2型糖尿病肾病Ⅲ期中医证型及其相关因素的回顾性研究

作者	单位
张广德	中国中医科学院西苑医院内分泌科
邹本良	中国中医科学院西苑医院内分泌科
孟辉	北京孙河社区卫生服务中心
黄佳娜	中国中医科学院西苑医院内分泌科

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中文摘要:

目的探讨2型糖尿病肾病Ⅲ期的中医证型及其相关因素间关系。方法将209例2型糖尿病住院患者分为Ⅲ期组和对照组,分别收集年龄、病程、体重指数(body mass index,BMI)、糖化血红蛋白(glycatedhaemoglobin A1 c,HbA1c)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、血肌酐(serum creatinine,Scr)、尿微量白蛋白(microalbuminuria,MALB)指标。对Ⅲ期组病例按照本证、标证进行辨证分型。结果Ⅲ期组与对照组比较,病程[(107.74±96.19)、(82.03±79.10)个月]、BMI[(26.25±4.02)、(24.95±3.56)kg/m~2]、Scr[(71.93±24.24)、(65.91±13.70)mmol/L]差异有统计学意义(P<0.05);本证气阴两虚证38例,所占比率最高,为36.19%;标证瘀证51例,所占比率最高,为48.58%;本证中脾肾气虚证组MALB(mg/24 h,128.77±103.59)高于阴虚燥热证(88.43±68.93)和气阴两虚证组(82.60±55.22),本证三组间差异有统计学意义(P<0.05);标证三组间HbA1c比较(%),瘀证(10.73±2.71)、湿证(8.80±2.19)、痰瘀证(8.83±2.09)差异有统计学意义(P<0.05);TG(mmol/L)水平三组间(2.29±1.58,4.37±5.92,2.40±2.18)差异有统计学意义(P<0.05)。结论病程、BMI及Scr可能是2型糖尿病肾病Ⅲ期发病的危险因素;2型糖尿肾病Ⅲ期气阴两虚兼瘀证常见;MALB与脾肾气虚证更相关;HbA1c与瘀证更相关;TG与湿证更相关。

英文摘要:

Objective To explore the relationship between Chinese medicine syndrome patterns(CMSP) and their associated factors in patients with type 2 diabetic nephropathy stageⅢ(DN2-3).Methods Retrospective analysis was conducted on 209 patients with type 2 diabetes mellitus(T2DM).The patients were allocated into two groups,the DN2-3 group and the control group.Some related clinical materials and laboratory indexes, including age,course of disease,body mass index(BMI),glycosylated hemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),blood levels of total cholesterol(TC),triglyceride (TG),high and low density lipoprotein(HDL and LDL),serum creatinine(Scr) and microalbuminuria(MALB) as well as their CMSP(both the essential syndrome and the superficial syndrome) in the DN2-3 group were collected and compared.Results Significant differences were found between the DN2-3 group and the control group in aspects of course of disease(months,107.74±96.19 vs.82.03±79.10),BMI(kg/m~2,26.25±4.02 vs.24.95±3.56) and Scr level(mmoL/L,71.93±24.24 vs.65.91±13.70,P<0.05).The qi-yin deficiency SP(38 cases,36.19%),and the blood stasis(51 cases,48.58%) presented as the dominant essential and superficial CM-SP respectively in DN2-3 patients,holding the highest proportion.Analysis on the relationship of associated indices among patients with different CMSP showed statistical differences presented in level of MALB,i.e.which in pi-shen qi-deficiency SP(128.77±103.59 mg/24h) was higher than in yin-deficiency dryness -fire SP and qi-yin deficiency SP(88.43±68.93 mg/24h and 82.60±55.22 mg/24h,P<0.05);it also presented in HbA1c(%) and TG levels(mmol/L),those in stasis SP were 10.73±2.71 and 2.29±1.58 ),in dampness SP were 8.80±2.19%and 4.37±5.92,and in stasis-phlegm SP were 8.83±2.09 and 2.40±2.18 (all P<0.05).Conclusions The risk factors for occurrence of DN2-3 may be the course of disease,BMI and Scr.Qi-yin deficiency with blood-stasis is the most commonly encountered syndrome in patients with DN2-3.Relations of MALB with Pi-Shen qi-deficiency pattern;HbA1c with blood-stasis pattern,and TG with dampness syndrome are distinctly exhibited in them.

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