腹膜透析合并消化道症状患者的中医证候与营养指标相关性分析

Analysis on the Relations between TCM Syndromes and Nutritional Status in the Peritoneal Dialysis Patients with Gastrointestinal Symptoms

目的分析腹膜透析合并消化道症状患者的中医证候与营养指标之间的相关性,为临床辨证施治提供参考。方法将81例腹膜透析合并消化道症状的患者进行中医辨证分型,对各证型患者进行消化道症状临床评分,测定患者平均每日每千克体重能量摄入(DEI)、蛋白质摄入(DPI)及血清白蛋白(ALB)水平。结果本虚证中脾肾气虚39例(48.1%)、气阴两虚16例(19.8%)、脾肾阳虚10例(12.3%)、阴阳俱虚9例(11.1%)、肝肾阴虚7例(8.6%);脾肾阳虚证的DEI比脾肾气虚证及气阴两虚证明显减少(P<0.05或P<0.01),脾肾阳虚证及阴阳俱虚证的ALB比脾肾气虚证明显下降(P<0.01)。标实证中血瘀证36例(35.3%)、湿热证26例(25.5%)、湿浊证25例(24.5%)、热毒证12例(11.8%)、无标证3例(2.9%);湿浊证及湿热证与热毒证比较,临床评分明显偏高(P<0.01)。结论腹膜透析合并消化道症状的患者本虚证候中以脾肾气虚证为主,而标实证候中以血瘀、湿热、湿浊证为主,且与营养指标中DEI、ALB有一定相关性。

Objective To analyze the relations between the TCM syndromes and the nutritional status in the peritoneal dialysis patients with gastrointestinal symptoms in order to facilitate the clinical treatment.Methods The 81 peritoneal dialysis patients with gastrointestinal symptoms were differentiated according to the TCM differentiation treatment. They were scored based on their gastrointestinal symptoms. Their daily energy intake （DEI） and protein intake （DPI） per kilogram of body weight,and the serum albumin （ALB） level were measured.Results In the Ben-root-deficiency syndromes,there were 39 cases（48.1%） of spleen and kidney qi deficiency,16 cases （19.8%） of both qi and yin deficiency,10 cases （12.3%） of spleen and kidney yang deficiency,9 cases （11.1%） of both yin and yang deficiency,and 7 cases （8.6%） of liver and kidney yin deficiency. The DEI of those cases with spleen and kidney yang deficiency was significantly lower than that of those with spleen and kidney qi deficiency and both qi and yin deficiency （P〈0.05 or P〈0.01）. The ALB of those cases with spleen and kidney yang deficiency and both yin and yang deficiency was significantly lower than that of those who with spleen and kidney qi deficiency （P〈0.01）. In the Biao-symptom-excess syndromes,there were 36 cases （35.3%） of blood stasis,26 cases （25.5%） of damp heat,25 cases （24.5%） of damp turbidity,12 cases （11.8%） of evil heat toxins,and 3 cases （2.9%） without Biao-symptom. The score of those cases with the syndrome of damp turbidity and damp heat was significantly higher than those who with the syndrome of evil heat toxins in comparison （P〈0.01）.Conclusion Of the peritoneal dialysis patients with gastrointestinal symptoms,the syndrome of spleen and kidney qi deficiency is the main one in the deficiency syndromes,while the syndromes of blood stasis,damp heat,and damp turbidity are the main excess ones,and there is a certain relation with DEI and ALB in the nutritional indices.