慢性肾脏病患者中医证型分布与营养状态相关性分析

摘要

目的:分析慢性肾脏病(CKD)患者证型的分布特点及其与临床分期、营养状态的关系,为临床实践提供参考.方法:参照中华中医药学会肾病分会2006年<慢性肾衰竭的诊断、辨证分型及疗效评定>标准对126例CKD不同分期的患者进行中医辨证,同时通过主观综合营养评估法(SGA)、肱三头肌皮褶厚度(TSF)、上臂围(AC)、上臂肌围(AMC)的测量评估患者营养状态,运用SPSS 17.0软件对数据进行统计分析.结果:本虚证方面,各证型分布情况为脾肾气虚60例(47.6%)、气阴两虚33例(26.2%)、肝肾阴虚14例(11.1%)、脾肾阳虚12例(9.5%)、阴阳俱虚7例(5.6%),随着CKD分期的进展,肝肾阴虚证和脾肾阳虚证的比例有减少的趋势,阴阳俱虚证的比例呈增加的趋势.标实证方面,各证型分布情况为无标证56例(44.4%),湿热证31例(24.6%)、湿浊证25例(19.8%)、血瘀证12例(9.5%)、热毒证2例(1.6%),随着CKD分期的进展,无标证的比例逐渐减少,血瘀证比例逐渐增多,湿浊证、湿热证比例也有增多的趋势.结合营养状态分析,阴阳俱虚证患者的TSF、AC最小,差异具有统计学意义(P<0.05,P<0.01),AMC也最小,但差异无统计学意义(P>0.05),SGA评分B级患者的比例最高,但差异无统计学意义(P＞0.05).血瘀证SGA评分为B级的比例最高,差异有统计学意义(P<0.01),TFS、AC、AMC最低,差异无统计学意义(P>0.05).结论:CKD患者证型分布有一定规律可循,与CKD分期的进展可能相关,且与营养状态指标有一定相关性,阴阳俱虚证、血瘀证营养状态可能最差.%Objective;To analyze the relationship between traditional Chinese medicine syndromes and the nutritional status in chronic kidney disease ( CKD ) patients. Methods;A questionnaire based on the criteria made by the Nephropathy Branch of China Association of Chinese Medicine in 2006 was used in 126 CKD patients. And patients Subjective global assessment scores, triceps skinfold muscle arm( TSF ), arm circumference( AC ), arm muscle circumference( AMC ) were measured to assess their nutritional status. Then the results were analyzed by SPSS 17. 0. Results;In the asthenia syndromes, spleen - kidney - qi deficiency took the largest proportion ( 47. 6% ). And proportion of yin - yang deficiency was larger and larger while the proportion of liver - kidney deficiency and spleen - kidney deficiency was smaller and smaller with the progress of CKD stage. In the excess syndromes, non - syndrome took the largest proportion ( 44.4% ). And proportion of stasis syndrome, wet - muddy syndrome and wet - heat syndrome was larger and larger with the progress of CKD stage. TFS and AC of yin - yang deficiency was smallest and the difference was statistically significant. AMC was smallest, too. And Class B for SGA of yin -yang deficiency took highest percentage, but the difference was not statistically significant P>0.05 ). Class B for SGA of stasis syndrome took highest percentage and the difference was statistically significant P <0. 01 ). The TFS, AC, AMC of stasis syndrome were smaller than other syndromes, but the difference was not statistically significant P > 0. 05 ). Conclusion; There are certain rules to follow with the traditional Chinese medicine syndromes in CKD patients and the nutritional status were certain correlation with the rules, This may help us in the clinical practice.