350例2型糖尿病肾病患者阴阳两虚证判别分析

Discriminant analysis of both yin and yang deficiency syndrome in 350 patients with type 2 diabetic nephropathy

目的:探索2型糖尿病肾病(DN)阴阳两虚证的客观诊断方法。方法:本研究采用横断面调查的方法,在7家研究单位收集符合2型DNⅢ、Ⅳ、Ⅴ期患者共350例,分析各期DN患者阴阳两虚证的分布及阴阳两虚证与非阴阳两虚证临床观察指标的差异,最后建立阴阳两虚证的判别函数。结果:350例DN患者,阴阳两虚证208例,占59%;阴阳两虚证在Ⅲ、Ⅳ、Ⅴ期所占的比例逐步升高,分别为34%、62%和86%,各分期差异具有统计学意义(P<0.05);阴阳两虚证与非阴阳两虚证差异显著的指标还包括:糖尿病病程、收缩压、血红蛋白、糖化血红蛋白、24h尿蛋白定量、血肌酐和尿素氮(P<0.05);应用贝叶斯判别(Bayes)对糖尿病分期和上述指标做判别分析,得到证候的判别方程。用逐一回代法和刀切法验证方程的效率,误判率均为19.71%。结论:对2型糖尿病肾病的相关指标做判别分析,可以在一定程度上对阴阳两虚证进行客观的诊断。

Objective： To develop an objective assessment of both yin and yang deficiency syndrome in patients with diabetic nephropathy（DN）.Methods： A cross-sectional survey was performed,and a total of 350 patients with type 2 diabetic nephropathy stage Ⅲ,Ⅳ or Ⅴfrom 8 centers were enrolled in this survey.The distribution of both yin and yang deficiency syndrome in DN was described,and the clinical parameters were compared between both yin and yang deficiency syndrome and the others.At last,discriminant analysis was used for the objective assessment of both yin and yang deficiency syndrome.Result： In all the 350 patients,the proportion of 208 cases with both yin and yang deficiency syndrome was 59%.From stage Ⅲ to Ⅴ,there was an increased proportion with a statistic significance（P0.05） in each stage,which were 34%,62%,and 86% respectively.In addition,there were 7 parameters with statistic differences between both yin and yang deficiency and the others,including diabetes duration,systolic pressure,hemoglobin,glycated hemoglobin,24-hour urine protein,serum creatinine and urea nitrogen（P0.05）.The equations were built for the assessment of both yin and yang deficiency by Bayes discriminant analysis.The error rates tested by backtracking and jackknife methods were both 19.71%.Conclusion： Disciminant analysis of clinical parameters associated with DN could be useful for the objective assessment of both yin and yang deficiency syndrome.