280例血液透析患者中医证型分布

Distribution of Chinese Medicine Syndromes Types in 280 Cases Hemodialysis Patients

目的:观察280例血液透析患者中医证型的分布情况及各证型、兼证患者实验室指标的差异。方法:通过问卷调查和中医四诊对280例血液透析患者进行辨证,统计患者中医本证、兼证的分布情况,分析透析时间、原发病及实验室指标与中医证型的关系。结果:280例血液透析患者以脾肾气虚证最多,其他证型依次为气阴两虚证>肝肾阴虚证>脾肾阳虚证>阴阳两虚证。兼证以血瘀证、湿热证最多,其他兼证依次为湿浊证>水气证>风动证。从各中医证型来看,脾肾气虚证多兼湿浊证,肝肾阴虚证多兼血瘀证,脾肾阳虚证多兼湿浊证,气阴两虚证多兼血瘀证。透析年龄≤36月的患者均以脾肾气虚证为主,透析年龄>36月的患者均以脾肾气虚证和气阴两虚证为主。慢性肾炎及糖尿病患者的中医证型以脾肾气虚证及气阴两虚证为主,高血压病及梗阻性肾病患者的中医证型以脾肾气虚证为主,多囊性肾病的中医证型以脾肾气虚证及肝肾阴虚证为主。肝肾阴虚证患者甲状旁腺激素(PTH)水平高于脾肾阳虚证患者(P<0.05)。风动证患者PTH水平高于水气证患者(P<0.05)。结论:血液透析患者病机特点为本虚标实,本虚以气、阴、阳虚为主,标实以血瘀、湿热、湿浊为主,虚实夹杂贯穿疾病始终。

Objective： To observe the distribution of Chinese medicine syndrome types in 280 patients that received hemodialysis and the difference of laboratory indexes among patients with different syndromes and accompanied syndromes. Methods： Differentiated patterns of the 280 patients that received hemodialysis with questionnaire and four diagnostic methods of Chinese medicine, recorded distribution of basic syndromes and accompanied symdrones of the patients, analyzed relationship of Chinese medicine syndrome with penetration time, primary disease, laboratory indexes. Results： Among 280 patients with hemodialysis, pattern of most patients was qi deficiency in spleen and kidney type, while other patterns were in sequance of qi-yin deficientcy type〉 yin deficiency of liver and kidney type〉 yang deficiency of spleen and kidney type〉 yin-yang deficientcy type. Blood stasis type and damp heat type were the most common in accompanied syndromes, while other patterns were in sequance of damp turbidity type〉 liquid-qi type〉 wind type. From the aspect of Chinese medicine syndrome types, patients with qi deficiency in spleen and kidney type mostly accompanied by damp turbidity type; patients with yin deficiency of liver and kidney type mostly accompanied by blood stasis type., patients with yang deficiency of spleen and kidney type mostly accompanied by damp heat type; patients with qi-yin deficientcy type mostly accompanied by damp heat type. Patients with dialysis-time less than or equal to 6 months, and those between 13 to 36 months mainly suffered from qi deficiency in spleen and kidney type, while patients with dialysis-time over 36 months were mainly qi deficiency in spleen and kidney type and qi-yin deficiency type. Chinese medicine syndrome types of patients with chronic nephritis or diabetes mellitus were mainly qi deficiency in spleen and kidney type and qi-yin deficiency type, while patients with hypertension and obstructive nephropathy were mainly qi deficiency in spleen and kidney type, patients with polycystic kidney disease were mainly qi deficiency in spleen and kidney type and yin deficiency of liver and kidney type. The PTH levels of patients with yin deficiciency of liver and kidney type were higher than those of the patients with yang deficiency of spleen and kidney type（P 〈 0.05）. PTH levels of patients with wind type were higher than those of the patients with liquid-qi type（P 〈 0.05）. Conclusion. Pathogenesis features of patients with hemodialysis is fundamental deficiency and incidental excess. Fundamental deficiency is mainly characterized by deficiency of qi, yin and yang, and incidental excess is characterized by blood stasis and damp heat and damp turbidity, while deficiency and excess coexist syndrome always exists.