摘要
糖尿病肾病(DN)是糖尿病(DM)严重的微血管并发症之一,又称“糖尿病性肾小球硬化症”,在临床以进行性白蛋白尿、高血压和进展性肾衰竭为主要特征。在亚洲,糖尿病肾病已逐渐成为终末期肾病的首要致病因素,且与心血管疾病危险增加有关。糖尿病肾病发病率高,一旦出现临床蛋白尿,病情发展便不易逆转,如能在早期积极控制,肾脏的损害大多可以逆转,甚至完全恢复,因此对早期糖尿病肾病的研究有着重要意义。
糖尿病属中医消渴病范畴,古代虽无糖尿病肾病病名,但因其多从消渴病发展而来,现代有医家称糖尿病肾病为消渴病肾病,也注重对此病早期的防治,认为其病机是消渴日久,气阴两虚、脾肾亏虚、气化失司,而致精微渗漏,瘀血、湿浊、痰毒瘀阻经络,如此往复,最终导致元气衰败、三焦壅滞等严重证候。而在此病早期病机中,往往兼夹“瘀”、“热”、“湿”、“痰”、“郁”等,特别是“瘀”贯穿糖尿病肾病病程始终。
目的：本课题尝试从早期2型糖尿病肾病的发病特点和中医证候入手,总结早期2型糖尿病肾病患者的年龄、病程、症状等一般资料和中医证型分布情况,分析不同因素与中医血瘀证和痰瘀互结证的相关性,比较二者的临床特点,为早期2型糖尿病肾病的中医辨证治疗提供参考。
方法：分析2011年5月至2012年4月期间,在中日友好医院中医糖尿病科就诊的2型糖尿病肾病Ⅲ期患者76例,对患者的性别、年龄、合并症等一般资料和中医证型采用描述性分析,计数资料采用卡方检验,计量资料采用独立样本t检验,方差不齐采用校正检验,比较中医血瘀证组和痰瘀互结证组在性别、年龄、体重指数、糖化血红蛋白等因素的差异性。
结果：
1.调查的患者中,男性占61.8%,女性占38.2%,发生频次较高的症状依次为,乏力、便秘、便溏、手足麻或痛、头晕、口干。
2.合并症的发生率依次为,高血压82.19%,糖尿病周围神经病变41.10%,冠心病31.51%,糖尿病视网膜病变28.77%,陈旧性脑梗塞19.18%。
3.中医辨证本虚证的发生率依次为,气阴两虚证59.42%、脾肾气虚证20.29%、肝肾阴虚证13.43%、气血两虚证10.14%。标实证的发生率依次为,痰瘀互结证50.72%、血瘀证44.93%、湿热证11.59%、阴虚阳亢证10.14%、肝郁气滞证7.25%。
4.痰瘀互结证组的体重指数、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、吸烟史和脂肪肝病史参数水平明显高于血瘀证组(P<0.05),痰瘀互结证组的年龄参数水平明显低于血瘀证组(P<0.05)。
结论：
1.早期2型糖尿病肾病患者尤其中年人和男性,应注重血糖、血压、血脂和体重的控制,以及良好的生活方式如规律的饮食起居、戒烟等,以更好的控制此病。
2.早期2型糖尿病肾病的合并症中,高血压的患病率最高为82.19%,且随着糖尿病肾病的进展,高血压的患病率增加。
3.早期2型糖尿病肾病的中医证候中,本虚证主要是气阴两虚证和脾肾气虚证,其次是肝肾阴虚证、气血两虚证,标实证主要是痰瘀互结证和血瘀证,其次是湿热证、阴虚阳亢证、肝郁气滞证。
4.早期2型糖尿病肾病患者中,痰瘀互结证较血瘀证存在更明显的总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、脂肪肝及体重控制不良问题,对早期2型糖尿病肾病的危险性更大。
Diabetic Nephropathy is one serious micrangium complication of diabetes mellitus, also known as diabetes mellitus glomerulus sclerosis, which clinical principal character is albuminuria hypertension and progressivity renal failure In Asia, Diabetic Nephropathy has been proved to be the chiefly pathogenic factor of End-stage Renal Disease, connected with cardiovascular disease risk. Diabetic Nephropathy morbidity is high, once emerge clinical albuminuria,it is hard to control patient's condition.If controlled positively in the early days, the harm of renal can be changed over even fully recovered,so the study of DN early stage is necessary.
