【作者】 林碧莹；

【导师】 余俊文；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的本课题通过对慢性肾功能不全(chronic renal failure, CRF)患者的中医学症状进行观察统计,旨在总结慢性肾功能不全的中医证候学特点,及其与相关实验室指标的关系,探讨其不同证候的发生发展规律,为我们对提高该病中医辨证规律的认识,更好的应用中医辨证手段有针对性地改善患者症状、延缓病情的发展提供理论依据。方法本项研究根据《中药新药临床研究指导原则(试行)》中的慢性肾功能不全的中医证候诊断标准制定慢性肾功能不全临床信息调查表,采集符合诊断标准和纳入标准的慢性肾功能不全患者的一般情况、中医四诊信息以及相关的实验室检查。采用资料完整的病例建立数据库并进行统计分析。计数资料采用X2检验,计量资料用t检验、u检验、方差分析、相关与回归分析等。用因子分析法归纳出中医证型；采用频数分布法进行中医证型分布研究。对慢性肾功能不全患者的中医证候特点及分布规律进行了初步探讨。结果1.本次调查CRF患者共176例。男性92例,女性84例,平均年龄为58.33±18.16岁。年龄分布以70-79岁年龄组所占比例最大(22.73%)；其次为60-69岁和40-49岁两个年龄组。各年龄组男女分布无显著性差异(P>0.05)。2.原发疾病中最常见的是慢性肾小球肾炎(38.64%),其次是糖尿病肾病(21.59%)、高血压肾病(16.48%)、痛风性肾病(9.09%)、梗阻性肾病(6.82%),多囊肾(5.68%)及乙肝相关性肾炎(1.7%)相对少见。3.运用因子分析得到13个公因子,最终将其归纳为：脾肾气虚证；脾肾阳虚证；肝肾阴虚证；气阴两虚证；脾肾阳虚、湿浊内蕴证；脾肾气虚、水气内停证；阴阳两虚、瘀血阻络证；湿热证；瘀血证等9个证候。所调查患者以本虚证多见,占39.77%,其次是虚实夹杂,占32.39%,标实证占27.85%；其中,脾肾两虚者所占比例最大,共82例(46.59%),其次是肝肾阴虚证(22例,12.5%),阴阳两虚证最少(10例,5.68%)。标实证中湿浊证所占比例最大(27例,15.34%)、瘀血证次之(26例,14.77%)。经方差分析,在各证候中性别分布无显著差异(X2=6.298,P>0.05)。4.相关性分析结果显示不同CKD分期与证型之间存在着相关性(P<0.05,r=0.48)。5.临床指标与证候之间的关系：方差分析结果显示5个本虚证候中Ccr、Scr水平不全相同(P<0.05),两两比较结果提示脾肾阳虚证与阴阳两虚证Ccr水平无显著性差异(P>0.05),但脾肾气虚证、肝肾阴虚证、气阴两虚证分别与脾肾阳虚证及阴阳两虚证比较,Ccr、Scr水平均有显著性差异(P<0.05)。标实证中湿浊证、水气证、湿热证、瘀血证患者Ccr、Scr、UA水平不全相同(P<0.05),两两比较结果显示水气证、湿热证、瘀血证患者Ccr、Scr、UA水平分别与湿浊证患者比较均有显著性差异(P<0.05)。结论1.慢性肾功能不全好发于中老年人。2.通过采用因子分析得到13个公因子,最终归纳成脾肾气虚证；脾肾阳虚证；肝肾阴虚证；气阴两虚证；脾肾阳虚、湿浊内蕴证；脾肾气虚、水气内停证；阴阳两虚、瘀血阻络证；湿热证；瘀血证9个证候,从数理学角度得出了脏腑、气血、阴阳亏虚以及湿浊证和血瘀证是CRF的基本病理基础,提示正虚邪实是慢性肾功能不全主要病机特点,其中本虚主要表现为脾肾脏虚损,标实中湿浊既是病理产物又是致病因素,而瘀血贯穿CRF整个病理过程瘀血贯穿CRF整个病理过程。3.在慢性肾功能不全的不同阶段有不同的特点：在早期以本虚证或标实证为主,随着肾功能的下降,逐渐出现邪实证侯,呈现本虚标实之象,最终走向正愈虚,邪愈实的终末期肾衰。更多还原

【Abstract】 ObjectiveIn this research, according to observe and statistic the TCM symptom about the chronic renal failure (CRF) patients, we try to summarize the Characteristic and distributed rule of the TCM Syndrome of the chronic renal failure, it can provides the theory basis to improve the understanding for this disease at the aspect of Chinese medicine dialectical rules and for a better use of Chinese medicine dialectical method to improves the patient symptom with target-oriented.MethodsThis study under the "guiding principles of Chinese medicine clinical research drug (Trial)" in chronic renal failure syndrome diagnosis criteria of chronic renal failure developed clinical information questionnaire collected met the diagnostic criteria and inclusion criteria of chronic renal failure patients in general, Chinese medical information and related laboratory tests. Using a database of cases with complete data and statistical analysis. Count data using X2 test, measurement data using t test, u test, variance analysis, correlation and regression analysis. Summarized using factor analysis syndromes; using frequency distribution method of syndromes research. Chronic renal failure syndromes in patients with the characteristics and distribution of a preliminary study.Results1. The survey of 176 cases of CRF patients. Male,92 cases of 84 cases female, mean age was 58.33±18.16 years. Age 70 to 79 age group the largest proportion (22.73%); followed by 60 to 69 years and 40 to 49 age group. Men and women of all age groups was no significant differences in the distribution(P＞0.05).2. The most common primary disease was chronic glomerulonephritis (38.64%), followed by diabetic nephropathy (21.59%), hypertensive nephropathy (16.48%), gouty nephropathy (9.09%), obstructive nephropathy (6.82%), polycystic kidney