慢性肾脏病-肾性贫血的中医证型分布特点  

Distribution Characteristic of Traditional Chinese Medicine Syndrome Types of Chronic Kidney Disease-Renal Anemia

作　　者：唐珑 赵文景[2] 王耀献[1] 周静威[1] TANG Long;ZHAO Wenjing;WANG Yaoxian;ZHOU Jingwei(Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing China 100700;Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University,Beijing China 100010)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京中医医院,北京100010

出　　处：《中医学报》2024年第3期638-642,共5页Acta Chinese Medicine

基　　金：首都卫生发展科研专项项目(首发2020-3-2235);北京中医医院院级课题项目(LYYB202211)。

摘　　要：目的:探讨慢性肾脏病-肾性贫血(chronic kidney disease-renal anemia,CKD-RA)的中医证型分布特点,为CKD-RA的精准辨证和规范用药提供依据。方法:收集249例CKD 3—5期非透析患者的中医证候学、肾功能、贫血、铁代谢等临床资料,分析其中医证型分布与CKD分期、铁缺乏、贫血指标之间的关系。结果:CKD 3—5期的肾性贫血患者本虚证以肝肾阴虚证(36.95%)为主,主要分布在CKD 4期;其次为脾肾阳虚证,主要分布在CKD 3期;脾肾阳虚证与肝肾阴虚证在CKD 5期所占比例相同。69.88%的患者表现为虚实夹杂,脾肾阳虚兼水湿证最多见;肝肾阴虚在兼湿热证、血瘀证和浊毒证中均占比最高。与单纯的RA比较,伴有铁缺乏的RA患者在4种中医证型中的占比有显著性差异(χ^(2)=7.813,P=0.049)。肝肾阴虚证在伴有铁缺乏的RA患者中比例较高,与脾肾气虚证比较,差异有统计学意义(P<0.008)。气血两虚证患者血红蛋白均低于其他3种证型(P<0.05),血清铁高于肝肾阴虚证、脾肾阳虚证患者(P<0.05)。肝肾阴虚证患者的血清铁、转铁蛋白饱和度与脾肾气虚证、气血两虚证比较,差异有统计学意义(P<0.05)。4种证型间总铁结合力、血清铁蛋白比较,差异无统计学意义(P>0.05)。结论:CKD 3—5期RA患者中肝肾阴虚证占比最高,该证型多伴有铁缺乏,容易出现铁代谢异常。Objective:To explore the distribution characteristics of traditional Chinese medicine syndrome types in chronic kidney disease renal anemia(CKD-RA),and to provide a basis for accurate diagnosis and standardized medication of CKD-RA.Method:Collect clinical data on traditional Chinese medicine syndromes,renal function,anemia,and iron metabolism from 249 non dialysis patients with CKD in stages 3-5,and analyze the relationship between the distribution of traditional Chinese medicine syndromes and CKD staging,iron deficiency,and anemia indicators.Results:Renal anemia patients in stage 3-5 of CKD mainly have Liver and Kidney Yin deficiency syndrome(36.95%),mainly distributed in stage 4 of CKD,followed by Spleen and Kidney Yang deficiency syndrome,mainly distributed in stage 3 of CKD.The proportion of Spleen and Kidney Yang deficiency syndrome and Liver and Kidney Yin deficiency syndrome in stage 5 of CKD is the same.There are 69.88%of patients show a mixture syndrome of deficiency and excess,with Spleen and Kidney Yang deficiency combined with Dampness syndrome being the most common;The Liver and Kidney Yin deficiency has the highest proportion in the concurrent Damp Heat syndrome,blood stasis syndrome,and Turbid Toxin syndrome.Compared with pure RA,there is a significant difference in the proportion of RA patients with iron deficiency among the four traditional Chinese medicine syndromes(χ^(2)=7.813,P=0.049).The proportion of Liver and Kidney Yin deficiency syndrome is high in RA patients with iron deficiency,and the difference is statistically significant compared to Spleen and Kidney Qi deficiency syndrome(P<0.008).Patients with Qi and blood deficiency syndrome had lower hemoglobin levels than the other three syndrome types(P<0.05),and higher serum iron(SI)levels than patients with liver kidney yin deficiency syndrome and Spleen and Kidney Yang deficiency syndrome(P<0.05).The SI and transferrin saturation(TSAT)of patients with Liver and Kidney Yin deficiency syndrome were compared with Spleen and Kidney Qi deficie

关 键 词：慢性肾脏病-肾性贫血 中医证型 铁代谢 

分 类 号：R277.52[医药卫生—中医学]