慢性肾小球肾炎中医证候学特点研究

【作者】 王剑飞；

【导师】 王耀献；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 博士

【摘要】 目的：本研究依据临床流行病学方法和原则,通过前瞻性横断面研究以及回顾性临床调研对200例慢性肾小球肾炎(CKD前期)患者中医证候进行研究,探求慢性肾炎正虚与邪实的证侯分布及组合特点；通过研究慢性肾小球肾炎中医证侯与临床生化免疫指标的相关性,为临床辨证提供客观依据；通过采用因子分析法对中医证型的分布规律进行分析和归纳,客观再现慢性肾炎证候的本质。方法：(1)样本量估计：按照多因素分析的一般规律,将样本含量设定为所有变量数目的5-10倍,选取200例慢性肾小球肾炎患者。(2)《临床病例调研表》的制定：根据本学科专业知识参照卫生部制定发布的《中药新药临床研究指导原则》和中医临床诊疗术语证候部分制定。(3)统计学方法：计数资料以频数表、百分率或构成比描述；差异性分析采用T检验、卡方检验、方差分析、非参数检验等方法；采用因子分析方法,提取支配慢性肾小球肾炎四诊变量的公因子,根据专业知识对其进行分析和解释。结果：(1)本次调查具有完整肾活检病理报告的患者以IgA肾病最为多见,占总体54.2%,远高于其他病理类型。(2)54个症状出现频率排在前10位的是：少气乏力>小便黄赤＞口苦＞口粘＞心烦易怒＞大便粘滞＞畏寒肢冷＞腰部隐痛(休息缓解)＞善叹息＞潮热盗汗。(3)本虚证候发生率依次是：气虚＞肾虚＞脾虚＞阳虚＞阴虚＞肝肾阴虚＞阴虚动风；标实证候发生率依次是：湿热证＞瘀血证＞肝郁气滞＞水湿＞肝郁化火＞毒邪＞痰浊＞外风。(4)证候组合方面：湿热+瘀血组明显多于单纯湿热或单纯瘀血组；湿热+瘀血组脾肾阳虚和肝郁化火的发生率明显高于其他两组。(5)因子分析结果得出13个公因子,其中因子10的出现率最高,其包括的证候为湿热证和瘀血证；单纯本虚证的因子中以气虚为主的因子8的出现率最高。结论：(1)慢性肾炎本虚证气虚发生率最高,而实邪以湿热和瘀血最为多见,提示湿热和瘀血是慢性肾炎的重要病机,并且二者可能通过协同作用加重对正气的耗伤和气机的阻滞。(2)因子分析虽不能代替传统中医辨证,但能对中医证候进行较理想的分离,顺利得到独立的证候分组,特别是排在前3位的证候中二者都包括了瘀血证和气虚证,这也验证了本研究第二部分中主要的研究结论。更多还原

【Abstract】 Objective:The methods and principles based on the clinical epidemiology, through the cross-sectional study and review of clinical research on 200 cases of chronic glomerulonephritis in Early lesions of CKD TCM research, explore the TCM Hou features of the distribution and composition in chronic nephritis; by studying the relevance of TCM Hou chronic glomerulonephritis and clinical biochemical indicators of immunity, in order to provide objective evidence of clinical dialectic; by using factor analysis on the distribution of TCM to analyze and summarize, the objective Reproduction of the nature of chronic nephritis syndrome.Methods:(1) sample size:In.accordance with the general rules of multivariate analysis, the sample size is set to 5-10 times the number of all variables, select the 200 cases of chronic glomerulonephritis patients. (2) "Clinical Case Investigation Form " development: According to the reference to the discipline of expertise developed by the Ministry of Health issued the "Guidelines for clinical research drug medicine"and-traditional Chinese medicine syndromes in terms of clinical diagnosis and treatment part of the development. (3) statistical methods:frequency count data to the table, percentage or description of constituent ratio; differences were analyzed by T test, chi-square test, ANOVA, non-parametric test and other methods; using factor analysis method to extract dominant chronic glomerular Nephritis, the common factor of four diagnostic variables, according to its expertise in analysis and interpretation.Results:(1) The survey has a complete report of renal biopsy in patients with IgA nephropathy the most common, accounting for 54.2% overall, far higher than other pathologic types. (2) frequency of 54 top 10 symptoms are:less gas fatigue> red yellow urine> I suffer> mouth stick> upset irritability> stool viscosity> aversion to cold> lower back pain (ease off)> Easy to sigh> hot flushes and night sweats. (3) The order of the incidence of deficiency are:qi> kidney> spleen> Yang> Yin>Yin deficiency of liver and kidney> Yin moving air; The order of the the incidence of Biaoshi Syndrome are:damp> blood stasis syndrome> liver qi Yu> wet> stagnation of the fire> toxin> phlegm> outside air. (4) The combination syndrome:the Damp-heat+Blood stasis group was more than simply Damp-heat or simply Blood-stasis group; Damp-heat of spleen-kidney deficiency of yang and liver fire were significantly higher than that of the other two groups. (5) Factor analysis of 13 common factors obtained, of which the highest occurrence rate of 10 factors, which include the syndrome of damp-heat and Blood-stasis; Simple factor in the deficiency occurs in the highest rate of factor 8 which mainly lack of qi.Conclusion:(1) the highest incidence is the deficiency of qi in chronic nephritis, while the Damp-heat and Blood-stasis in Biaoshi Syndrome are the mos t common, suggest ing that Damp-heat and Blood-stasis is an important pathogenesis of chronic nephritis, and both may synergistically increase the consumption of healthy qi and block of qi-flow. (2) factor analysis, although not a substitute for traditional TCM, factor analysis, but can be more satisfactory separation of the syndrome successfully by independent groups, especially the top three in both the syndrome include the Blood-stasis and Qi-deficiency, which also verifies t-he main conclusion of the study in the second part of this study.更多还原