【作者】 曾靖；

【导师】 陈伯钧；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 目的:探讨伴代谢综合征的慢性肾脏病患者的大动脉僵硬度、体重指数及血脂等指标的变化趋势,为中医证的客观化研究做有益探讨。方法:本研究纳入伴代谢综合征的慢性肾脏病患者247例,按临床症状、舌象、脉象辩证,按中医辩证分型,分为六个证型组,即脾肾气虚型组、气阴两虚型组、肝肾阴虚型组、脾肾阳虚型组、痰浊阻遏型组、痰瘀互结型组。其中脾肾气虚型组21例、气阴两虚型组29例,肝肾阴虚型组26例,脾肾阳虚型组43例,痰浊阻遏型组69例,痰瘀互结型组59例。分析证型分布规律,并同时测定其体重指数、腰围、血糖、血脂、血清白蛋白、血清肌酐、血清肌酐清除率、超敏C反应蛋白、颈-股脉搏波速度等指标,分析各证型上述指标的差异以及颈-股脉搏波速与各项相关指标的相关性分析。结果:1.伴代谢综合征的慢性肾脏病患者中医辨证以痰浊阻遏型所占比例最大(27%),其后依次为痰瘀互结型(24%)、脾肾阳虚型(17%),气阴两虚型(12%)、肝肾阴虚型(11%)和脾肾气虚型(9%)。2.各证型组间不同慢性肾脏病分期的比例不一,但在脾肾气虚证组、气阴两虚证组以及肝肾阴虚证组中主要集中以慢性肾脏病1期、2期、3期为主,而在脾肾阳虚证组、痰浊阻遏证组以及痰瘀互结证组中,慢性肾脏病1期、2期、3期比例明显减少,慢性肾脏病4、5期比例明显增多。3.各证型组的体重指数、腰围、空腹血糖、餐后两小时血糖、甘油三酯、高密度脂蛋白胆固醇、血清肌酐水平、超敏C反应蛋白水平、收缩压、舒张压、脉压以及颈-股脉搏波速均较正常组高,有统计学差异(P＜0.05);各证型组的血清肌酐清除率以及血清白蛋白水平明显低于正常对照组,有统计学差异(P＜0.05)。4.痰瘀互结证组的体重指数以及腰围均较其它证型组高,有统计学差异(P＜0.05)。各证型组间体重指数比较,痰瘀互结证组与痰浊阻遏证组间比较无统计学差异(P＞0.05),脾肾气虚证组和气阴两虚证组间比较无统计学差异(P＞0.05),其余各组间两两比较均有统计学差异(P＜0.05);各证型组间腰围比较,痰瘀互结证组与痰浊阻遏证组间比较无统计学差异(P＞0.05),气阴两虚证组和肝肾阴虚证组间比较无统计学差异(P＞0.05),其余各组间两两比较均有统计学差异(P＜0.05)。5.各证型组间的空腹血糖、餐后两小时血糖两两相比较无统计学差异(P＞0.05)。各证型组间甘油三酯以及高密度脂蛋白胆固醇比较,肝肾阴虚证组和脾肾气虚证组之间无统计学差异(P＞0.05),其余各证型组间两两比较有统计学差异(P＞0.05)。6.各证型组之间血清肌酐水平以及血清肌酐清除率两两比较,无统计学差异(P＞0.05)。血清白蛋白水平,脾肾阳虚证组和气阴两虚证组间相比无统计学差异(P＞0.05),肝肾阴虚证组和脾肾气虚证组间相比亦无统计学差异(P＞0.05),其余各证型组间两两比较有统计学差异(P＜0.05)。超敏C反应蛋白水平,痰瘀互结证组和痰浊阻遏证组间相比无统计学差异(P＞0.05),脾肾阳虚证组和气阴两虚证组间相比无统计学差异(P＞0.05),肝肾阴虚证组和脾肾气虚证组间相比无统计学差异(P＞0.05),其余各证型组间两两比较有统计学差异(P＜0.05)。7.各证型组间脉压、颈-股脉搏波速度比较:痰瘀互结证组＞痰浊阻遏证组＞脾肾阳虚证组＞气阴两虚证组＞肝肾阴虚证组＞脾肾气虚证组,各组间两两比较有统计学差异(P＜0.05)。8.对所有研究对象证型分布与颈-股脉搏波速度分级进行比较分析,结果显示各组间脉搏波速度等级构成比存在显著差异(P＜0.05)。其中痰瘀互结证组患者中、重度患者比例明显高于其余各组(P＜0.05),而脾肾气虚证组中脉搏波速度评价为正常的患者比例高于其余各组(P＜0.05),且未出现重度的患者。正常患者在各证型组中所占比例比较结果:脾肾气虚证＞肝肾阴虚证＞气阴两虚证＞脾肾阳虚证＞痰浊阻遏证＞痰瘀互结证。9.颈-股脉搏波速度和年龄、SBP、PP呈正相关,有显著统计学意义(P＜0.001),与甘油三酯、超敏C反应蛋白呈正相关,有统计学意义(P＜0.05);与高密度脂蛋白胆固醇、血清白蛋白呈负相关,有统计学意义(P＜0.05)。10.多元逐步回归分析结果表明,年龄、收缩压、脉压和高密度脂蛋白胆固醇是影响患者颈-股脉搏波速度的独立因素,调整决定系数为0.567,回归方程为颈-股脉搏波速度(m/s)=2.981+0.025年龄(岁)+0.032收缩压(mmHg)+0.044脉压(mmHg)+0.230高密度脂蛋白胆固醇,(各偏回归系数P＜0.05)。结论:1.伴代谢综合征的慢性肾脏病人中医证型以痰浊阻遏型和痰瘀互结型居多。2.研究发现,伴代谢综合征的慢性肾脏病患者的各项生化指标均明显高于正常对照组。3.不同证型组间各项指标存在一定的差异,痰瘀互结型和痰浊阻遏型的各项指标与其它各证型组间存在明显差异,各中医证型组间大动脉僵硬度的变化与中医证型衍化规律一致,可作为辩证伴代谢综合征的慢性肾脏病人的客观指标及疗效参考评价依据。更多还原

【Abstract】 Objective:To study the relationship between the level of blood glucose,blood fat,body mass index(BMI),waist circuferrence,blood pressure,pulse pressure, carotid-femoral pulse wave velocity(CF-PWV)and the different TCM syndrome in Chronic Kidney Disease(CKD)patients with Metabolic Syndrome(MS),in order to find the objective evidence of differentiation of symptoms and signs of traditional Chinese medicine of metabolic syndrome and to guide clinic treatment better.Methods:Two hundred and forty seven CKD patients with MS were divided into six group through TCM differentiation,the deficiency of spleen Qi and kidney Qi syndrome group,the deficiency of Qi and Yin syndrome group,the deficiency of liver Yin and kidney Yin syndrome group,the deficiency of spleen yang and kidney yang syndrome group,the phlegm and abiding spleen syndrome group,the phlegm and blood stasis syndrome group.Twenty one patients belonged to the deficiency of spleen Qi and kidney Qi syndrome