基于重复测量资料的糖尿病肾脏病病机演变研究

Study on evolution of pathogenesis of diabetic kidney disease based on repeated measurement data

目的:初步探讨糖尿病肾脏病(DKD)基本病机及其演变。方法:回顾性分析"十一五"DKD临床研究纳入患者的中医证候资料。运用重复测量方差分析法分析随访24个月各证素积分的变化趋势,并采用单因素方差分析比较不同时点各证素之间的差异。结果:共纳入患者146例,不同随访时间点各证素积分之间有差异(P<0.05),不同证素不同随访时间点积分有差异(P<0.05)。气虚证、阳虚证、阴虚证积分高于其它证素,血瘀证与痰湿证积分差异不大,血虚证和湿浊证积分相对较低。入组时气虚证与阴虚证、血瘀证与痰湿证、阴虚证与阳虚证、血虚证与湿浊证的积分之间没有差异,其余证素两两之间比较均有差异(P<0.05)。随访12、24个月时,气虚证与阳虚证、血瘀证与痰湿证、阴虚证与阳虚证、血虚证与湿浊证之间没有差异,其余证素两两之间比较均有差异(P<0.05)。结论:DKD气虚证最多见,血瘀证贯彻始终,气虚血瘀是DKD的基本病机。

Objective: To explore the basic pathogenesis and evolution of diabetic kidney disease(DKD) preliminarily. Methods: The syndrome data of DKD patients included in the clinical research during the 'Eleventh Five-Year' was analyzed retrospectively. The variation tendency in score of syndrome elements during the follow-up of 24 months was analyzed by using ANOVA for repeated measurement, and the difference among each syndrome element in different time points was compared by using ANOVA. Results: A total of 146 patients were included. There was significant difference among each syndrome elements in different time points(P<0.05). The score of syndrome of qi deficiency, syndrome of yang deficiency and syndrome of yin deficiency was significantly higher than the other syndromes, the difference in score between syndrome of blood stasis and syndrome of phlegm-dampness was not significant, and the score of syndrome of blood deficiency and syndrome of dampnessturbidity was relatively low. The difference in score between syndrome of qi deficiency and syndrome of yin deficiency, syndrome of blood stasis and syndrome of phlegm-dampness, syndrome of blood deficiency and syndrome of dampness-turbidity, syndrome of yang deficiency and syndrome of yin deficiency was not significant at baseline, and the difference among the rest syndromes was significant(P<0.05). The difference in score between syndrome of qi deficiency and syndrome of yang deficiency, syndrome of blood stasis and syndrome of phlegm-dampness, syndrome of yin deficiency and syndrome of yang deficiency, and syndrome of blood deficiency and syndrome of dampness-turbidity was not significant on 12-month and 24-month follow-up, and the difference among the rest syndromes was significant(P<0.05). Conclusion: Syndrome of qi deficiency is the most common syndrome of DKD. Syndrome of blood stasis runs throughout the occurrence and development of DKD. Qi deficiency and blood stasis is the basic pathogenesis of DKD.