佛山市老年慢性肾病患者中医体质调查及多因素Logistic回归分析

Investigation on traditional Chinese medicine constitution of elderly patients with chronic kidney disease in Foshan City and multivariate Logistic regression analysis

目的 对佛山市老年慢性肾病(CKD)患者的中医体质进行调查,采用多因素Logistic回归分析偏颇体质的危险因素。方法 929例免费体检的老年CKD患者,通过问卷调查方式调查患者中医体质,比较不同体质患者的基础资料,利用Logistic回归模型分析偏颇体质的危险因素。结果 发放929份问卷调查,有效回收896份, 33份问卷因患者临床资料不合格(或者子资料不齐全)导致无效。896例患者中平和质91例(10.16%),偏颇体质805例(89.84%),包括气虚质102例(11.38%)、阳虚质104例(11.61%)、阴虚质101例(11.27%)、痰湿质96例(10.71%)、湿热质99例(11.05%)、血瘀质103例(11.50%)、气郁质99例(11.05%)、特禀质101例(11.27%)。偏颇体质患者高血压、糖尿病、冠心病、陈旧性脑梗死占比分别为20.99%、21.24%、18.88%、11.80%,明显高于平和质的8.79%、7.69%、7.69%、2.20%,差异均具有统计学意义(P<0.05)。气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质患者的年龄、肌酐、尿素氮、尿酸、尿微量白蛋白、吸烟年限、饮酒年限、舒张压、收缩压、空腹血糖、总胆固醇、甘油三酯、腹围、体质量指数均高于平和质,差异有统计学意义(P<0.05);气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质、特禀质患者的饮食习惯评分、生活习惯评分低于平和质患者,运动时间短于平和质患者,差异具有统计学意义(P<0.05)。Logistic回归分析显示:肌酐高、尿素氮高、尿酸高、尿微量白蛋白高、年龄大、吸烟年限长、体质量指数大、饮酒年限长、舒张压高、收缩压高、腹围大、空腹血糖高、总胆固醇高、甘油三酯高、生活习惯差、饮食习惯差、运动时间短、合并症是老年CKD患者偏颇体质的危险因素(P<0.05)。结论 年龄、吸烟、饮酒、体质量指数、血压、腰围、血糖、血脂、生活习惯、饮食习惯、运动情况、合并症等影响老年CKD的中医体质;老年CKD不同中医体质患者之间肾功能指标存在差异,因此在实际治疗中,需综合考虑患者中医体质,结合不同患者体质、症状表现、病史、生活习惯、饮食习惯等多方面情况,为治疗方案制定提供参考依据。

Objective To investigate the traditional Chinese medicine constitution of elderly patients with chronic kidney disease(CKD)in Foshan City,and multivariate Logistic regression is used to analyze the risk factors of biased constitution.Methods 929 elderly CKD patients with free physical examination were investigated by questionnaire to investigate the patients'Chinese medicine constitution.The basic information of patients with different constitutions was compared,and the risk factors of biased constitution was analyzed by Logistic regression model.Results 929 questionnaires were issued,896 questionnaires were effectively recovered,and 33 questionnaires were invalid due to unqualified clinical data(or incomplete sub-data).Among the 896 patients,there were 91 cases(10.16%)of moderate constitution,805 cases(89.84%)of biased constitution,including 102 cases(11.38%)of qi-deficiency constitution,104 cases(11.61%)of yang-deficiency constitution,101 cases(11.27%)of yin-deficiency constitution,96 cases(10.71%)of phlegm dampness constitution,99 cases(11.05%)of damp-heat constitution,103 cases(11.50%)of blood stasis constitution,99 cases(11.05%)of qi-stagnation constitution,and 101 cases(11.27%)of intrinsic constitution.The proportions of hypertension,diabetes,coronary heart disease and old cerebral infarction in patients with biased constitution were 20.99%,21.24%,18.88%and 11.80%,which were significantly higher than those of 8.79%,7.69%,7.69%and 2.20%in patients with moderate constitution,and the differences were statistically significant(P<0.05).The age,creatinine,urea nitrogen,uric acid,urinary microalbumin,smoking years,drinking years,diastolic blood pressure,systolic blood pressure,fasting blood glucose,total cholesterol,triglycerides,abdominal circumference,and body mass index of patients with qi-deficiency,yang-deficiency,yin-deficiency,phlegm dampness,damp-heat,blood stasis,qi-stagnation,and intrinsic constitution were all higher than those with mild constitution,and the differences were statistically significant(P<0.05).Patients with qi-deficiency,yang-deficiency,yin-deficiency,phlegm dampness,damp-heat,blood stasis,qi-stagnation,and intrinsic constitution had lower scores for dietary habits and lifestyle habits than those of patients with moderate constitution,and shorter exercise time than patients with moderate constitution.The differences were statistically significant(P<0.05).Logistic regression analysis showed that high creatinine,high urea nitrogen,high uric acid,high urinary microalbumin,old age,long smoking years,high body mass index,long drinking years,high diastolic blood pressure,high systolic blood pressure,large abdominal circumference,high fasting blood glucose,high total cholesterol,high triglyceride,poor lifestyle habits,poor diet,short exercise time,and complications were risk factors for biased constitutionin in elderly CKD patients(P<0.05).Conclusion Age,smoking,drinking,body mass index,blood pressure,waist circumference,blood glucose,blood lipids,lifestyle habits,dietary habits,exercise and comorbidities affect the traditional Chinese medicine constitution of the elderly with CKD.There are differences in renal function indicators among elderly CKD patients with different traditional Chinese medicine constitutions.Therefore,in actual treatment,it is necessary to comprehensively consider the traditional Chinese medicine constitutions of patients,combined with different constitutions,symptoms,medical history,lifestyle habits,diet habits and other aspects of patients,so as to provide reference for the formulation of treatment plans.