group,twenty nine patients belonged to the deficiency of Qi and Yin syndrome group,twenty six patients belonged to the deficiency of liver Yin and kidney Yin syndrome group,forty three patients belonged to the deficiency of spleen yang and kidney yang syndrome group,sixty nine patients belonged to the phlegm and abiding spleen syndrome group,fifty nine patients belonged to the phlegm and blood stasis syndrome group.Body height,body weight and waist circumference were measured. BMI was calculated.Blood glucose,blood fat,serum albumin,creatinine, creatinine clearance rate(Ccr),supersensitive C reactive protein(sCRP), CF-PWV,and etc,were checked.Analysis the differences of all the indices between each TCM syndrome group.Analysis the dependability between carotid-femoral pulse wave velocity and other indices.In addition,all the indices of the control group(50 persons)who were healthy were checked and compared with all the groups of metabolic syndrome. Results:1.The main TCM syndrome of the CKD patients with MS was phlegm and abiding spleen syndrome(27%),and others were phlegm and blood stasis syndrome(24%), the deficiency of spleen yang and kidney yang syndrome(17%),the deficiency of Qi and Yin syndrome(12%),the deficiency of liver Yin and kidney Yin syndrome(11%)and the deficiency of spleen Qi and kidney Qi syndrome(9%).2.The proportion of CKD stage in each TCM syndrome group were different.The deficiency of spleen Qi and kidney Qi syndrome group,the deficiency of Qi and Yin syndrome group;and the deficiency of liver Yin and kidney Yin syndrome group are mainly in CKD stage 1,CKD stage 2 and CKD stage 3.But in the deficiency of spleen yang and kidney yang syndrome group,phlegm and abiding spleen syndrome group and phlegm and blood stasis syndrome group were mainly in CKD stage 4 and CKD stage 5.3.BMI,waist circumference,fasting blood glucose,blood glucose after meal, trig]yceride(TG),high density lipid cholesterol(HDL-C),creatinine,sCRP, systolic blood pressure,diastolic blood pressure,pulse pressure and CF-PWV of each TCM syndrome group were all higher than the control group(P＞0.05);the serum albumin and Ccr were lower than the control group(P＜0.05).4.BMI and waist circumference of phlegm and blood stasis syndrome group were significant higher than any other group(P＜0.05),there was no significant difference of BMI between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also no significant difference between the deficiency of Qi and Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group(P＞0.05),and there was significant difference of BMI between the other groups(P＜0.05);there was no significant difference of waist circumference between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also no significant difference between the deficiency of Qi and Yin syndrome group and the deficiency of liver Yin and kidney Yin syndrome group(P＞0.05);and there was significant difference of waist circumference between the other groups(P＜0.05).5.There was no significant difference of fasting blood glucose and blood glucose after meal betweeneach TCM syndrome group(P＞0.05);there were no