摘要
糖尿病肾病(DN)是糖尿病最常见的并发症之一,是由包括遗传、代谢、生长因子、细胞因子等多种因素导致的,目前糖尿病肾病是糖尿病患者的主要死因,随着糖尿病发生率的逐渐升高,糖尿病肾病的发病人数也相应增加。根据糖尿病肾病的临床特点,可归属于中医学的“肾消病”、“水肿”、“胀满”、“水病”、“尿浊”、“关格”等范畴,近年来,吕仁和教授通过在临床中对DN的进一步认识后,指出：DN病位明确在肾,故把消渴病日久导致的水肿、尿浊、吐逆、胀满、肾消、关格等症状称为“消渴病肾病”。目前对DN尚无理想的治疗方法,但中医药治疗糖尿病肾病的研究在近几年已经积累了丰富的经验,在临床治疗当中显示出了独特的优势。
目的：本课题是在中医理论指导下,对2型糖尿病肾病Ⅲ、Ⅳ期患者进行中医证候观察,分析其病因病机,研究其中医证侯与客观指标相关性,为提高临床疗效提供参考。
方法：(1)回顾性统计了2009年11月至2011年1月于北京中医药大学东直门医院肾病内分泌科住院的糖尿病肾病病人；(2)依据Mongensen分期标准,只研究符合纳入标准者的103例Ⅲ、Ⅳ期糖尿病肾病病人；(3)应用EPIDAT3.0编程录入数据,为保证录入准确性,采用两次录入法,SPSS 13.0软件进行统计分析,一般资料统计采用频数统计,证型相关统计采用行×列卡方检验,证素与实验室指标相关性采用双变量相关分析,检验水平P<0.05,表示差异有显著性。
结果：通过本资料研究可知：(1)DN(Ⅲ期)以倦怠乏力、气短懒言、五心烦热等症状最多见；DN(Ⅳ期)以水肿、腰膝酸软、倦怠乏力、气短懒言、视物模糊、腰痛等症状最常见。(2)DN(Ⅲ期)以气虚、阴虚证侯最常见；DN(Ⅳ期)以气虚、阴虚、阳虚证侯最常见,且DN中医证侯本质特点为本虚标实,本虚以气虚、阴虚、阳虚为主；标实证则为血瘀证、痰浊证、湿浊证,且血瘀贯穿DN(Ⅲ、Ⅳ期)始终。(3)对于HbA1c,阴虚与HbAlc呈负相关；湿浊证与HbA1c呈正相关。对于24hUPr,气虚证、阴虚证与24hUPr呈负相关；阳虚证、痰浊证、湿浊证与24hUPr呈正相关。对于BUN、Scr,阳虚证与其呈正相关。(4)且对于病程,气虚、阴虚、阳虚、血虚、血瘀、痰浊、湿浊与其无相关性。对于年龄,痰浊证与年龄呈正相关。对于收缩压、舒张压,阳虚证与其呈正相关。
Diabetic nephropathy (DN) is one of the most common complication of diabetes, By including genetic、metabolic、growth factors、cytokines and other factors, the current diabetic patients with diabetic nephropathy is the leading cause of death, with the gradual increase in the incidence of diabetes, the incidence of diabetic nephropathy in a corresponding increase in the number. According to the clinical features of diabetic nephropathy, Chinese medicine can be attributed to the "elimination of renal disease," "edema"、"fullness"、"water" disease,"urinary cloud"、"off grid"and other areas in recent years,Lu Renhe Professor of reference for further study of DN that the DN bit in kidney disease to occur, such as falling Diabetes edema、fullness、urine turbid、Tuni、renal elimination, off grid embolism referred to as "Diabetes nephropathy". DN present there is no ideal treatment, but in the treatment of diabetic nephropathy in recent years has accumulated a wealth of experience in the clinical treatment of them shows a unique advantage.
Objective:This subject is under the guidance of TCM theory, in type 2 diabetic nephropathyⅢ、ⅣSyndrome of the observation and analysis of its pathogenesis, to study TCM related factors and objective indicators, provide a reference to improve the clinical efficacy.
Methods:(1) retrospectively the November 2009-January 2011 in Beijing University of Chinese Medicine, Dongzhimen Hospital, Endocrinology, nephropathy patients hospitalized diabetic nephropathy; (2) According to Mongensen staging criteria, only studies that met the inclusion criteria The 103 cases wereⅢ,Ⅳpatients with diabetic nephropathy; (3) application EPIDAT3.0 programming input data input to ensure the accuracy of, the use of two input methods, SPSS 13.0 software for statistical analysis, general statistics using frequency statistics, securities Statistical model using row×column chi-square test. Syndromes associated with the laboratory parameters used bivariate correlation analysis to test the level of P<0.05, indicated that the difference was statistically significant.
Results:Research shows this:(1) DN (Ⅲperiod) to fatigue fatigue, shortness of breath lazy words, the five most common symptoms of hot upset; DN (Ⅳperiod) to edema,weak waist,malaise,fatigue,shortness of breath lazy words, Blurred vision, back pain and other symptoms the most common. (2) DN (Ⅲperiod) to qi deficiency, yin deficiency syndrome the most common; DN (Ⅳperiod) to qi deficiency, yin, yang deficiency syndrome the most common and essential characteristics of TCM DN-based virtual real, the Empty qi、yin, yang-based;Evidence was marked blood stasis,phlegm,moisture permits, and Blood through the DN (Ⅲ、Ⅳperiod) is always. (3) HbAlc, HbAlc was negatively correlated with the deficiency; wet muddy card was positively correlated with HbAlc. For 24hUPr, qi deficiency, yin deficiency negatively correlated with the 24hUPr; Yang deficiency, phlegm, dampness syndrome and 24hUPr positive correlation. For BUN, Scr, Yang deficiency and its positive correlation. (4) and, for patients, qi, yin, yang deficiency, blood deficiency, blood stasis, phlegm, dampness with no correlation. For age, phlegm was positively correlated with age. For systolic pressure, diastolic blood pressure, was positively correlated with Yang Deficiency.
引文
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