
There are two parts in the first part. The first summarizes the Chronic Nephritis related concepts and the etiology and pathogenesis; The second first reviews the previous Syndrome standard of Chronic Nephritis, and then introduces research status of TCM syndrome, and syndrome with modern physical and chemical indicators.
The second part is the literature research, mainly from the literature of the past 11 years, summarized up the common symptoms of chronic nephritis in the modern literature, and TCM syndrome distribution and extraction of Chronic Nephritis syndrome factor and clinical epidemiology of the questionnaire provided a reference.
The third part is the clinical studies, this study observed 289 cases with Chronic Nephritis in patients with clinical data, from general information,laboratory tests and diagnostic message. Use of multivariate statistical analysis method of the common syndrome of chronic nephritis distribution characteristics and pathogenesis machine.
Results:(1)The higher prevalence was of middle-aged and young; Women slightly higher than men, men and women with a ratio of 0.9:1. Patient age were from 79 and 18 years old. (2) In term of the general test index for, patients with Chronic Nephritis, blood pressure control was not ideal, the rise of CL, UA, CHO and TG is more, which often aggravate the original disease. (3) Clinical research showed that the common symptoms were fatigue, weakness, edema, five upset hot, low back pain, weak knees, dizziness, dry throat, nocturia, dry mouth, loss of appetite, sticky mouth slimy and etc. Common symptoms were the literature research exhaustion, edema, lumbar debility, loss of appetite, wan abdominal distension and fullness, loose stools, dry mouth, five upset hot, dry throat, chills limb cold and etc. The research results were basically the same, which main performance for the Spleen and Stomach symptoms and Shen symptoms. (4) The literature research finds that most of the syndrome type is the self, or not mentioned in the article Diagnostic Criteria.At present the confusion of syndrome standard, Chronic Nephritis syndrome differentiation of parting urgently need a relatively uniform standard. (5)The clinical research part,collecting cases material, established the four diagnostic information database, used multivariate statistical analysis methods to research the distribution characteristics of the syndrome. By clustering analysis, we can conclude that the disease could a syndrome factor kidney, liver, spleen, sexual disease syndrome factor is wet, heat, deficiency, blood stasis; Through the factor analysis shows that the disease the Chronic Nephritis syndrome factor may be in the kidney, spleen, ill sex syndrome factor mainly is empty, wet, blood stasis; Factor analysis also summarizes the basic chronic nephritis syndrome combination. (6)Through the literature research, the disease of syndrome factor frequency row of the top three were the kidney, spleen, the liver. Disease syndrome factor frequency row four were before qi, Yin deficiency, wet, blood stasis. (7)Through a variety of detection index and syndromes typical related analysis:F1 (mainly to hot and humid) and X6 (blood around white blood count) and X10 (neutrophils percentage) were related, F2 (mainly to Yang deficiency) and X10 (neutrophils percentage) negative correlation.
Conclusions:(1) Through the exploratory factor analysis and cluster analysis to chronic glomerulonephr it is four diagnostic informat ion research clinic, from the Angle of statistics that its main disease syndrome factors are Spleen and Kidney, time sickness syndrome factors are Liver, Lungs, disease syndrome factors mainly were Qi deficiency, Yin deficiency and Yang deficiency, and disease syndrome factors mainly were dampness, heat and blood stasis. (2) The study finded that the hot and humid syndrome with peripheral white blood cell and neutrophils percentage was related, and Yang deficiency syndrome and neutrophils percentage was negatively related.It Suggested that these two laboratory parameters can be used as the basis of the clinical differentiation syndrome of the disease. (3)Used statistical analysis methods of dimension reduction thought to study TCM syndrome, and traditional method than the syndrome differentiation, is more advantageous to the syndrome in the research objective evidence of professional technology and combine to make the syndrome factor constitute more clear, consensus degree increase, and it can make up for the traditional methods of syndrome differentiation of subjectivity is too strong defects. It's the study of standardization of syndrome, one of the feasible way, which is worth further further discussed.
引文
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