基于多中心疾病登记系统的膜性肾病中医主要证型分布特征分析

Exploration of Distribution Characteristics of Traditional Chinese MedicineSyndrome Types of Idiopathic Membranous Nephropathy Based onMulti-center Electronic Medical Records System

【目的】分析特发性膜性肾病(IMN)患者临床诊疗数据,探讨IMN患者中医证型分布特征及影响因素,以期丰富对IMN中医证型的认识,为研究IMN的主要病机和中医临床诊治提供一定依据。【方法】基于IMN临床研究电子数据采集系统,采用横断面调查方法,分析多中心来源的187例IMN患者的临床诊疗数据,归纳其中医证型分布规律;根据IMN的危险分层将患者分为低风险组、中风险组、高风险组3组,并根据地域将患者分为广东组和黑龙江组2组,分析不同IMN的危险分层及地域对中医证型分布特征的影响。【结果】(1)中医证候分布情况:187例患者中,分布频率居前3位的分别为:小便混浊或有明显泡沫尿167例(89.30%),舌苔腻、舌胖大或齿痕158例(84.49%),水肿134例(71.65%);中医证型分布情况:湿阻证频次最高,共169例(90.37%),其次为气虚证165例(88.24%)、血瘀证89例(47.59%)。(2)分组情况:187例患者中,低风险组102例(54.54%)、中风险组54例(28.88%)、高风险组31例(16.58%);广东组147例(78.61%),黑龙江组40例(21.39%)。(3)IMN证型分布的影响因素中,在IMN的危险分层方面,低风险组患者中湿阻证的占比为83.33%(85/102),中风险组为98.15%(53/54),高风险组为100.00%(31/31),3组患者的湿阻证比例比较,差异有统计学意义(P=0.002);在地域方面,广东组和黑龙江组的瘀血证比例分别为55.10%(81/147)和20.00%(8/40),不同地域的血瘀证比例比较,差异有统计学意义(P<0.001);在兼夹证型方面,高风险组的气虚血瘀湿阻证比例[64.52%(20/31)]明显高于低风险组和中风险组的34.31%(35/102)、38.89%(21/54);广东组的气虚血瘀湿阻证比例[46.94%(69/147)]明显高于黑龙江组的17.50%(7/40),而气虚湿阻证比例[31.97%(47/147)]明显低于黑龙江组的60.00%(24/40),差异均有统计学意义(P<0.05)。【结论】本研究归纳和分析了IMN患者的中医证候、中医证型分布规律及其影响因素,探讨了湿证在IMN疾病发生中的关键作用,这对于进一步揭示湿证内涵、促进IMN中医证候研究具有重要意义。

Objective The clinical data of patients with idiopathic membranous nephropathy(IMN)were analyzed to explore the distribution characteristics of traditional Chinese medicine(TCM)syndrome types and the influencing factors,with a view to enriching the understanding of TCM syndrome types and providing a basis for studying the primary pathogenesis and clinical management of IMN.Methods Based on the electronic data collection system of IMN clinical research,the clinical diagnosis and treatment data of 187 IMN patients from multi-center sources were analyzed using a cross-sectional survey method to summarize the distribution pattern of their TCM syndrome types.The included patients were divided into three groups according to the risk stratification of IMN,namely low-risk group,medium-risk group and high-risk group,and the included patients were divided into Guangdong group and Heilongjiang group according to the source of the patients.The effects of risk stratification and source of IMN patients on the distribution characteristics of TCM syndrome types were analyzed.Results(1)For the distribution of TCM syndrome manifestations among the 187 patients,the top 3 three syndrome manifestations were cloudy urine or obvious foamy urine in 167 cases(89.30%),greasy tongue coating,enlarged tongue or tooth-marked tongue in 158 cases(84.49%),and edema in 134 cases(71.65%).The distribution of TCM syndromes was shown as dampness obstruction syndrome with the highest frequency(169 cases,90.37%),followed by qi deficiency syndrome(165 cases,88.24%)and blood stasis syndrome(89 cases,47.59%).(2)The results of risk stratification of 187 IMN patients showed that 102 cases(54.54%)were in the low-risk group,54 cases(28.88%)were in the medium-risk group and 31 cases(16.58%)were in the high-risk group.And the grouping of the source of the patients showed that 147 cases(78.61%)were in the Guangdong group and 40 cases(21.39%)were in the Heilongjiang group.(3)The analysis of the factors influencing the distribution of IMN syndromes showed that in terms of risk stratification of IMN,the patients with dampness obstruction syndrome accounted for 83.33%(85/102)in the low-risk group,98.15%(53/54)in the medium-risk group and 100.00%(31/31)in the high-risk group,and the difference of the proportion of dampness obstruction syndrome was statistically significant among the three groups(P=0.002).In terms of the source of the patients,the patients with blood stasis syndrome accounted for 55.10%(81/147)in the Guangdong group and 20.00%(8/40)in the Heilongjiang groups,and the difference of the proportion of blood stasis syndrome was statistically significant between the two groups(P<0.001).For the distribution of the complicated syndromes,high-risk group had higher proportion of the complicated syndrome of qi deficiency,blood stasis and dampness obstruction than low-risk group and medium-risk group,manifested as 64.52%(20/31)vs 34.31%(35/102)and 38.89%(21/54).Guangdong group had higher proportion of the complicated syndrome of qi deficiency,blood stasis and dampness obstruction than the Heilongjiang group[46.94%(69/147)vs 17.50%(7/40)],while had lower proportion of the complicated syndrome of qi deficiency and dampness obstruction than the Heilongjiang group[31.97%(47/147)vs 60.00%(24/40)].The differences were all statistically significant(P<0.05).Conclusion This study summarized and analyzed the TCM syndrome manifestations of IMN patients and the distribution pattern and its influencing factors of TCM syndromes,and the key role of dampness syndrome in the development of IMN disease was also explored.The results will be beneficial for further revealing the connotation of dampness syndrome and promoting the study of TCM syndrome of IMN.