2型糖尿病肾病患者中医证型系统聚类分析及与疾病分期的关系  

Cluster analysis of TCM syndrome types in patients with type 2 diabetic nephropathy and its relationship with disease staging

作　　者：田永明 武士锋[1] 赵晰[1] TIAN Yongming;WU Shifeng;ZHAO Xi(The First Affiliated Hospital of Tianjin University of Chinese Medicine,National Clinical Research Center for Chinese Medical Acupuncture&Moxibustion,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院、国家中医针灸临床医学研究中心,天津300381

出　　处：《实用医学杂志》2023年第22期2994-2999,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81783151)。

摘　　要：目的探讨2型糖尿病肾病(type 2 diabetic nephropathy,T2DN)患者中医证型系统聚类分析及与疾病分期之间的关系。方法选择2020年3月至2022年10月于天津中医药大学第一附属医院确诊的170例T2DN患者。比较T2DN患者中医证型的一般情况。同时观察患者的中医证型的分布情况,包括T2DN患者的中医本证和中医兼证。采用系统聚类分析,绘制聚类图。采用简单对应分析中医证型与疾病严重程度的对应性。结果早期T2DN、临床T2DN、终末期肾病(end stagerenal disease,ESRD)的主要中医证型分别为气阴两虚挟瘀证(38.46%)、气滞痰瘀证(37.88%)、气滞痰瘀证(50.00%)。截取聚类图的不同位置,证型分型不同,其中,D点截取分为5个证型:肝肾阴虚证、心肾两虚证、肝胃火盛证、气阴两虚挟瘀证及气滞痰瘀证。在170例T2DN患者中,肝肾阴虚证40例(23.53%),心肾两虚证26例(15.29%),肝胃火盛证29例(17.06%),气阴两虚挟瘀证20例(11.76%),气滞痰瘀证55例(32.35%)。气阴两虚挟瘀证和气滞痰瘀证在二维投影图中间,并未偏向T2DN病变程度某一分级;肝胃火盛证偏向Ⅴ期,心肾两虚证偏向Ⅳ期,肝肾阴虚证偏向Ⅰ~Ⅲ期。结论T2DN患者的基本中医证型为肝肾两阴、心肾两虚、肝胃火盛、气阴两虚挟瘀及气滞痰瘀。且随着T2DN发展,中医证型逐渐由肝肾两阴到心肾两虚到肝胃火盛,而气阴两虚挟瘀及气滞痰瘀伴随T2DN患者的各个阶段。Objective To explore the cluster analysis of TCM syndromes in patients with type 2 diabetic nephropathy(T2DN)and its relationship withdisease staging.Methods A total of 170 patients with T2DN admit‐tedto our hospital from March 2020 to October 2022 were selected.The general dataof TCM syndromes of T2DN patients,and the distribution of TCM syndromes were observed,including the original TCM syndrome and the concurrent TCM syndrome.The cluster diagram was drawnby using systematic cluster analysis.The correspondence between TCM syndrome types and disease severity was analyzed by simple correspondence.Results The main TCM syndromes of early T2 DN,clinical T2 DN and end-stage renal disease(ESRD)were qi and yin deficiency with blood stasis syndrome(38.46%),qi stagnation and phlegm stasis syndrome(37.88%),qi stagnation and phlegm stasis syndrome(50.00%).The different positions of the cluster diagram were intercepted,and the syndrome types were different.Among them,the D-point interception was divided into five syndromes:liver and kidney yin syndrome,heart and kidney deficiency syndrome,liver and stomach fire syndrome,qi and yin deficiency with stasis syndrome and qi stagnation and phlegm stasis syndrome.Among 170 patients with T2DN,there were 40 cases(23.53%)of liver and kidney yin syndrome,26 cases(15.29%)of heart and kidney deficiency syndrome,29 cases(17.06%)of liver and stomach fire syndrome,20 cases(11.76%)of qi and yin deficiency with blood stasis syndrome,and 55 cases(32.35%)of qi stagnation and phlegm stasis syndrome.In the middle of the two-dimensional projection,qi and yin deficiency with blood stasis syndrome and qi stagnation and phlegm and blood stasis syndrome were not biased towards a certain grade of T2 DN lesion degree;the liver-stomach fire syndrome was biased towards stage V,the heart-kidney deficiency syndrome was biased towards stageⅣ,and the liver-kidney yin syndrome was biased towards stageⅠ-Ⅲ.Conclusion The basic TCM syndromes of T2 DN patients were liver and kidney yin,heart and kidney de

关 键 词：2型糖尿病肾病 中医证型 聚类分析 疾病分期 

分 类 号：R241.4[医药卫生—中医诊断学]