211例慢性肾脏病2～4期患者中医证候证型分布的调查研究

211 patients with 2-4 period of chronic kidney disease for investigate the distribution of TCM syndrome types

目的探讨慢性肾脏病2-4期患者中医证候证型分布特点及其相互关系。方法随机调查患者211例,比较中医证型及慢性肾脏病（CKD）原发病种、分期与中医证型证候间的相关性。结果 211例患者共涉及7个中医证型,其中单纯气虚（定位肺脾肾）52例,气阴两虚75例,单纯阴虚（定位肝肾）32例,为慢性肾脏病的主要3个证型。共涉及3类原发疾病,其中：气阴两虚在肾小球肾炎中表达率最高（40.84%）,脾肾气虚在肾小管间质病中表达率最高为（28.78%）,高血压相关肾损害组多表现为气血两虚（32%）。本虚证中,阳虚多见于高血压相关肾损害组（88%）;标实证中肾小球肾炎易出现浊毒证（75%）,高血压相关肾损害组易出现血瘀证（75%）。随着CKD分期及病情的不同,CKD4期的患者最容易表现为气血阴阳虚证,浊毒证及血瘀证逐渐加重,气滞证表现不明显。结论肾小球肾炎与气阴两虚证、浊毒证、血瘀证相关;肾小管间质病与脾肾气虚、浊毒证相关;高血压相关肾损害与气血两虚（阳虚）—血瘀证相关。

Objective To explore the patients with chronic kidney disease （CKD） 2 -4 period of TCM syndrome type＇s distribution characteristics and their mutual relations. Methods Take random survey for 211 patients with chronic kidney dis- ease of TCM syndrome type, Compared the staging of primary diseases and the mutual relationship between the syndrome types of TCM. Results In 211 cases, received 7 of TCM syndrome types： pure deficiency （positioning lung, spleen and kid- ney） in 52 cases, Qi and Yin deficiency of 75 cases, Yin deficiency （positioning kidney） 32 cases, Involved three types of primary disease, Among them, Qi and Yin deficiency in glomerulonephritis expression rate up to 40.84%, spleen and kidney deficiency expressed in renal tubular interstitial disease rate is as high as 28.78 %, high blood pressure related to renal damage and 32% more performance for Qi and blood deficiency syndrome, Yang deficiency more related to renal damage in hypertension group. In enrichment constitution, glomerulonephritis is easy to appear in the empirical virus cloud syndrome （75%） ,high blood pressure related to renal damage group prone to blood stasis （75%）.As the different stages and situa- tion of chronic kidney disease （CKD）, CKIM period patients most likely to show the Qi, blood, Yin and Yang deficiency, virus cloud syndrome and blood stasis in patients with progressive, and Qi stagnation syndrome presents not obviously. Conelusion Glomerulonephritis associated with Qi and Yin deficiency syndrome, turbidity toxin syndrome, blood stasis, renal tubtdar interstitial disease, spleen and kidney empty, turbidity toxin syndrome;Hypertension related renal damage and Qi （Yang） deficiency-blood stasis. CKD stage has no obvious relationship with the syndrome types of TCM.