糖尿病肾病(Ⅲ～Ⅴ期)患者中医临床证候学特点及相关因素分析

Study on Syndrome-manifestation of Traditional Chinese Medicine and Relevant Factors in Patients with Diabetic Nephropathy（Ⅲ~Ⅴperiod）

目的：通过搜集确诊为糖尿病肾病（Diabetic nephropathy,DN）Ⅲ～Ⅴ期的患者病例资料、症状表现及相关的生化指标,以期发现DNⅢ～Ⅴ期中医证候学的特点、临床中医证型的规律及其与生化指标的相关性。方法：以调查问卷的方式收集301例DNⅢ～Ⅴ期患者的病例资料,包括中医证型分布、主要症状表现,并对各中医证型的血肌酐、肾小球滤过滤（Glomerular Filtration Rate,e GFR）、24 h尿蛋白、体重指数、血清白蛋白、血脂、血红蛋白等指标进行统计分析。结果：（1）DNⅢ～Ⅴ期患者中发生率前10位的临床症状为：疲乏、肢体麻木、小便泡沫增多、肢体浮肿、夜尿频多等,以脾肾气虚症状为主要表现。（2）DNⅢ期以气阴两虚型为主（66.7%）,DNⅣ期以脾肾气虚为主（67.7%）,DNⅤ期仍以脾肾气虚型为主（61.8%）,阴阳两虚型明显上升（38.2%）。（3）所有入组患者中脾肾气虚型所占比例最大（56.15%）,其次为气阴两虚型（30.23%）、阴阳两虚型（11.63%）,阴虚燥热型比例最少（2%）;（4）DNⅢ～Ⅴ期中医证型的兼证表现为：阴虚燥热型、气阴两虚型、脾肾气虚型以湿热证、瘀证为主,阴阳两虚型以瘀证、痰瘀证为主,瘀证贯穿始终,占据优势。（5）伴随DN病情的加重,中医证型的转变,患者24 h尿蛋白、血肌酐、血尿酸等均明显上升（P〈0.01）,而GFR、血清白蛋白、血红蛋白均显著降低（P〈0.01）。结论：DNⅢ～Ⅴ期以脾肾气虚型比例最高（56.15%）,随着DN病情的进展,兼证的比例逐步增加,其中瘀证在各证型中占据最大比例,DN中医证型与24 h尿蛋白、肾功能、血清白蛋白等预后指标密切相关。

Objective：To collect diagnosed as diabetic nephropathyⅢ～Ⅴ of patients with clinical data,symptoms and related biochemical parameters in order to find DNⅢ～Ⅴ of traditional Chinese medicine syndrome characteristics,clinical syndromes type of law and the correlation with biochemical indicators. Methods：A questionnaire collected 301 cases of DNⅢ～Ⅴ patients with clinical data,including the distribution of traditional Chinese medicine,the main symptoms,and various syndromes of serum creatinine,glomerular filtration filter（Glomerular Filtration Rate,e GFR）,24-hour urine protein,body mass index,serum albumin,cholesterol,hemoglobin and other indicators for statistical analysis. Results：（1）DNⅢ～Ⅴ incidence of patients before 10 clinical symptoms are：fatigue,numbness,increased urination foam,limb edema,nocturia,etc.,to spleen qi deficiency symptoms as the main performance.（2）DNⅢ based on a Yin deficiency type（66.7%）,DNⅣ based on a spleen Qi deficiency（67.7%）,DNⅤ of spleen Qi deficiency is still dominated（61.8%）,Yin and Yang type significantly rise to（38.2%）.（3）All enrolled patients with spleen Qi deficiency largest proportion（56.15%）,followed by Yin deficiency type（30.23%）,Yin and Yang type（11.63%）,Yin hot proportional minimum（2%）.（4）DN Ⅲ～Ⅴ traditional Chinese medicine syndromes and certificates as follows：Yin hot type,Yin deficiency type,spleen Qi deficiency with damp-heat syndrome,stasis based,Yin and Yang type in stasis,phlegm stasis mainly stasis throughout,an advantage.（5）DN illness accompanied by a marked increase in aggravated traditional Chinese medicine shift patients 24-hour urine protein,serum creatinine,uric acid etc.（P〈0.01）,and GFR,serum albumin,hemoglobin were significantly lower（P〈0.01）. Conclusion：DNⅢ～Ⅴ of spleen Qi deficiency with the highest percentage（56.15%）,with the proportion of DN progress of the disease,and permit a gradual increase,which accounted for the largest proportion of stasis in various syndromes,DN syndromes and 24 hour urine protein closely related to renal function,serum albumin and other prognostic factors.