基于病理学分期的糖尿病肾病中医辨证分型研究

Syndrome Differentiation Based on Renal Biopsy Pathology of Diabetic Nephropathy

目的:探讨糖尿病肾病(DN)中医辨证分型的分布规律及其和糖尿病肾病病理分期的关系。方法:纳入医院随访1年以上且经病理学诊断的DN患者,按照Tervaet提出的糖尿病肾病病理分期标准进行分期,同时采集患者的临床资料进行中医辨证分型,进行统计学处理。结果:共纳入经肾活检诊断为糖尿病肾病患者353例,病理分期情况,Ⅰ期52例,Ⅱa期90例,Ⅱb期29例,Ⅲ期141例,Ⅳ期41例;中医辨证分型情况,本虚证中,阴虚燥热证13例,气阴两虚证151例,脾肾气虚证140例,阴阳两虚证49例;标实证中,寒湿证19例,湿热证68例,瘀证212例,痰瘀证54例;中医证型在不同的病理分期中的分布有统计学差异。肾脏生存率方面,本虚证中,阴虚燥热证生存率最高,阴阳两虚证生存率最低;在标证中,痰瘀证患者生存率最低。结论:糖尿病肾病的中医分型在不同的病理分期中的分布有规律可循,气阴两虚证、瘀血证发生率高于其他证型;病理分期中的具体指标和不同的中医分型具有相关性;中医分型和糖尿病肾病的生存率相关,阴阳两虚证、痰瘀证患者生存率低,预后不佳。

Objective ： To research the distribution of TCM syndrome differentiation of diabetic nephropathy （DN） and its relationship with pathological stage of DN. Method：The DN patients through pathological diagnosis which have more than one year history were enrolled. By the Tervaet criterion of pathological stage of DN, we made syndrome differentiation in TCM by collecting the clinical data and carried out a statistical processing at last. Result ： We collected 353 DN patients who met the criterion in total. By the pathological stage criterion of DN, there were 52 patients with phase Ⅰ , 90 with phase Ⅱ a,29 with phase Ⅱ b,141 with phase Ⅲ ,41 with phase Ⅳ. About syndrome differentiation,there were 13 patients with Yin deficiency and dryness -heat type, 151 with Qi -Yin deficiency type, 140 with Qi deficiency of spleen and kidney type,49 with Yin- Yang deficiency type, 19 with cold -dampness type,68 with heat -dampness type, 212 with blood stasis type,54 with phlegm and blood stasis type. Multivariate COX analysis showed that syndrome differentiation was the independent risk factor for renal prognosis. Conclusion：Among the syndrome differentiation of DN, Qi - Yin defi- ciency type and blood stasis type were more frequently than other types. The result showed that syndrome differentiation was significantly correlated with pathological stage of DN. Yin - Yang deficiency type and phlegm and blood stasis type were independent risk factors for renal prognosis in DN.