276例特发性膜性肾病中医证候分布及其影响因素分析  

Distribution Characteristics of Traditional Chinese Medicine Syndromes and Influencing Factors of Idiopathic Membranous Nephropathy in 276 Cases

作　　者：刘玉旋 李平 梁昌昌 王新慧 曾勤 陈楠 余仁欢[4] LIU Yuxuan;LI Ping;LIANG Changchang;WANG Xinhui;ZENG Qin;CHEN Nan;YU Renhuan(Graduate School,Beijing University of Chinese Medicine,Beijing 100029,China;Cardiovascular Department,the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine,Beijing 100029,China;Department of Nephrology,The Third Hospital of Hebei Medical University,Hebei 050051,China;Department of Nephrology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]北京中医药大学第三附属医院心血管科,北京100029 [3]河北医科大学第三医院肾病科,河北050051 [4]中国中医科学院西苑医院肾病科,北京100091

出　　处：《世界中医药》2022年第22期3229-3234,3241,共7页World Chinese Medicine

基　　金：国家重点研发计划项目(2019YFC1708503);中国中医科学院自主选题研究项目(5050109)。

摘　　要：目的:探讨特发性膜性肾病(IMN)的中医证候分布特点及其影响因素。方法:采用横断面调查研究方法,收集2017年10月至2019年10月在中国中医科学院西苑医院与河北医科大学第三医院就诊患者的基本信息、实验室指标、中医症状,进行中医辨证分型,分析IMN的中医证型分布情况及其影响因素。结果:276例IMN中医证型中纯虚证19.57%,纯实证10.87%,虚实夹杂证69.57%。虚证分布为:脾肾气虚证>脾肾阳虚证>肝肾阴虚证>肺肾气虚证>气阴两虚证。实证分布为:湿热证>湿瘀互结>水湿证>血瘀证。病程>2年肝肾阴虚证明显高于病程<2年(26.39%对比12.07%),体质量超重湿瘀互结证明显高于正常(41.96%对比19.23%);血浆白蛋白<30 g/L脾肾气虚证(55.15%对比34.55%)、血瘀证(31.40%对比17.82%)均较血浆白蛋白>30 g/L明显偏高;使用糖皮质激素观察组肝肾阴虚证(27.27%对比13.09%)、肺肾气虚证(20.00%对比7.33%)均较未使用糖皮质激素组明显偏高;差异均有统计学意义(均P<0.05)。结论:IMN中医证候复杂,以虚实夹杂证居多。其基本病机为脾肾两虚,在此基础上常有水、湿、热、痰、瘀、湿瘀互结等病理产物。病程、体质量、血浆白蛋白、使用糖皮质激素治疗均为影响IMN中医证型分布的因素。Objective:To investigate the distribution characteristics of traditional Chinese medicine(TCM)syndromes and their influencing factors in idiopathic membranous nephropathy(IMN).Methods:The basic information,laboratory indicators,and TCM symptoms of the patients who visited the Nephrology Department of Xiyuan Hospital of China Academy of Chinese Medical Sciences and the Third Hospital of Hebei Medical University from October 2017 to October 2019 were collected by the cross-sectional survey and analyzed for TCM syndrome differentiation.The TCM syndrome distribution of IMN and the influencing factors were analyzed.Results:Among the TCM syndromes of IMN in 276 IMN cases,deficiency syndrome accounted for 19.57%,excess syndrome for 10.87%,and deficiency-excess in complexity syndrome for 69.57%.Deficiency syndromes were ranked as follows:qi deficiency in the spleen and the kidney syndrome>yang deficiency in the spleen and the kidney>yin deficiency in the liver and the kidney syndrome>qi deficiency in the lung and the kidney syndrome>qi and yin deficiency syndrome.Excess syndromes were ranked as follows:dampness-heat syndrome>dampness and blood stasis syndrome>water-dampness syndrome>blood stasis syndrome.The proportion of yin deficiency in the liver and the kidney syndrome in patients with the course of disease>2 years was significantly higher than that with the course of disease<2 years(26.39%vs 12.07%).The proportion of dampness and blood stasis syndrome in overweight patients was significantly higher than that in patients with normal weight(41.96%vs 19.23%).The proportions of qi deficiency in the spleen and the kidney syndrome(55.15%vs 34.55%)and blood stasis syndrome(31.40%vs 17.82%)in patients with plasma albumin<30 g/L were significantly higher than those in patients with plasma albumin>30 g/L.The proportions of yin deficiency in the liver and the kidney syndrome(27.27%vs 13.09%)and qi deficiency in the lung and the kidney(20.00%vs 7.33%)in patients treated with glucocorticoid were significantly higher than those i

关 键 词：特发性膜性肾病 横断面研究 脾肾两虚 湿瘀互结 病程 体质量 血浆白蛋白 糖皮质激素 

分 类 号：R259[医药卫生—中西医结合] R256[医药卫生—中医内科学]