467例糖尿病肾脏病Ⅲ~Ⅳ期患者湿浊证证候分布规律及与临床特征的相关性研究

Study on the distribution pattern of dampness-turbidity syndrome and its correlation with clinical characteristics in 467 cases of diabetic kidney disease stage Ⅲ-Ⅳ

目的:探讨糖尿病肾脏病(DKD)Ⅲ~Ⅳ期患者的湿浊证证候分布规律,并分析其与临床特征的相关性。方法:通过临床横断面调查研究,采集467例符合纳入标准的DKDⅢ~Ⅳ期患者的中医证候、一般资料、病史资料、检查指标、兼夹虚性证候比例、积分,采用相关性分析、Logistic回归分析探讨DKD湿浊证证候分布及与临床特征的相关性。结果:湿浊证患者占DKD总数的56.7%,其中DKDⅣ期患者的湿浊证比例显著高于DKDⅢ期患者(P<0.05),且湿浊证候积分相对更高(P<0.05)。与非湿浊证组比较,湿浊证组合并高血压病史、高脂血症病史、高尿酸血症病史的比例更高(P<0.05),空腹血糖(FPG)、糖化血红蛋白(HbA1c)、钾(K)、磷(P)、肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、甘油三酯(TG)、尿蛋白(PRO)、尿微量白蛋白与尿肌酐比值(ACR)水平更高(P<0.05),而血红蛋白(HGB)、估算肾小球滤过率(eGFR)水平更低(P<0.05),且兼夹虚性证候比例和证候积分更高(P<0.05);相关性分析中DKD患者湿浊证候积分与2型糖尿病病程、P、Scr、BUN、UA、PRO、ACR、24小时尿蛋白总量(24h-UTP)、气虚证候积分、阳虚证候积分呈正相关(P<0.05),与HGB、白蛋白(ALB)、eGFR呈负相关(P<0.05);多因素回归分析显示,P、Scr、UA、气虚证候积分、阳虚证候积分与DKD湿浊证呈正相关(P<0.05),eGFR与DKD湿浊证呈负相关(P<0.05)。结论:湿浊证是普遍存在于DKD患者中的标实证型,一定程度上促进疾病进展,而P、Scr、UA等代谢产物蓄积可能是DKD湿浊证临床客观化指标。

Objective:To investigate the distribution pattern of dampness-turbidity syndrome of diabetic kidney disease(DKD)stage II-IV patients and to analyze its correlation with clinical characteristics.Methods:This study collected data on traditional Chinese medicine(TCM)syndromes,general information,medical history,examination indices,and the proportion and integration of deficiency syndromes from 467 patients with DKD stages II-IV by clinical cross-sectional study design.Then,using correlation analysis and logistic regression,we investigated the distribution of dampness-turbidity syndrome in DKD and its association with clinical features.Results:Patients with dampness-turbidity syndrome accounted for 56.7%of those with DKD.The prevalence of dampness-turbidity syndrome was significantly higher in DKD Stage IV than in Stage II(P<0.05).Additionally,the severity of dampness-turbidity syndrome was relatively higher(P<0.05).Compared to the non-dampness-turbidity syndrome group,patients with dampness-turbidity syndrome had a higher prevalence of hypertension,hyperlipidemia,and hyperuricemia(P<0.05).They also exhibited higher levels of FPG,HbA1c,K,P,Scr,BUN,UA,TG,PRO,and ACR(P<0.05),while having lower levels of HGB and eGFR(P<0.05).Furthermore,the proportion and severity of deficiency syndrome were higher in this group(P<0.05).Correlation analysis revealed that the score of dampness-turbidity syndrome in DKD patients was positively correlated with the duration of type 2 diabetes,as well as levels of P,Scr,BUN,UA,PRO,ACR,24-hour UTP,and scores of qi-deficiency and yang-deficiency syndromes(P<0.05).Multivariate logistic regression showed that P,Scr,UA,and scores of qi-deficiency and yang-deficiency syndromes were positively correlated with dampness-turbidity syndrome(P<0.05),while eGFR was negatively correlated with dampness-turbidity syndrome(P<0.05).Conclusion:Dampness-turbidity syndrome commonly exists in patients with DKD,which promotes the development of disease to some extent.Moreover,accumulation of metabolic products such as P,Scr,UA may be objective indicators reflecting dampness-turbidity syndrome in patients with DKD.