【作者】 刘颖；

【导师】 魏仲南；

【作者基本信息】 福建中医药大学 ， 中医内科学， 2010， 硕士

【摘要】 目的：糖尿病(diabetes mellitus, DM)最常见的慢性微血管并发症之一是糖尿病肾病(diabetic nephropathy, DN),同时也是终末期肾衰竭的首要原因。目前为止西医很难实现延缓糖尿病肾病发展进程的目的。中医药对DN的研究仍存在着辨证分型不规范、辨证分型难以体现糖尿病肾病自身独有的特点,缺乏流行病学研究等诸多缺点。本研究的目的是运用证素辨证方法观察终末期糖尿病肾病的病位、病性分布规律及病位、病性与各项西医化验指标的相关性分析,来探讨终末期糖尿病肾病的中医发展规律及临床病变特点,以此为中医辨证施治提供统一、规范的辨证标准,提高中医治疗效果,改善终末期糖尿病肾病患者生存质量,有效缓解症状,提供全面、客观的新的理论依据。方法：严格纳入福建中医药大学附属第二人民医院和南京军区福州总院血液透析室符合纳入标准的血液透析患者,分为终末期糖尿病肾病组与终末期非糖尿病肾病组,病例采集时间2008年10月至2010年01月。运用朱文峰教授证素辨证理论观察两组患者病位、病性辨证规律及病位、病性与各项西医化验指标的相关性分析。结果：以糖尿病为原发病的终末期肾病患者进入血液透析时血肌酐水平明显低于非糖尿病组；甲状旁腺激素、磷、胆固醇、脑利钠肽(brain natriuretic peptide, BNP)等指标糖尿病肾病组明显高于非糖尿病组；糖尿病肾病组血浆白蛋白、血红蛋白等指标明显低于非糖尿病组；糖尿病肾病组肾小球滤过率减退和肾小管功能受损程度较非糖尿病组严重；糖尿病肾病血液透析患者均已出现左心室肥大且左室重构,其中以向心性肥厚为主,依次为离心性肥厚、向心性重构,只有少数正常。终末期糖尿病肾病显证病位以肾为主,其次为脾、肝、心、肺、肌肤、心神、胃。终末期糖尿病肾病显证病性以气虚为多见,其次为血虚、阳虚、阴虚、湿、痰、水停、津亏、热、精亏、气滞、血瘀；终末期糖尿病肾病前证病位以心为主,其次为肝、心神、肌肤、胃、胆、肺、脾、表、大肠。终末期糖尿病肾病前证病性以精亏为多见,其次为痰、寒、热、气滞、血瘀、燥、湿、动风、外风、水停、阳亢、津亏、阳虚、阴虚、血热。各项西医化验指标与病位相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与肾、脾有显著相关性；血浆白蛋白与肾、脾有显著相关性；血红蛋白均与脾有显著相关性；血浆纤维蛋白原与肝、脾有显著相关性；BNP与心有显著相关性；胆固醇与脾有显著相关性。各项西医化验指标与病性相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与气虚、血虚、阳虚、湿有显著相关性；血浆白蛋白与气虚、血虚有显著相关性；血红蛋白与气虚、血虚有显著相关性；血浆纤维蛋白原与气虚、血虚有显著相关性；BNP与气虚、阳虚有显著相关性。结论：终末期糖尿病肾病证素辨证涉及的病位、病性明显多于非糖尿病组,故相关的临床表现更多,而某些病位或病性证素积分明显高于非糖尿病组,故相应的症状病变程度较非糖尿病组更严重。西医生化指标与某些病位、病性有显著相关性。因此,证素辨证能准确辨识当前病变病位证素和病性证素,将其客观化、规范化,是临床辨证的根本目的,对临床辨证论治有重要的意义。更多还原

