基于多中心疾病登记系统的膜性肾病中医主要证型分布特征分析  

Exploration of Distribution Characteristics of Traditional Chinese MedicineSyndrome Types of Idiopathic Membranous Nephropathy Based onMulti-center Electronic Medical Records System

作　　者：张铭睿 洪晓帆 包崑[1,2,3] 梁星 蔡凤丹 郑佳旋 江莎 黄小燕 ZHANG Ming-Rui;HONG Xiao-Fan;BAO Kun;LIANG Xing;CAI Feng-Dan;ZHENG Jia-Xuan;JIANG Sha;HUANG Xiao-Yan(The Second Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;State Key Laboratory of Dampness Syndrome of Traditional Chinese Medicine,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China;Guangdong-Hong Kong-Macao Joint Laboratory of Chinese Medicine and Immune Diseases Research,Guangzhou 510120 Guangdong,China;Shenzhen Bao’an Traditional Chinese Medicine Hospital,Shenzhen 518133 Guangdong,China)

机构地区：[1]广州中医药大学第二临床医学院,广东广州510405 [2]广州中医药大学第二附属医院省部共建中医湿证国家重点实验室,广东广州510120 [3]粤港澳中医药与免疫疾病研究联合实验室,广东广州510120 [4]深圳市宝安区中医院,广东深圳518133

出　　处：《广州中医药大学学报》2023年第7期1581-1589,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81974565);省部共建中医湿证国家重点实验室专项(编号:SZ2021ZZ02,SZ2021ZZ09,SZ2021ZZ36);2020广东省科技创新战略专项资金(粤港澳联合实验室)(编号:2020B1212030006);广州市科技计划项目(编号:202102010212,202102020529);广东省中医院博士后专项科研课题(编号:10814)。

摘　　要：【目的】分析特发性膜性肾病(IMN)患者临床诊疗数据,探讨IMN患者中医证型分布特征及影响因素,以期丰富对IMN中医证型的认识,为研究IMN的主要病机和中医临床诊治提供一定依据。【方法】基于IMN临床研究电子数据采集系统,采用横断面调查方法,分析多中心来源的187例IMN患者的临床诊疗数据,归纳其中医证型分布规律;根据IMN的危险分层将患者分为低风险组、中风险组、高风险组3组,并根据地域将患者分为广东组和黑龙江组2组,分析不同IMN的危险分层及地域对中医证型分布特征的影响。【结果】(1)中医证候分布情况:187例患者中,分布频率居前3位的分别为:小便混浊或有明显泡沫尿167例(89.30%),舌苔腻、舌胖大或齿痕158例(84.49%),水肿134例(71.65%);中医证型分布情况:湿阻证频次最高,共169例(90.37%),其次为气虚证165例(88.24%)、血瘀证89例(47.59%)。(2)分组情况:187例患者中,低风险组102例(54.54%)、中风险组54例(28.88%)、高风险组31例(16.58%);广东组147例(78.61%),黑龙江组40例(21.39%)。(3)IMN证型分布的影响因素中,在IMN的危险分层方面,低风险组患者中湿阻证的占比为83.33%(85/102),中风险组为98.15%(53/54),高风险组为100.00%(31/31),3组患者的湿阻证比例比较,差异有统计学意义(P=0.002);在地域方面,广东组和黑龙江组的瘀血证比例分别为55.10%(81/147)和20.00%(8/40),不同地域的血瘀证比例比较,差异有统计学意义(P<0.001);在兼夹证型方面,高风险组的气虚血瘀湿阻证比例[64.52%(20/31)]明显高于低风险组和中风险组的34.31%(35/102)、38.89%(21/54);广东组的气虚血瘀湿阻证比例[46.94%(69/147)]明显高于黑龙江组的17.50%(7/40),而气虚湿阻证比例[31.97%(47/147)]明显低于黑龙江组的60.00%(24/40),差异均有统计学意义(P<0.05)。【结论】本研究归纳和分析了IMN患者的中医证候、中医证型分布规律及其影响因素,探讨了湿证在IMNObjective The clinical data of patients with idiopathic membranous nephropathy(IMN)were analyzed to explore the distribution characteristics of traditional Chinese medicine(TCM)syndrome types and the influencing factors,with a view to enriching the understanding of TCM syndrome types and providing a basis for studying the primary pathogenesis and clinical management of IMN.Methods Based on the electronic data collection system of IMN clinical research,the clinical diagnosis and treatment data of 187 IMN patients from multi-center sources were analyzed using a cross-sectional survey method to summarize the distribution pattern of their TCM syndrome types.The included patients were divided into three groups according to the risk stratification of IMN,namely low-risk group,medium-risk group and high-risk group,and the included patients were divided into Guangdong group and Heilongjiang group according to the source of the patients.The effects of risk stratification and source of IMN patients on the distribution characteristics of TCM syndrome types were analyzed.Results(1)For the distribution of TCM syndrome manifestations among the 187 patients,the top 3 three syndrome manifestations were cloudy urine or obvious foamy urine in 167 cases(89.30%),greasy tongue coating,enlarged tongue or tooth-marked tongue in 158 cases(84.49%),and edema in 134 cases(71.65%).The distribution of TCM syndromes was shown as dampness obstruction syndrome with the highest frequency(169 cases,90.37%),followed by qi deficiency syndrome(165 cases,88.24%)and blood stasis syndrome(89 cases,47.59%).(2)The results of risk stratification of 187 IMN patients showed that 102 cases(54.54%)were in the low-risk group,54 cases(28.88%)were in the medium-risk group and 31 cases(16.58%)were in the high-risk group.And the grouping of the source of the patients showed that 147 cases(78.61%)were in the Guangdong group and 40 cases(21.39%)were in the Heilongjiang group.(3)The analysis of the factors influencing the distribution of IMN syndromes showed that in

关 键 词：特发性膜性肾病 多中心数据采集系统 中医证型研究 湿阻证 气虚证 血瘀证 

分 类 号：R269.2[医药卫生—中西医结合]