慢性肾脏病-肾性贫血的中医证型分布特点

Distribution Characteristic of Traditional Chinese Medicine Syndrome Types of Chronic Kidney Disease-Renal Anemia

目的:探讨慢性肾脏病-肾性贫血(chronic kidney disease-renal anemia,CKD-RA)的中医证型分布特点,为CKD-RA的精准辨证和规范用药提供依据。方法:收集249例CKD 3—5期非透析患者的中医证候学、肾功能、贫血、铁代谢等临床资料,分析其中医证型分布与CKD分期、铁缺乏、贫血指标之间的关系。结果:CKD 3—5期的肾性贫血患者本虚证以肝肾阴虚证(36.95%)为主,主要分布在CKD 4期;其次为脾肾阳虚证,主要分布在CKD 3期;脾肾阳虚证与肝肾阴虚证在CKD 5期所占比例相同。69.88%的患者表现为虚实夹杂,脾肾阳虚兼水湿证最多见;肝肾阴虚在兼湿热证、血瘀证和浊毒证中均占比最高。与单纯的RA比较,伴有铁缺乏的RA患者在4种中医证型中的占比有显著性差异(χ^(2)=7.813,P=0.049)。肝肾阴虚证在伴有铁缺乏的RA患者中比例较高,与脾肾气虚证比较,差异有统计学意义(P<0.008)。气血两虚证患者血红蛋白均低于其他3种证型(P<0.05),血清铁高于肝肾阴虚证、脾肾阳虚证患者(P<0.05)。肝肾阴虚证患者的血清铁、转铁蛋白饱和度与脾肾气虚证、气血两虚证比较,差异有统计学意义(P<0.05)。4种证型间总铁结合力、血清铁蛋白比较,差异无统计学意义(P>0.05)。结论:CKD 3—5期RA患者中肝肾阴虚证占比最高,该证型多伴有铁缺乏,容易出现铁代谢异常。

Objective:To explore the distribution characteristics of traditional Chinese medicine syndrome types in chronic kidney disease renal anemia(CKD-RA),and to provide a basis for accurate diagnosis and standardized medication of CKD-RA.Method:Collect clinical data on traditional Chinese medicine syndromes,renal function,anemia,and iron metabolism from 249 non dialysis patients with CKD in stages 3-5,and analyze the relationship between the distribution of traditional Chinese medicine syndromes and CKD staging,iron deficiency,and anemia indicators.Results:Renal anemia patients in stage 3-5 of CKD mainly have Liver and Kidney Yin deficiency syndrome(36.95%),mainly distributed in stage 4 of CKD,followed by Spleen and Kidney Yang deficiency syndrome,mainly distributed in stage 3 of CKD.The proportion of Spleen and Kidney Yang deficiency syndrome and Liver and Kidney Yin deficiency syndrome in stage 5 of CKD is the same.There are 69.88%of patients show a mixture syndrome of deficiency and excess,with Spleen and Kidney Yang deficiency combined with Dampness syndrome being the most common;The Liver and Kidney Yin deficiency has the highest proportion in the concurrent Damp Heat syndrome,blood stasis syndrome,and Turbid Toxin syndrome.Compared with pure RA,there is a significant difference in the proportion of RA patients with iron deficiency among the four traditional Chinese medicine syndromes(χ^(2)=7.813,P=0.049).The proportion of Liver and Kidney Yin deficiency syndrome is high in RA patients with iron deficiency,and the difference is statistically significant compared to Spleen and Kidney Qi deficiency syndrome(P<0.008).Patients with Qi and blood deficiency syndrome had lower hemoglobin levels than the other three syndrome types(P<0.05),and higher serum iron(SI)levels than patients with liver kidney yin deficiency syndrome and Spleen and Kidney Yang deficiency syndrome(P<0.05).The SI and transferrin saturation(TSAT)of patients with Liver and Kidney Yin deficiency syndrome were compared with Spleen and Kidney Qi deficiency syndrome and Qi blood deficiency syndrome,and the differences were statistically significant(P<0.05).There was no statistically significant difference in total iron binding capacity(TIBC)and serum ferritin(FER)among the four syndrome types(P>0.05).Conclusion:The proportion of Liver and Kidney Yin deficiency syndrome is highest in RA patients with CKD3-5 stage,which is often accompanied by iron deficiency and is prone to abnormal iron metabolism.