维持性血液透析患者160例中医证型分析

Chinese Traditional Medicine Syndrome Differentiation of 160 Cases of Maintained Hemodialysis Patients

目的:分析维持性血液透析患者160例的中医证型特点与相关影响因素,为进一步血液透析患者慢性并发症的中医药防治研究打下基础。方法:以统一的中医辨证分型标准对160例维持性血液透析患者进行主证与兼证的辨证分型。同时检测生化、血常规、透析充分性(KT/V)、甲状旁腺素(iPTH)和高敏C反应蛋白(hs-CRP)水平。对结果行统计学分析。结果:160例患者中,脾肾气虚患者和肝肾阴虚患者明显多于脾肾阳虚患者和阴阳两虚患者(P<0.05)。兼有瘀血的患者明显多于风动/风燥、水湿和湿热兼证者(P<0.01)。脾肾气虚和肝肾阴虚患者透析龄<5年的比例显著高于脾肾阳虚证和阴阳两虚证(P<0.05)。阴阳两虚证的KT/V、血红蛋白和血浆白蛋白均值均显著低于其他三证(P<0.05)。阴阳两虚和脾肾阳虚患者的iPTH和hs-CRP水平则高于脾肾气虚和肝肾阴虚患者。兼夹证中水湿证的血浆白蛋白水平低于其他三证,风动/风燥证的iPTH水平则高于另三证(P<0.05)。结论:维持性血液透析患者的中医辨证分型有其特殊性,临床须根据患者的不同特点加以四诊合参。

Objective： To investigate the characteristics and correlative factors of Chinese traditional medicine syndrome differentiation of 160 cases of maintained hemodialysis （MHD） patients, and then to provide some reference on prevention and treatment of chronic complications of MHD patients. Methods： Dominant and subordinate syndrome differentiation were performed on 160 cases of MHD patients by unify syndrome differentiation standard. Biochemistry parameters, blood regular tests, dialysis adequacy, intact parathyroid hormone （iPTH） and high sensitive c-reactive protein （hs-CRP） were detected. Both results were analyzed by statistics methods. Results：In 160 cases of MHD, the proportion of spleen-kidney Qi deficiency and liver-kidney Yin deficiency syndrome was obviously higher than that of spleen-kidney Yang deficiency and Yin-yang deficiency syndrome （ P 〈 0.05）. The patients with subordinate syndrome of blood stasis were more than wind and dampness syndrome （ P 〈0.01 ）. The proportion of patients with less than 5-year dialysis duration among spleen-kidney Qi deficiency and liver-kidney Yin deficiency syndrome was obviously higher than that of spleen-kidney Yang deficiency and Yin-yang deficiency syndrome （P 〈 0.05）. The KT/V, plasma hemoglobin and albumin level of Yin-yang deficiency syndrome was lower than other three syndromes （ P 〈 0. 05）. The iPTH and hs-CRP value of spleen-kidney Yang deficiency and Yin-yang deficiency syndrome was higher than other two syndromes （ P 〈 0. 05）. The plasma albumin of dampeness syndrome was lower and the iPTH of wind syndrome was higher than other three syndromes （P 〈 0.05）, Conclusion ： The syndrome differentiation of MHD patients has particularity. The treatment should combine four diagnostic methods according to the different patients.