disease (5.68%) and hepatitis B associated glomerulonephritis (1.7%) is relatively rare.3. Using factor analysis,13 common factors, ultimately be summarized as follows: spleen and kidney qi deficiency; spleen deficiency syndrome; liver kidney yin; Qi and Yin deficiency; spleen deficiency, dampness intrinsic evidence; spleen kidney virtual, water and gas within the stop card; yin and yang deficiency, blood stasis syndrome; damp; blood stasis syndrome, etc.9. The investigation to this deficiency in patients with more common, accounting for 39.77%, followed by false is mixed, accounting for 32.39%, accounting for 27.85% positive standard; of which were the largest proportion of spleen and kidney deficiency, a total of 82 patients (46.59%), followed by the liver and kidney yin deficiency syndrome (22 cases,12.5%), deficiency of both yin and yang, at least (10 cases,5.68%). Empirical evidence of dampness marked the largest proportion (27 cases,15.34%), followed by blood stasis (26 cases,14.77%). Analysis of variance in the gender distribution of the syndrome was no significant difference (X2= 6.298, P> 0.05).4. Correlation analysis showed evidence of different CKD stages and there is a correlation between type (P<0.05, r= 0.48).5. Clinical indicators and the relationship between syndrome:analysis of variance results indicate that five of the deficiency of waiting in Ccr, Scr level of incompetence the same (P<0.05), pairwise comparison results suggest that spleen and kidney yang syndrome and deficiency of both yin and yang Ccr levels were not significantly different (P> 0.05), but the spleen and kidney qi deficiency, liver and Kidney Yin Deficiency, Spleen Qi and Yin deficiency respectively, and deficiency of both yin and yang deficiency syndrome and comparison, Ccr, Scr levels significantly difference (P<0.05). Empirical evidence in the marked wet cloud, water and gas cards, dampness, blood stasis syndrome Ccr, Scr, UA the same level of failure (P<0.05), pairwise comparisons show that the water gas card, dampness, blood stasis syndrome Ccr, Scr, UA levels and dampness syndrome were significantly different (P<0.05).Conclusion1. Chronic renal failure occurs in the elderly2. By using factor analysis,13 common factors, and finally, into the spleen and kidney qi deficiency; spleen deficiency syndrome; liver kidney yin; Qi and Yin deficiency; spleen deficiency, dampness intrinsic evidence; spleen and kidney Qi, water vapor within the stop card; yin and yang deficiency, blood stasis syndrome; damp; blood stasis syndrome 9, obtained from several physical point of view internal organs, blood, yin and yang deficiency and blood stasis syndrome of turbid damp and The basic pathology is the basis of CRF, suggesting that evil is real is the virtual chronic renal failure characteristics of the main pathogenesis, in which the virtual kidney deficiency and mainly for the spleen, marked pathological fact in both the wet product is turbid pathogenic factors, and blood stasis CRF throughout the pathological process of the pathological process of blood stasis through the CRF.3. In chronic renal failure at different stages have different characteristics:in the earlier evidence of this deficiency syndrome, or standard-based, with the decline in renal function, evidence began to emerge evil Hou, showing signs of the vacuity, the ultimate trend is more false, evil more realistic end-stage renal failure.更多还原