肾脏血流动力学与糖尿病肾病中医辨证分型的相关性

Relation between Renal Hemodynamics and Chinese Medicine Syndrome Type in Diabetic Nephropathy

目的探讨糖尿病肾病(DN)的肾脏血流动力学改变与中医证型的相关性。方法选择DN患者489例,正常对照组50例。采用彩色多普勒(CDFI)观察肾血流灌注程度分级;再用脉冲波多普勒(PW)观察叶间动脉血流频谱,测量收缩期峰值血流速度(VS)、舒张期末血流速度(VD)、平均血流速度(VM)、搏动指数(PI)、阻力指数(RI)值。结果随着病情的发展,中医证候出现阴虚燥热→气阴两虚→阴阳两虚→阳衰瘀阻的演变规律;肾动脉血流灌注随之逐渐降低,经Ridit分析,组间差异有统计学意义(P<0.01);肾髓质内叶间动脉血流频谱指标VS、VD、VM值呈逐渐降低,气阴两虚组、阴阳两虚组、阳衰瘀阻组与正常对照组及阴虚燥热组比较,差异有统计学意义(P<0.01)。余3组间比较,差异有统计学意义(P<0.05或P<0.01)。肾髓质内叶间动脉血流频谱指标PI及RI值呈逐渐增高,气阴两虚组、阴阳两虚组、阳衰瘀阻组与正常对照组比较,差异有统计学意义(P<0.01)。结论 DN的肾血流动力学与中医证候分布有一定的相关性,可作为其诊断分型的客观指标之一。

Objective To observe the relationship between renal hemodynamics and Chinese medicine syndrome type in dia- betic nephropathy （DN）. Methods Totally 489 cases of DN and 50 cases of normal subjects were selected. Color Doppler was used to observe the renal perfusion grade. Pulsed wave Doppler was used to observe spectrum of interlobar arterial blood flow. The values of peak systolic velocity （VS）, diastolic velocity （VD）, average maximum velocity （VM）, pulsatile index （PI） and resistance index （RI） were measured. Results As disease progressed, the syndrome developed in the order of yin deficiency dryness-heat syndrome, qi yin deficiency syndrome, yin-yang deficiency syndrome and yang deficiency stasis obstruction syn- drome. The renal artery blood flow reduced gradually, with significant differences between groups （P〈0.01）. The values of VS, VD and VM decreased gradually, especially in qi-yin deficiency group, yin-yang deficiency group and yang deficiency stasis obstruction group as compared with the normal control group and yin deficiency dryness-heat group （P〈0.01）. There were significant differences among other three groups （P〈0.05 or P〈0.01）. The values of PI and RI gradually increased, especial- ly in qi-yin deficiency group, yin-yang deficiency group and yang deficiency stasis obstruction group as compared with the nor- mal control group （P〈0.01）. Conclusion Renal hemodynamics is related to Chinese medicine syndrome type in DN and it could be used as an objective indicator for syndrome diagnosis.