There isn't a name of Diabetic Nephropathy in ancient,but the characteristic of DN is similar with traditional Chinese Medicine disease,such as turbid or dropsy.Modern doctors of TCM consider the pathogenesis is that,both Qi and Yin is vain,the function of spleen and renal is abnormal, so as to nutrition leakage,blood stasis,humid turbid and sputum noxious impeded main and collateral channels,even vitality exhausted.The early stage of DN always simultaneous stasis heat humid gloomy sputum, especially stasis influence the whole course of DN.
Objective:This research investigated the general information and TCM syndrome of patients who were diagnosed type2Diabetic Nephropathy early stage, analyzed relationship of different factors between blood stasis syndrome and sputum blood stasis syndrome, offering information for TCM cognition and treat.
Methods:This research which collected the76cases of patients who were diagnosed type2Diabetic Nephropathy early stage, analyzed the general information and TCM syndrome by using descriptive analysis, chi-square test for enumeration data, independent samples t-test for measurement date, and analyzed relationship of different factors between blood stasis syndrome and sputum blood stasis syndrome.
Results:
1.In investigated cases, the male sex taked up61.8%, the female sex taked up38.2%, and the symptom which occured frequently are feeble, foamed urine, astriction, lower limb dropsy, hands and feet numb or hurt, dizziness, thirst.
2.The morbidity of complication are hypertension82.19%, diabetic peripheral neuropathies41.10%, coronary heart disease31.51%, diabetic retinopathy28.77%, cerebral infarction19.18%.
3.The morbidity of TCM deficiency syndrome are, both qi and yin deficiency syndrome59.42%, spleen and kidey-yang deficiency syndrome20.29%, liver and kidney-yin deficiency syndrome13.43%, qi-blood deficiency syndrome10.14%. The morbidity of TCM symptom syndrome are blood-sputum stasis syndrome50.72%, blood stasis syndrome44.93%, humid-heat syndrome11.59%, yin deficiency yang without restricted syndrome10.14%, liver constraint qi stagnation syndrome7.25%.
4.The parameters of BMI, TC, LDL-C, HbA1c, Smoking history and Fatty liver medicine history in blood-sputum stasis syndrome group is higher than blood stasis syndrome group(p<0.05), and the parameters of age in blood-sputum stasis syndrome group is lower than blood stasis syndrome group(p<0.05).
Conclusion:
1.The patients of early type2diabetic nephropathy especially the male sex, should emphasize controlling blood sugar, hypertension, blood fat, BMI, and reasonable life-style such as no smoking and regular daily life.
2.Hypertension is the highest morbidity in early type2diabetic nephropathy complications. With early type2diabetic nephropathy evolving, the morbidity of hypertension is increasing.
3.In early type2diabetic nephropathy, the main TCM deficiency syndrome are qi-yin deficiency syndrome, spleen and kidey-yang deficiency syndrome, the next are liver and kidney-yin deficiency syndrome, qi-blood deficiency syndrome. The main TCM symptom syndrome are blood-sputum stasis syndrome, blood stasis syndrome, the next are humid-heat syndrome, yin deficiency yang without restricted syndrome, liver constraint qi stagnation syndrome.
4.In early type2diabetic nephropathy, the badness control of BMI, TC, LDL-C, HbA1c, Fatty liver in blood-sputum stasis syndrome is more obvious than blood stasis syndrome, which is more harmful for patients'health.
引文
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