195例慢性肾脏病3～5期中医证候分布规律探析

Analysis of Syndrome Distribution Law for 195 Cases of Chronic Kidney Disease at 3～5 Stage

目的:探讨慢性肾脏病3～5期非透析病人中医证候分布规律及其与疾病分期、中医症状积分,血生化指标等的关系。方法:采用问卷调查方式,在广东地区5家中医院前瞻性收集慢性肾脏病3～5期非透析病人的四诊及相关资料,由经过培训的中医副主任医师对证候分型进行判断。结果:从CKD 3期到5期,脾肾气虚证和血瘀证出现频次均为最高,但脾肾阳虚和浊毒证所占比例分别在本虚证和标实证中呈递增趋势。腰膝酸软,畏寒肢冷,纳呆,恶心呕吐,脘腹胀满,水肿症状在脾肾阳虚证表现最明显(P<0.05),口干症状在气阴两虚证表现最明显(P<0.05),口苦症状在肝肾阴虚证表现最明显(P<0.05)。血红蛋白、血肌酐、血尿素氮、eGFR、血清白蛋白指标在阴阳两虚证或脾肾阳虚证病人中较差(P<0.05)。结论:慢性肾脏病3～5期非透析患者本虚证以脾肾气虚为主,标实证中血瘀证贯穿疾病始终,但多与其他标证兼杂。从CKD 3期到5期,随着病情的加重,脾肾阳虚证、浊毒内蕴证的临床表现逐渐明显。

Objective：To explore the relationship between traditional Chinese medical syndrome distribution regularity and dis- ease stages, TCM symptoms, blood biochemical index of chronic kidney disease （CKD）at 3 -5 stage without dialysis. Methods：We prospectively collected four diagnostic and related materials of patients with chronic kidney disease at 3 - 5 stage in 5 hospitals in Guangdong by questionnaire. The syndrome was judged by trained associate chief physicians of Chinese medicine. Results ：The ap- pear frequency of spleen and kidney deficiency as well as blood stasis were maximum. The percentages of spleen and kidney ~ang deficiency and turbidity poison appeared the increasing trend respectively in Benxu syndrome and Biaoshi syndrome. Lumbar de- bility, fear of the cold and cold extremities, nausea and vomiting, abdominal distension, edema symptoms were most notable in the spleen and kidney Yang syndrome, while dry mouth symptom in qi and Ying deficiency, mouth bitter in liver and kidney deficien- cy. Hemoglobin, creatinine, blood urea nitrogen, eGFR, serum albumin indexes were poor in the Yin and Yang deficiency syndrome or spleen and kidney yang deficiency syndrome in patients. Conclusion ： For patients with chronic kidney disease at 3 - 5 stage without dialysis, kidney spleen deficiency syndrome is the main syndrome in Benxu syndrome, combined with blood stasis syn- drome. From 3 stage to 5, the clinical implication of deterioration of the spleen and kidney Yang syndrome, turbidity poison is in- creasingly obvious.