102例维持性腹膜透析营养不良患者中医证型分布特点

摘要

Objective:To analyze the TCM syndrome characteristics of the malnutritional patients with maintenance perito-neal dialysis,and study on the TCM Pathogenesis for the patients. Methods:The Syndrome differentiation types of 102 malnutritional patients with maintenance peritoneal dialysis were defined,and analysis the characteristics of distribution of TCM syndrome types. Re-sults:According to the malnutrition degree:In mild malnutritional patients in Deficiency in origin,the most TCM syndrome is the both Spleen Qi and Kidney Qi Deficiency Syndrome. With the malnutrition degree aggravated,the ratio of Yang Deficiency of Spleen and Kidney and deficiency of both yin and yang were increased obviously. In mild malnutritional patients in excess in superficiality,the most TCM syndrome is the Damp Pathogen Syndrome,and then is the Blood Stasis Symptom. With the malnutrition degree aggrava-ted,the ratio of Damp-heat Syndrome,Blood Stasis Symptom,Fengdong syndrome were increased gradually. The relationship of di-alysis adequacy and TCM syndrome:In Deficiency in origin,Kt/V﹥1. 7,the most TCM syndrome is the both Spleen Qi and Kidney Qi Deficiency Syndrome. with the Kt/V decreased,the ratio of the both Spleen Qi and Kidney Qi Deficiency Syndrome were decreased obviously,and deficiency syndrome of both liver and kidney yin,deficiency of both qi and yin,deficiency of both yin and yang were increased obviously. In excess in superficiality,Kt/V﹥1. 7,the most TCM syndrome is the Damp Pathogen Syndrome,and then are the Blood Stasis Symptom,Damp-heat Syndrome. with the Kt/V decreased,the ratio of the Damp Pathogen Syndrome and Blood Stasis Symptom were decreased obviously. Damp-heat Syndrome and Fengdong syndrome were significantly increased. Conclusion:The distribution of TCM syndrome types for the malnutritional patients with maintenance peritoneal dialysis have closely correlation with the adequacy of PD. The TCM Pathogenesis can be summarized“deficiency in origin and excess in superficiality”. Deficiency of spleen and kidney is the main pathogenesis in Deficiency in origin,and stagnation of damp turbidity and static blood is the main path-ogenesis in excess in superficiality.%目的：分析维持性腹膜透析患者营养不良的中医证型特点，并探讨其中医发病机制。方法：对102例维持性腹膜透析营养不良患者进行中医辨证分型，对其分型特点进行分析。结果：根据营养不良程度：本虚证轻度营养不良患者中脾肾气虚证最多，随着营养不良程度加重，脾肾阳虚证和阴阳两虚证比例明显增加。标实证轻度营养不良患者中湿浊证最多，其次为瘀血证，随着营养不良程度加重，湿热、瘀血、风动证比例逐渐增加。透析充分性与中医证型：本虚证中，Kt/V﹥1．7，脾肾气虚证出现率最高，随着Kt/V值降低，脾肾气虚证比例明显减少，肝肾阴虚证、气阴两虚证和阴阳两虚证比例明显增加。标实证中，Kt/V﹥1．7，湿浊证出现率最高，其次为瘀血证、湿热证，随着Kt/V值降低，湿浊证、瘀血证患者比例明显减少，湿热证、风动证比例明显增加。结论：PD营养不良患者中医证型分布与透析充分性密切相关，其发病机制可概括为“本虚标实”，本虚以脾肾亏虚为主，标实以湿浊瘀血为主。