慢性肾脏病合并代谢综合征患者的中医证候分析

目的:对慢性肾脏病(CKD)合并代谢综合征(MS)患者的中医证候进行回顾性研究,了解CKD合并MS的证候特征,为CKD的个体化诊治提供指导。方法:收集2007年～2009年住院或门诊的CKD患者,其中CKD合并MS组121例,CKD非合并MS组123例,设计中医证候临床观察表,对两组病人临床脉证进行调查研究。结果:(1)CKD合并MS组男性患病人数明显高于女性,年龄大于CKD非合并MS组。两组病程及慢性肾脏病的分期差异无统计学意义。(2)代谢综合征各组分比较:CKD合并MS组腰围(W)、BMI、高血压发生率、FPG、TG、LDL-C明显高于CKD非合并MS组(P<0.01)。HDL-C明显低于CKD非合并MS组(P<0.05)。(3)两组病人肾损害比较:Scr、BUN、24h尿蛋白定量、血尿及肾衰竭发生率两组相比差异无统计学意义(P<0.05)。CKD合并MS组UA明显高于CKD非合并MS组(P<0.001)。(4)两组病人中医证候的比较:虚证中合并MS组以脾肾气虚多见,非合并MS组以气阴两虚多见;实证中合并MS组以血瘀、痰湿、热盛多见,非合并MS组以湿热、血瘀为多见;合并MS组实证中两证以上相兼的现象较非合并MS组常见;合并MS组血瘀证和热盛证兼夹、血瘀和痰湿证兼夹、血瘀、痰湿和热盛证兼夹多见,非合并MS组以血瘀和湿热证兼夹、湿热和热盛证兼夹多见。两组总的证候均以虚实夹杂为主要特征。结论:CKD合并MS的中医证候特点以虚实夹杂,多证相兼为主要特征。虚证以脾肾气虚为主,实证以血瘀、痰湿、热盛为主。

TCM Syndrome Analysis of Chronic Kidney Disease Patients with Metabolic Syndrome

Objective:Retrospective system study for TCM syndrome of chronic kidney disease(CKD) patients with complicated with metabolic syndrome(MS) and comparison with the TCM syndrome of CKD patients non-complicated with MS,which contribute to understand the characteristic of TCM syndrome in patients of CKD complicated with MS,provide guidance for the individual treatment of CKD.Methods:We collected 244 cases of hospital or clinic patients with CKD,including 121 patients with CKD complicated with MS(MS group),and 123 patients with CKD of non-complicated MS(non-MS group),then we research for the clinical symptoms,tongue diagnosis and pulse-taking diagnosis of the two groups according to TCM syndrome observation chart.Results:(1) The male patients were obviously higher than female in MS group,and patients in MS group were older than non-MS group,there were no statistical differences in terms of the course and the stage of CKD between two groups.(2) Comparison of component of metabolic syndrome in two groups:waist,BMI,FPG,TG,LDL-C and incidence of hypertension were higher in MS group than in non-MS group.HDL-C decreased in MS group than in non-MS group.(3)Renal injury in two groups:Serum creatinine,blood urea nitrogen,the prevalence of hematuria and renal insufficiency had no significant difference between two groups (P>0.05).As expected,with MS group had significantly higher uric acid (P<0.01).(4) Asthenia syndrome often emerged in MS group was splenonephro-Qi deficiency syndrome,while in non-MS group was Qi-Yin deficiency syndrome.Blood stasis,phlegmatic hygrosis,excessive heat were often showed in MS group,while damp-heat syndrome,blood stasis were often showed in non-MS group.Two or more than two kinds of excess syndrome or more were more common in MS group than in non-MS group.Incorporation syndrome of blood stasis and excessive heat,blood stasis and phlegmatic hygrosis,blood stasis,phlegmatic hygrosis and excessive heat were more frequent in MS group than in non-MS group.Incorporation syndrome of damp-heat and blood stasis,damp-heat and excessive heat were more common in non-MS group than in MS group (P<0.05).The characteristic of syndrome of MS group and non-MS group showed deficiency and excess.Conclusion:The characteristic of syndrome of CKD complicated with MS showed combination of many a syndrome,deficiency and excess,splenonephro-Qi deficiency syndrome was mainly common in deficiency syndrome,while blood stasis,phlegmatic hygrosis,excessive heat syndrome were often showed in excess syndrome.