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超重及肥胖型的糖尿病肾病中医证候特点研究分析

The TCM Syndrome Analysis of Overweight Diabetic Nephropathy and Fueling Diabetic Nephropathy

作者: 专业:中医学(专业学位) 导师:赵玲 年度:2015 学位:硕士  院校: 广州中医药大学

Keywords

Overweight, Obesity, Diabetic nephropathy, Syndrome differentiation type

        糖尿病肾病是导致糖尿病患者发生肾衰竭的主要原因并且其发病率日渐升高。所以临床医生也越来越重视这一情况。而超重、肥胖引起的脂类代谢异常更是可以进一步促进糖尿病肾病的进展。在糖尿病肾病的早期阶段可以通过严格控制血糖、血压和血脂等,来防止或延缓糖尿病肾病的发展。在现代有很多的治疗方法:如改变生活方式,主要包括合理控制体重、糖尿病饮食、戒烟及运动;控制血糖、血压、血脂、蛋白尿等;透析治疗和移植等。随着中医药越来越得到人们的重视,在未来的治疗上,我们应该增加中医药在治疗该病的比重,但目前针对超重及肥胖型糖尿病肾病的辨证论治仍缺乏统一规范的标准。目的:本研究通过回顾性调查研究,收集超重及肥胖型糖尿病肾病患者的相关情况,主要包括其基本信息、中医四诊资料等,研究以及探索其中医症状分布规律,明确超重及肥胖型糖尿病肾病的辨证分型,为治疗该病提供中医临床的依据。方法:本研究主要采用横断面调查研究方法,首先进行大量的文献调研,根据超重及肥胖型糖尿病肾病的临床特点及伴随症状等,设计中医证候信息采集表,收集在2012年11月-2015年1月在广东省中医院住院的超重及肥胖型糖尿病肾病患者的相关资料,完成相关调查表的填写,然后按统计学的要求建立信息数据库并且完成相关的数据录入及核对,结合统计资料,使用SPSS17.0统计软件,采用因子分析及聚类分析的方法,对超重及肥胖型糖尿病肾病证候进行总结及分型。结果:1.对超重及肥胖型糖尿病肾病201例病例资料的统计分析表明,超重及肥胖型糖尿病肾病主要的临床症状包括口干多饮、精神萎靡、视物模糊、肢体麻痛、肢体浮肿、夜尿、泡沫尿等;而比较常见的舌脉象分别有舌暗红、舌淡暗、苔黄腻、苔白腻、苔薄白、脉弦滑、脉弦细。2.采用因子分析的统计方法对15个中医症状及13个舌脉象进行降维处理,一共提取了20个公因子。对20个公因子进行聚类分析,结合临床实际,在导师指导下,得出超重及肥胖型糖尿病肾病的4种证候分型,分别为湿热瘀阻型、痰湿化热型、心肾气虚型、气虚湿瘀型。3.根据因子得分,对纳入患者进行分组,湿热瘀阻证46例(22.89%),痰湿化热证105例(52.23%),心肾气虚证22例(10.95%),气虚湿瘀证28例(13.93%)。由此可知超重及肥胖型糖尿病肾病的患者中,以痰湿化热、湿热瘀阻者居多。结论:超重及肥胖型糖尿病肾病患者中较常见的症状有口干多饮、精神萎靡、视物模糊、肢体麻痛、肢体浮肿等,较常见舌脉象有舌暗红、舌淡暗、苔黄腻、苔白腻、苔薄白、为脉弦滑、脉弦细。总结出4种中医辨证分型:湿热瘀阻型、痰湿化热型、心肾气虚型、气虚湿瘀型。在这四个分型中以痰湿化热证占的比例最高,湿热瘀阻证次之,两者所占比例超过七成,提示本病患者多以湿热为主。当前,初步摸索出相关中医证候规律,为超重及肥胖型糖尿病肾病的临床诊断和治疗提供了依据,也为中医证候的标准化研究做出了有益的尝试。
    ObjectiveDiabetic Nephropathy is the leading causes of kidney failure for Diabetes patients, and the incidence of DN is increasing. So more and more clinicians pay attention to this desease. However, the abnormal lipid metabolism which is caused by overweight and obesity can further promote the progress of Diabetic Nephropathy. In the early stages of Diabetic Nephropathy, strict control of blood glucose,blood pressure and blood lipid is the effetive way to prevent the development of Diabetic Nephropathy.Modern treatment such as:lifestyle changes which including weight control, diabetic diet, smoking cessation and athletic sports;control of blood glucose,blood pressure and blood lipid and dialyse or transplantation can’t stop disease progression. Although they have obtained certain clinical curative effect, there are still limitations and side effects that cannot be ignored. As traditional Chinese medicine get more and more attention,, we should increase the proportion of traditional Chinese medicine in the future treatment of DN. But nowdays, the unified specification standards of syndrome differentiation and treatment in overweight and obesity Diabetic Nephropathy is still blank.PurposeThis study collected the related dates of overweight and obesity Diabetic Nephropathy patients through the retrospective investigation, and the mainly dates included the basic information, TCM four diagnostic data. All dates are collected for researching and exploring the distributed regularity of TCM symptoms, defining the syndrome differentiation and treatment of overweight and obesity Diabetic Nephropathy, and providing the useful basis for the clinical treatment of DN.MethodsA cross-sectional survey research method was used in this study. Firstly, we designed a TCM symptom information collection table, according the large number of literature investigation, clinical characteristics and accompanying symptoms of the overweight and fueling Diabetic Nephropathy, and guidance of our tutor. Secondly, we filled in the questionnaire through collecting related information of the overweight and fueling Diabetic Nephropathy inpatient’s during November 2012-January 2015 in Guangdong Province TCM Hospital. And then, we established the information database in accordance with requirements statistics, and finished the data entry and check. Finally, we summarized and classifyed the syndrome of overweight and fueling DN using factor analysis and cluster analysis method of SPSS17.0 software.Results1.The statistical analysis of 201 cases overweight and fueling Diabetic Nephropathy patients showed that the main clinical symptoms included dry mouth drink more, depression, blurred vision, body pain, limb edema, nocturia, bubble urine, etc. And the more common tongue picture were dark red, light and dark tongue, yellow greasy moss, white greasy moss, moss thin white, the more common type of pulse were thready and slippery pulse, string pulse.2. After dimension reduction processing of 15 TCM symptoms and 13 tongue pulse condition using factor analysis,20 common factor were extracted. Combining with clinical practice and under the guidance of our tutor, clustering analysis of the 20 common factor concluded 4 kinds of TCM syndrome classification:the hot and humid,phlegm and blood stasis type, the lack of heat phlegm wet type, heart kidney deficiency type, qi deficiency and blood stasis wet type.3. According to the factor score, we classifyed the patients into 4 groups:46 cases (22.89%) in the hot and humid, phlegm and blood stasis type,105 cases (52.23%) in the the lack of heat phlegm wet type,22 cases (10.95%) in the heart kidney deficiency type,28 cases (13.93%) in the qi deficiency and blood stasis type wet. Thus mainly TCM syndromes of the overweight and obesity Diabetic Nephropathy patients were the hot and humid, phlegm and blood stasis type and the lack of heat phlegm wet type.ConelusionThe most common clinical symptoms of the overweight and obesity Diabetic Nephropathy patients included dry and drinking more, weakness, blurred vision, limbs pain and edema. The most common conditions of the tongue and the pulse were dark red tongue, light and dark tongue, yellow or white greasy fur, thin and white fur, thready and slippery pulse and small and wiry pulse. The study summed up 4 TCM syndrome differentiations:stagnant dampness-heat type, the lack of heat phlegm wet type, heart kidney deficiency type and qi deficiency and blood stasis type wet. Among the four types, The proportion of the the lack of heat phlegm wet type is the highest percentage, and the hot and humid, phlegm and blood stasis type is the second. Both accounted for more than seventy percent, which suggested that patients with this disease, more is given priority to with hot and humid. We have preliminarily obtained the regularity of TCM syndrome, which provided the basis for the treatment and dignosis for the overweight and obesity Diabetic Nephropathy, and made a beneficial attempt for the standardization study of TCM syndrome.
        

