2型糖尿病合并慢性肾脏病的临床病理特点及中成药应用分析

Clinical Pathological Characteristics of Type 2 Diabetes Mellitus Complicated with Chronic Kidney Disease and Analysis of the Application of Chinese Patent Medicine

目的:分析糖尿病肾脏疾病(DKD)与非糖尿病肾脏疾病(NDKD)鉴别的预测因素,归纳2型糖尿病(T2DM)合并慢性肾脏病(CKD)患者中成药的用药规律,为临床鉴别NDKD及合理使用中成药提供参考。方法:采用回顾性分析,选取中日友好医院2010—2018年行肾活检的463例T2DM患者,根据病理诊断将患者分为DKD组65例(14.04%),DKD合并NDKD组85例(18.36%),NDKD组313例(67.60%)。使用logistic回归分析筛选NDKD临床预测因素,总结中成药治疗T2DM合并CKD患者的用药规律。结果:1)2型糖尿病NDKD的临床预测因素包括:无糖尿病视网膜病变、糖尿病病程<6年、血红蛋白≥120 g/L、肾小球源性血尿、未达到肾综范围蛋白尿。其中无糖尿病视网膜病变具有最高的预测意义(OR,14.902;95%CI,5.989~37.07)。2)2型糖尿病合并慢性肾脏病最常用的中成药为黄葵胶囊,其次为虫草类制剂,海昆肾喜胶囊及尿毒清颗粒。NDKD组单用中成药的比例高于其他2组(P<0.001),联用4种及以上中成药的比例低于其他2组(P<0.001)。随着疾病进展黄葵胶囊的使用比例逐渐下降,尿毒清颗粒的使用比例逐渐升高,虫草类制剂及海昆肾喜胶囊在CKD3-4期使用比例较高,到CKD5期有所下降。结论:1)NDKD临床预测因素包括:以无糖尿病视网膜病变为主、另外,糖尿病病程<6年、血红蛋白≥120 g/L、伴肾小球源性血尿等亦具有参考意义。2)中成药在慢性肾脏病中使用广泛,针对蛋白尿最常用的药物为黄葵胶囊,随着疾病进展虫草类制剂、海昆肾喜胶囊及尿毒清颗粒使用比例有所变化。

Objective:To analyze the predictive factors of the differential diagnosis between diabetic kidney disease(DKD)and non-diabetic kidney disease(NDKD),summarize the usage of Chinese patent medicine in type 2 diabetic mellitus(T2DM)complicated with chronic kidney disease(CKD)patient,to provide a reference for identification of NDKD and rational usage of Chinese patent medicine.Methods:A retrospective study was conducted to observe 463 type 2 diabetic patients who underwent renal biopsy in China-Japan Friendship Hospital from 2010 to 2018.The patients were divided into3 groups,65 in DKD group(14.04%),85 in DKD complicated with NDKD group(18.36%),and 313 in NDKD group(67.60%)according to the pathological results.Logistic regression analysis was used to screen the clinical predictive factors of NDKD,and the regularity of Chinese patent medicine in the treatment of type 2 diabetes mellitus complicated with chronic kidney disease were summarized.Results:1)The clinical predictors of T2DM NDKD include:non-diabetic retinopathy,course of diabetes<6 years,hemoglobin≥120 g/L,glomerular hematuria,proteinuria without meeting the standard of nephropathy syndrome.Non-diabetic retinopathy had the highest predictive significance(OR,14.902;95%CI,5.989-37.07);2)Huangkui capsule was the most commonly used Chinese patent medicine for treatment of T2DM complicated with CKD,followed by Cordyceps,Haikun Shenxi capsule and Niaodu Qing granules.Single use of Chinese patent medicine in NDKD group was higher while combination of four or more Chinese patent medicine ratio was lower than the other two groups(P<0.001).With the development of CKD,the proportion of Huangkui capsule decreased,the proportion of Niaodu Qing granules increased,the proportion of Cordyceps and haikun Shenxi capsule in CKD3-4 stage was higher,and it decreased in CKD5 stage.Conclusion:1)The clinical predictors of NDKD include mainly non-diabetic retinopathy,besides,course of diabetes<6 years,hemoglobin≥120 g/L,glomerular hematuria and so on also have significance.2)Chinese patent medicine is widely used in chronic kidney disease.The most commonly used drugs for proteinuria are Huangkui capsule,with the development of disease,the useage propotion of Cordyceps,haikun Shenxi capsule and Niaodu Qing granules were changed.