老年糖尿病肾病血液透析不同年限的中医证型分布及骨代谢相关指标变化研究  

Study on the distribution of TCM syndromes and the related index changes of bone metabolism of different dialysis years in elderly hemodialysis patients with diabetic nephropathy

作　　者：顾波[1] 王汉青[1] 赵颖丹[1] 马骏[1] 

机构地区：[1]上海市静安区中心医院肾内科,上海200040

出　　处：《河北中医》2018年第1期46-51,共6页Hebei Journal of Traditional Chinese Medicine

摘　　要：目的观察分析老年糖尿病肾病与老年非糖尿病肾病血液透析不同年限的中医证型分布规律和骨代谢相关指标的变化特点。方法参照《慢性肾衰竭的诊断、辨证分型及疗效评定(试行方案)》对90例老年糖尿病肾病组和120例老年非糖尿病组肾病血液透析不同年限患者分别进行中医辨证,观察其中医证型分布规律,同时检测血清甲状旁腺激素(PTH)、血清钙、血清磷的变化。结果 2组组内不同透析年限的本虚证分布比较差异有统计学意义(P<0.05),且透析前均以脾肾气虚证为主;随着透析年限的延长,老年糖尿病肾病组气阴两虚证和阴阳两虚证增多,老年非糖尿病肾病组透析1年仍以脾肾气虚证居多,后气阴两虚证增多。2组组间不同透析年限的本虚证分布比较显示,透析前比较差异无统计学意义(P>0.05),透析1年、3年时比较差异有统计学意义(P<0.05)。老年糖尿病肾病组不同透析年限的标实证分布比较差异无统计学意义(P>0.05),而老年非糖尿病肾病组比较差异有统计学意义(P<0.05),但2组透析前均以湿浊证居多,且随着透析年限的延长,湿热证、瘀血证和风动证增多。2组组间不同透析年限的标实证分布比较差异无统计学意义(P>0.05)。与透析前比较,2组在透析1年、3年、>5年时PTH均降低(P<0.05),血清钙均升高(P<0.05);老年非糖尿病肾病组血清磷在透析1年时下降(P<0.05),在透析3年时有升高趋势,而老年糖尿病肾病组血清磷水平随着透析年限的延长而有逐渐下降趋势。2组组间比较显示,透析前及透析3年时老年非糖尿病肾病组PTH及血清磷水平均高于老年糖尿病肾病组(P<0.05)。结论老年糖尿病肾病与老年非糖尿病肾病患者血液透析不同年限的中医证候既有相似处,又有各自特点。骨代谢相关指标的变化特点与中医证候的变化特点有许多共同点,可互为借鉴。Objective To observe and analysis the distribution of TCM syndromes and the related index changes of bone metabolism of different dialysis years in elderly hemodialysis patients with diabetic nephropathy and elderly hemodialysis patients with non-diabetic nephropathy of different dialysis years. Methods 90 cases of elderly hemodialysis patients with diabetic nephropathy and 120 cases of elderly hemodialysis patients with non-diabetic nephropathy were controlled syndrome differentiation by reference to the " diagnosis of chronic renal failure,syndrome differentiation and efficacy evaluation( pilot program) " standard to observe the distribution of TCM syndromes,and the changes of serum parathyroid hormone( PTH),serum calcium,serum phosphorus were detected. Results There were statistical difference on deficiency syndrome of different dialysis years intra-group( P < 0. 05). The qi deficiency of spleen and kidney syndrome was the majority before dialysis in two groups,and with the extension of dialysis years,the qi-yin deficiency syndrome and yin-yang deficiency syndrome increased in elderly diabetic nephropathy group,while qi deficiency of spleen and kidney syndrome was also the majority in elderly non-diabetic nephropathy group within dialysis one year,but later qi-yin deficiency syndrome increased. There was no statistical difference on deficiency syndrome before dialysis between-group( P > 0. 05),with statistical differences after dialysis one year and three years( P < 0. 05). There was no statistical difference on sthenia syndrome of different dialysis years in elderly diabetic nephropathy group( P > 0. 05). However,there were statistical differences on deficiency syndrome in elderly non-diabetic nephropathy group( P < 0. 05). The damp-turbidity syndrome was the majority before dialysis in two groups,and with the extension of dialysis years,damp-heat syndrome,blood-stasis syndrome and wind syndrome increased. There was no statistical difference on sthenia syndrome of different dialysis years between two groups(

关 键 词：糖尿病肾病 肾透析 骨和骨组织 病证规范化 

分 类 号：R587.24[医药卫生—内分泌] R459.5[医药卫生—内科学]