腹膜透析患者中医证型及其影响因素的临床观察  

Clinical Observation on TCM Syndromes and Effect Factors in Peritoneal Dialysis Patients

作　　者：盛梅笑 许陵冬 江燕 李正红 宋欢[2] 袁晓玲[2] 

机构地区：[1]南京中医药大学附属医院肾内科,南京210029 [2]南京中医药大学研究生院,南京210029

出　　处：《中国中西医结合肾病杂志》2014年第1期30-33,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：江苏省中医药领军人才项目(No.LJ200904)

摘　　要：目的:观察腹膜透析(PD)患者中医证型的分布与变化,分析影响证型的相关因素,为中医药治疗干预提供参考。方法:共96例PD患者,记录病史、症状体征与舌脉,进行中医辨证分型,同一患者当中医证型发生变化时进行连续性观察,并观察中医证型与透析龄、临床合并症及实验室指标间的关系。结果:(1)证型分布:本虚证以脾肾气虚证、脾肾阳虚证为主,分别占43.8%、26.0%,标实证依次为湿浊证、血瘀证、风动证、湿热证、水气证,以湿浊、瘀血证多见;(2)证型的变化:血瘀、湿热、湿浊等标实证可随病情发生变化;(3)证型与透析龄的关系:透析龄<24个月脾肾气虚、脾肾阳虚证与湿浊证多见,透析龄≥24个月脾肾阳虚、阴阳两虚、血瘀、风动证较多,组间比较差异有统计学意义(P<0.01或<0.05);(4)证型与临床合并症的关系:发生腹膜炎与非腹膜炎时比较湿热证增多,脾肾阳虚证减少,发生容量超负荷与非容量超负荷时比较水气证明显增多,但组间比较差异无统计学意义(P>0.05);(5)证型与实验室指标的关系:本虚证中阴阳两虚、脾肾阳虚证患者血Hb明显下降,血CRP升高,阴阳两虚证血Alb下降,脾肾阳虚证血iPTH升高,肝肾阴虚、气阴两虚证血TG升高,差异均有统计学意义(P<0.05),各标实证实验室指标比较差异无统计学意义(P>0.05)。结论:PD患者的中医证型本虚证以脾肾气虚与脾肾阳虚证为多,标实证主要为湿浊、血瘀证,透析龄、临床合并证及某些实验室指标是影响中医证型的因素。ABSTRACT Objective： To observe the distribution and alteration of syndromes of Traditional Chinese Medicine （TCM） in peritoneal dialysis （PD） patients, and to analyze the effect factors, which may be reference for TCM intervention. Methods：96 cases with PD were included in the study. Medical history, symptoms, signs, tongue and pulse images were recorded to differentiate syn dromes of TCM. Consecutive observation was made on the patients with changed syndrome. Moreover, the correlation between TCM syndrome, dialysis duration, clinical complications and laboratory data was also observed. Results： （ 1 ） Syndrome distribution ： Spleen kidney qi deficiency syndrome （43.8%） and spleen kidney yang deficiency syndrome （26.0%） are the primary in the root （Ben） deficiency syndromes. Superficiality （Biao） excess syndromes included turbid damp, blood stasis, wind moving, damp heat and fluid retention syndromes, among which turbid damp and blood stasis syndromes were more common. （2） Syndrome alteration ： superficiality excess syndromes, such as blood stasis, damp heat and turbid damp syndromes, changed as the disease progressed. （3） Correlation between syndromes and dialysis duration ： Spleen kidney qi deficiency, spleen kidney yang defi ciency and turbid damp syndromes were more common in patients with dialysis duration less than 24 months, while spleen kidney yang deficiency, yin yang deficiency, blood stasis and wind stirring syndromes were more common in patients with dialysis du ration no less than 24 months. The differences between the groups were statistically significant respectively （ P 〈 0.01 or P 〈 0.05 ）. （4） Correlation between syndromes and clinical complications： Damp heat syndrome occurred more and spleen kidney yang defi ciency less in the peritonitis cases than in the non peritonitis cases. Fluid retention syndrome occurred more in the overload vol ume cases than in the non overload volume cases. However, the differences

关 键 词：终末期肾衰竭 腹膜透析 中医证型 

分 类 号：R259[医药卫生—中西医结合]