【Abstract】 Objective:Diabetes mellitus(DM)of the most common chronic micro vascular complic-ation of diabetic nephropathy(DN), is also the leading cause of end-stage renal failure. Western difficult to achieve so far delayed the purpose of the development process of diabetic nephropathy. DN of traditional Chinese medicine on syndrome differentiation still exist are not standardized, syndrome differentiation of diabetic nephropathy is difficult to reflect its own unique features, the lack of epidemiological studies and many other shortcomings. The purpose of this study is to use the card to observe the differentiation factors of diabetic nephropathy patients with end-stage position, disease distribution and disease-bit sexual, disease resistance and various indicators of the relevance of Western laboratory analysis in order to provide a unified, Differentiation Standard specification to improve effectiveness of Chinese medicine to improve the life of patients with end-stage diabetic nephropathy quality, effective symptom relief, to provide comprehensive and objective of the new theoretical basis.Method:Strictly included in the Second People Hospital, and from Fujian Province, Fuzhou General Hospital of Nanjing Military Region, met the inclusion criteria hemodialysis center hemodialysis patients, case acquisition time from October 2008 to January 2010.Profe-ssor Zhu Wenfeng permit the use of dialectical theory of observation elements with end stage renal disease location, disease and disease-bit sexual differentiation rules, disease resistance and the Western analysis of the relevance of laboratory markers.Result:With end-stage diabetic renal disease entering hemodialysis patients with serum creatinine levels were significantly lower than the control group; parathyroid hormone, phosphorus, cholesterol, BNP and other indicators of diabetic nephropathy was significantly higher than non-diabetic nephropathy group; diabetic nephropathy serum albumin, hemoglob-in and other indicators were significantly lower than non-diabetic nephropathy group; diabetic nephropathy decreased glomerular filtration rate and renal tubular function in the serious extent of the damage than the control group; diabetic nephropathy have appeared in hemodialysis patients left ventricular hypertrophy, and left ventricular remodeling and dominated by concentric hypertrophy, followed by eccentric hypertrophy, concentric remodeling, only a small number of normal.End-stage diabetic nephropathy significant permit spaces to kidney disease mainly, followed by spleen, liver, heart, lung, skin, mind and stomach. End-stage diabetic nephropathy sexually explicit license to qi as a more common disease, followed by blood deficiency, yang and yin, wet, sputum, water stop, tianjin loss, heat, refined losses, qi stagnation, blood stasis; end-stage diabetic nephropathy spaces to heart disease before the card-based, followed by liver, mind, skin, stomach, gallbladder, lung, spleen, table, large intestine.End-stage diabetic nephropathy patients before the certificate of loss with precision as the more common, followed by sputum, cold, heat, qi stagnation, blood stasis, dry, wet, moving wind, outside the wind, the water stop, yang kang, jin loss, yang, yin deficiency, blood heat.Laboratory indicators of the Western position correlation with disease:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine are kidney, spleen and heart were significantly correlated; serum albumin were with the kidney, spleen, significant correlation; hemoglobin and spleen were significantly correlated; plasma fibrinogen were liver and spleen were significantly correlated; BNP and heart were significantly correlated; cholesterol and spleen were significantly correlated.Laboratory indicators of the Western analysis and disease-related:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine were qi deficiency, blood deficiency, yang deficiency, a significant correlation between wet; serum albumin were and qi, blood deficiency have significant correlation; hemoglobin and qi deficiency, blood deficiency significantly correlated; plasma fibrinogen were with qi deficiency, blood deficiency significantly correlated; BNP are and qi, yang and a significant correlation.Conclusion:End stage renal disease syndrome factor differentiation involves bit sick of significantly more than non-diabetic group, it is more related to clinical manifestations, disease location or disease in some elements of evidence points higher than non-diabetic group, so the corresponding symptom severity than non-diabetic group, even more serious. Traditional biochemical and certain disease location, disease has significant correlation. Therefore, the card can accur-ately identify the current prime differentiation disease diseases slip proof factors and disease factors, be objective, standardized, clinical differentiation is the fundamental purpose of the clinical syndrome differentiation has important significance.更多还原