超重及肥胖型的糖尿病肾病中医证候特点研究分析

摘要3-5
Abstract5-7
引言9-11
第一章 文献研究11-17
    1.1 祖国医学对糖尿病肾病的认识研究11-14
        1.1.1 古代中医对糖尿病肾病病因病机的认识11
        1.1.2 古代中医对糖尿病肾病的治疗11-12
        1.1.3 现代中医对糖尿病肾病病因病机研究进展12-13
        1.1.4 现代中医对糖尿病肾病的辨证论治13-14
    1.2 西医对肥胖型糖尿病肾病的认识研究14-17
        1.2.1 流行病学14-15
        1.2.2 发病机制15-16
        1.2.3 治疗方法16-17
第二章 临床研究17-30
    2.1 研究方案17-18
        2.1.1 研究对象来源17
        2.1.2 诊断标准17
        2.1.3 试验病例标准17-18
    2.2 研究方法18
        2.2.1 中医四诊信息的筛选18
        2.2.2 调查表设计18
        2.2.3 样本估计18
        2.2.4 统计分析18
    2.3 研究结果与分析18-27
        2.3.1 一般资料18-20
        2.3.2 超重及肥胖型糖尿病肾病患者的中医症状20-21
        2.3.3 超重及肥胖型糖尿病肾病中医四诊信息的因子分析、聚类分析及症型分布规律探讨21-27
    2.4 讨论27-30
        2.4.1 临床资料分析27
        2.4.2 中医四诊资料分析27-28
        2.4.3 因子分析、聚类分析及证型分布规律28-30
结语30-31
参考文献31-34
附录34-36
致谢36
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