significant difference of TG and HDL-C between the deficiency of liver Yin and kidney Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group,(P＞0.05);and there was significant difference of TG and HDL-C between the other groups(P＜0.05).6.There was no significant difference of creatinine and creatinine clearance rate among each TCM syndrome group(P＞0.05);there was no significant difference of serum albumin between spleen yang and kidney yang syndrome group and the deficiency of Qi and Yin syndrome group(P＞0.05);and also no significant difference between the liver Yin and kidney Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group(P＞0.05);and there was significant difference of serum albumin between the other groups(P＜0.05).There was no significant difference of sCRP between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also nosignificant difference between spleen yang and kidney yang syndrome group and the deficiency of Qi and Yin syndrome group; and there was significant difference of sCRP between the other groups(P＜0.05).7.The pulse pressure and CF-PWV:phlegm and blood stasis syndrome group＞phlegm and abiding spleen syndrome group＞spleen yang and kidney yang syndrome group＞the deficiency of Qi and Yin syndrome group＞the deficiency of liver Yin and kidney Yin syndrome group＞the deficiency of spleen Qi and kidney Qi syndrome group,there was significant difference between each group(P＜0.05).8.There was significant difference of CF-PWV level proportion between each group(P＜0.05);the proportion of sever level patients of phlegm and blood stasis syndrome group was significantly higher than any other group(P＜0.05);the proportion of normal level patients of he deficiency of spleen Qi and kidney Qi syndrome group was significantly higher than any other group(P＜0.05),the deficiency of spleen Qi and kidney Qi syndrome group＞the deficiency of liver Yin and kidney Yin syndrome group＞the deficiency of Qi and Yin syndrome group＞spleen yang and kidney yang syndrome group＞phlegm and abiding spleen syndrome group＞phlegm and blood stasis syndrome group(P＜0.05).9.There was significant positive correlation between CF-PWV and age,systolic blood pressure,pulse pressure(P＜0.001);there was positive correlation between CF-PWV and TG,sCRP(P＜0.05);there was negative correlation between CF-PWV and HDL-C,Alb(P＜0.05).10.In a multivariate regression analysis,CF-PWV was independently determined by age(＜0.05),SBP(＜0.05),PP(＜0.05),and HDL-C(＜0.05).Adjusted R~2 of the model was 0.567.The regression equation:CF-PWV(m/s)=2.981+0.025 age(years old)+0.032SBP(mmHg)+0.044PP(mmHg)+0.230HDL-C.Conclusion:1.The most common TCM syndrome in CKD patients with MS were phlegm and blood stasis syndrome and phlegm and abiding spleen syndrome.2.There is high level of all the indices in the CKD patients with MS.3.There was significant difference of the indices between each TCM syndrome group.There was close relationship between TCM syndrome and the indices.CF-PWV could be the objective evidence of different TCM syndrome.And the CF-PWV could be utilized as an index to evaluate the clinical effect and prognosis.更多还原