【作者】 夏春兰；

【导师】 吴浩祥；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：本研究通过观察糖尿病肾病肾功能相关指标如尿素氮、肌酐等与六经证型分布之间的关系,从而为六经辨证治疗糖尿病肾病提供临床借鉴。方法：本研究采取回顾性研究,通过对住院病人的症候及肾功能指标进行记录,填写症候观察表,利用统计学方法分析肾功能指标与六经证型的关系。计量资料采用x±s进行描述；计数资料用频数表示,并采用统计学方法分析糖尿病肾病临床证型的各分布频率,并分析肾功能与独立证型间的相关性。从而了解糖尿病肾病患者的六经证候分布规律及其与肾功能指标之间的相关性。成果：1.DN在男女间的发病率无明显差异。可发生于成年后的任何一个年龄阶段。随着DM病程的增长,DN的发病人数有所增长。在DN的各个六经证型中,男女比例分布均匀,无统计学差异。2.在DN的六经辨证分型中,以少阴阳虚寒湿证患者人数最多,占42.7%,其次为少阳失枢,胆火内郁证,占18.3%,而正虚阳郁,上热下寒证最少,仅占0.3%。3.随着患者病程的进展,患者的证型在进行变化,在早期,以阳证为多,后期,阴证的比例增大。4.对比各个不同证型的肾功能指标,经统计学处理,均有显著性差异。进一步进行两两比较,可见有一部分证型的肾功能指标间存在差异,但无规律可循。如将其用阴证、阳证阴阳寒热错杂证概括,可见由阳证→阴阳寒热错杂证→阴证肾功能的指标在逐渐加剧,进行两两比较,则提示阳证与阴阳寒热错杂证相比,其BUN、CREA、 UA、Cys C存在统计学差异；阴阳寒热错杂证与阴证相比,其CREA、Cys C存在统计学差异,而BUN、UA无统计性差异；阳证与阴证相比,其BUN、CREA、UA、Cys C均存在统计学差异。说明由阳证→阴阳寒热错杂证→阴证肾功能的指标间的差异是客观存在的。5.在肾功能受损的不同时期,证型的分布有所不同。随着肾损害的加重,阴证所占的比例越来越大。但不管在哪个时期,少阴阳虚寒湿证所占的比例都是最大的。结论：糖尿病肾病是糖尿病的常见并发症。辨证分型与病程的长短有关。病程短时,阳证偏多,病程长时,以阴证为多。在任何时期,少阴阳虚寒湿证所占的比例均是最大的。故此,在治疗中,我们应注意时刻顾护少阴心肾之气。另外对于处于不同肾损害时期的糖尿病肾病夏天患者,其证型分布不同。在代偿期,阳证所占比例较大,后期,则以阴证为主。其病变的总体发展趋势符合六经传变中由三阳传至三阴的规律。故运用六经辨证论治糖尿病肾病是可行的。更多还原

【Abstract】 ObjectiveThis research provide DN dialectical therapy for reference in clinical by observing the relationship of the type of six merdians distribution and the related indicators of renal function, such as urea nitrogen, creatinine.MethodsThis study as a retrospective study, by taking the patients’s related indicators of renal function records, filling in symptomatic observation table, use statistical methods to analysis the relationship between renal function index and syndrome types. Measurement data use x±s described; Count material use frequency said. Using the statistical methods to analysis each frequency distribution of the syndrome types of DN, and the relationship between renal function and the syndrome types. Understand the DN patient’s symptoms distribution regularity and treated renal function of the relationship between the related indicators of renal function.Results1. There is no significant difference in the incidence between men and women of DN. DN can happen at any adult age stages. With the DM course of growth, the number of the pathogenesis of DN increased. In each DN treated type, male and female proportion distributed homogeneously, with no statistical difference.2. Yang deficiency and cold-dampness of Shaoyin card is the most prevalent in the survey of six merdians, accounting for42.7%, and the least is weaken body resistance with Yang depression, heat in the upper and cold in the lower card, accounted for0.3%. 3. Along with the progress of the patients, the evidence in patients change the type. In the early days, Yang card is more, later period, Yin card increase and be the bigger part.4. After statistics processing, different types of renal function have a significant difference. Further comparison between two, some type are different, but no rules to follow. So summarize the six merdians type by Yin card, Yang card, Yin and yang, cold and heat mixed card, and then compare Yang card and Yin-yang and cold-heat mixed card, show that BUN, CREA, UA, Cys C are in a statistically significant difference; compare Yin-yang and cold-heat mixed card, and Yin card show that CREA, Cys C are in a statistically significant difference, while BUN, UA are not; compare Yang card and Yin card, show that BUN, CREA, UA, Cys C are in a statistically significant difference.5. The card type changes along with the kidney function. In compensatory period, the proportion of Yang card is larger than Yin card, and later, Yin card is major. No matter what, Yang deficiency and cold-dampness of Shaoyin card is the most.ConclusionDiabetic nephropathy is a common complication of diabetes. The six merdians type of diabetic nephropathy change by the course and renal function. The longer the course, the more the Yin card. The more serious the renal function, the more the Yin card. Lesions in the overall development trend accord with Six meridians transmission by three Yang to three Yin rule. So using six-channel differentiation treatment of diabetic nephropathy is feasible. At any time, Yang deficiency and cold-dampness of Shaoyin card of proportion of all is the biggest. Therefore, in treatment, we should pay attention to the Qi of Shaoyin.更多还原