糖尿病肾病证候要素提取及预后相关性研究

Study on the Relationship between Extraction of Syndrome Elements and Prognosis of Diabetic Nephropathy

目的提取糖尿病肾病(DN)的证候要素,研究证型与预后的相关性。方法将80例糖尿病肾病患者,进行证候要素提取,并统计与预后的相关性。结果提取80例符合DN诊断标准的病例证候要素,其分布频率分别为气虚证(25.6%)>阴虚证(14.7%)>阳虚证(22.1%)>湿浊证(22.4%)>血瘀证(15.2%),其证型中主证气阴两虚证17例,脾肾气虚证12例,脾肾阳虚证51例为主,兼证:湿浊证42例,血瘀证28例。结论随着患者病情的加重,中医证候主证由气阴两虚证向脾肾气虚证再由脾肾阳虚证进行演变,同时兼证中水湿向湿浊再由浊毒进行演变,其与主证的变化相关。其中气阴两虚证好转率为82.3%,脾肾气虚证好转率为33.3%,脾肾阳虚证好转率为23.5%,提示:随着DN疾病的发展,中医病机由气阴两虚证、脾肾气虚证,阴损及阳至脾肾阳虚证的发展演变规律,其中脾肾阳虚证预后最差,29.2%的患者转入血液透析。

Objective To extract syndrome elements of diabetic nephropathy(DN) and research correlation between syndrome type and prognosis. Methods Syndrome elements were extracted from 80 cases of DN, and correlation was calculated between prognosises.Results Symptomatic elements of 80 cases which met the DN diagnostic criteria were extracted, and the distribution frequencies were qi deficiency syndrome followed by yin deficiency syndrome(14.7%), yang deficiency syndrome(22.1%), wet turbid syndrome(22.4%),blood stasis syndrome(15.2%). There were 17 cases of spleen and kidney qi deficiency, 12 cases of spleen and kidney qi deficiency,and 51 cases of spleen and kidney YAng deficiency. And 42 cases of wet-turbid accompanying syndrome, 28 cases of blood stasis accompanying syndrome were included. Conclusion As the aggravation of the patient’s condition, main syndrome changes from qi-yin deficiency syndrome to qi deficiency of spleen and kidney and then to yang deficiency of spleen and kidney accompanying syndrome change from water dampness to turbid dampness and then to turbid toxins, which is related to main syndrome. The recovery rate of qi-yin deficiency, qi deficiency of spleen and kidney, yang deficiency of spleen and kidney syndrome was 82.3 %, 33.3%, 23.5%respectively. With the development of DN disease, the pathogenesis of TCM changes from qi-yin deficiency syndrome to Qi deficiency of spleen and kidney syndrome, and then to Yang deficiency of spleen and kidney syndrome. The prognosis of yang deficiency of spleen and kidney syndrome was the worst, and 29.2% of the patients need to hemodialysis therapy.