糖尿病肾病患者不同分期中医证候特点及证型分布的临床调查

A Clinical Investigation on the Characteristics and Distribution of TCM Syndromes in Different Stages of Diabetic Kidney Disease

目的:观察不同分期的糖尿病肾病(DKD)患者中医证候特点及证型分布,为提高DKD中医辨证精准水平提供相关依据。方法:依据纳入标准选择DKD患者,根据尿蛋白定量和肾小球滤过率水平(e GFR)分为3期:即早期DKD、进展期DKD、终末期DKD,收集各期患者主证和兼证的主要临床表现,通过描述性统计研究方法,对不同分期的中医证候特点及证型分布规律进行分析。结果:根据本研究制定的DKD分期标准,发现早期DKD处于微蛋白尿期,肾功能轻度受损,进展期出现临床大量蛋白尿,肾功能处于CKD3B期;终末期则以肾功能严重衰竭为主。三期中医证候分布各有特点:早期DKD以气阴两虚证为主,并可兼杂血瘀证;进展期DKD以脾肾气虚证为主,兼证以血瘀证和水湿盛多见;终末期DKD以脾肾阳虚证为主,并呈血瘀、水湿、痰浊兼杂重症。随着DKD临床蛋白尿水平升高和肾功能损害加剧,中医临床症状积分也随之增多。结论:随着DKD临床蛋白尿水平升高和肾功能损害加剧,不同DKD分期的中医症状出现频次增加、严重程度加剧,辨证分型各有特点。

Objective： We explored the distribution of TCM symptoms in different stages of diabetic kidney disease, in order to provide evidences and improve the level of DKD TCM syndrome differentiation precise. Methods：Selected patients with DKD ac- cording to the inclusion criteria. Patients were divided into three stages according the level of proteinuria and glomerular filtration rate （ eGFR）, which was： Early stage of DKD; Aadvanced stage of DKD; End stage of DKD. Collected main symptoms and the simulta- neous symptoms of every patient, analyzed the characteristics and the distribution of TCM syndromes in different stages, and explored the regular pattern of syndrome. Results：According to the DKD stage criteria, we found that the patients showed microalbuminuria with renal function slightly decrease in early stage of DKD; where as in advanced and end - stage of DKD, patients appeared clinical intense proteinuria and CKD3B stage; and renal severe failure in end -stage of DKD. The TCM syndromes appeared different charac- teristics in differrent stages of DKD, which showed Qi and yin deficiency of main syndrome in early stage of DKD compared with blood stasis of simultaneous symptoms ; spleen and kidney deficiency of main syndrome compared with blood stasis and water - wet pervading in advanced stage of DKD; and spleen and kidney Yang deficiency of main syndromes compared with blood stasis, water - wet perva- ding and stagnant phlegm in end - stage DKD. With the progress of DKD proteinuria and renal function damage, TCM clinical symp- tom scores also increased. Conclusion：With theprogress of DKD, clinical proteinuria and renal function damage, the frequency and severity of TCM symptoms was increased in different DKD stages, and the syndrome differentiation type has different features.