154例糖尿病肾病患者中医证型演变规律

Evolution rule of TCM syndrome types of 154 patients with diabetic nephropathy

目的:分析糖尿病肾病各期的中医证型分布特征及其与临床指标、各因素的相关性。方法:收集符合纳入标准的糖尿病肾病患者154例,采集患者的一般资料及相关临床指标,并将所有患者进行中医辨证分型,分析中医证型演变规律。结果:中医证型分布以肝肾阴虚证、浊毒犯胃证、气阴两虚证、气血两虚证、血瘀证、水气凌心证、脾肾阳虚证为主(P﹤0.05)。Ⅴ期中阴虚主证型最少(P﹤0.05)。阳虚主证型与心脑血管疾病呈负相关(OR=0.386,P=0.03);阳虚主证型与高胆固醇血症、贫血呈正相关(OR=3.281、2.559,P=0.007、0.037)。阴虚主证型DN与eGFR呈正相关(OR=1.771,P=0.001);阴虚主证型DN与BMI呈负相关(OR=0.409,P=0.042)。标实主证型与心脑血管疾病、BMI呈正相关(OR=2.560、2.801,P=0.049、0.005);标实主证型与糖化血红蛋白异常呈负相关(OR=0.394,P=0.020)。阳虚主证型Scr水平较其他证型的高,阴虚主证型水平eGFR较其他证型高,阳虚主证型RBC水平较其他证型低(P﹤0.05)。结论:糖尿病肾病分期与中医证型有一定相关性,其发展是阴损及阳的过程,湿热浊瘀因个体差异贯穿始终。

Objective:To analyze the correlativity between distribution characteristics of TCM syndrome types in different stages of diabetic nephropathy(DN)and clinical indexes as well as various factors.Methods:154 cases of patients with diabetic nephropathy who met the inclusion criteria were collected.Their general data and related clinical indexes were gathered.All patients were typed by TCM syndrome differentiation,and the evolution rule of TCM syndrome types was analyzed.Results:The distribution of TCM syndrome types was mainly as follows:liver and kidney yin-deficiency syndrome,turbid toxin attacking stomach syndrome,qi-yin both deficiency syndrome,qiblood both deficiency syndrome,blood stasis syndrome,pathogenic water attacking heart syndrome and spleenkidney yang deficiency syndrome(P﹤0.05).InⅤphase,the main syndrome type of yin deficiency was the least(P﹤0.05).DN of main syndrome type of yang-deficiency was correlated negatively to cardio-cerebrovascular diseases(OR=0.386,P=0.03),while positively to hypercholesterolemia and anemia(OR=3.281,2.559,P=0.007,0.037).DN of main syndrome type of yin-deficiency was correlated positively to eGFR(OR=1.771,P=0.001),while negatively to BMI(OR=0.409,P=0.042).DN of main syndrome type of excess in superficiality was correlated positively to cardiocerebrovascular diseases and BMI(OR=2.560,2.801,P=0.049,0.005),while negatively to abnormal glycosylated hemoglobin(OR=0.394,P=0.020).Scr of main syndrome type of yang deficiency was higher than Scr of other syndrome types.eGFR of main syndrome type of yin deficiency was higher than eGFR of other syndrome types.RBC of main syndrome type of yang deficiency was lower than RBC of other syndrome types(P﹤0.05).Conclusion:The staging of DN has correlativity with TCM syndrome differentiation typing,and DN development is a process of deficiency yin affecting yang,and damp-heat and turbid stasis run through the whole process due to individual differences.