糖尿病肾病患者Ⅲ、Ⅳ、Ⅴ期中医证候及分布规律

TCM syndromes and their distribution regularity in patients with diabetic nephropathy at stage Ⅲ,stage Ⅳ and stage Ⅴ

目的探讨280例糖尿病肾病(DN)患者Ⅲ、Ⅳ、Ⅴ期中医证候规律及证候分布规律,以期为DN的规范化诊治提供新的思路及理论支持。方法采用回顾性方法研究分析280例符合中西医诊断标准的Ⅲ、Ⅳ、Ⅴ期DN患者,针对各期患者主要及次要临床表现及问卷调查结果,采用德尔菲法总结DNⅢ、Ⅳ、Ⅴ期中医证候规律,采用聚类分析法探讨DNⅢ、Ⅳ、Ⅴ期中医证候分布规律,并进行描述性统计分析中医证候规律及其证候分布规律的特点。结果Ⅲ期和大量蛋白尿期DN患者中医症候特点为本虚标实,气阴两虚夹瘀型,Ⅴ期逐渐发展至气血阴阳俱虚,兼见湿浊、瘀血夹杂重症。结论随着DN的不断进展,中医症状出现相应频次的变化,其中医证候规律及其分布规律各有特点,对本病的临床诊治研究意义重大。

Objective To investigate the TCM syndromes and their distribution regularity in patients with diabetic nephropathy (DN) at stage Ⅲ,stage Ⅳ and stage Ⅴ in order to provide new ideas and theoretical support for the standardized diagnosis and treatment of diabetic nephropathy. Methods The clinical data about 280 patients with with diabetic nephropathy at stage Ⅲ,stage Ⅳ and stage Ⅴ who met the diagnostic criteria of Chinese and Western medicine were retrospectively analyzed. The primary and secondary clinical manifestations combined with the results of questionnaire were used to summarize the TCM syndromes and their distribution regularity in patients with diabetic nephropathy at stage Ⅲ,stage Ⅳ and stage Ⅴ by Delphi method. Moreover the TCM syndromes and their distribution regularity in patients with diabetic nephropathy at stage Ⅲ,stage Ⅳ and stage Ⅴ were analyzed by cluster analysis method and descriptive statistical analysis. Results The symptoms of TCM syndrome in patients with DN at stage Ⅲ and massive proteinuria were virtual standard, qi and yin deficiency and siltation,which in patients at stage V were gradually developed to qi and yin and yang deficiency, with severe turbidity and congestion. Conclusion With the continuous development of diabetic nephropathy, the symptoms of TCM have changed correspondingly. The rules and distribution regularity of medical syndrome have their own characteristics, which is of great significance for the clinical diagnosis and treatment of the disease.