Ⅳ型心肾综合征中医证候分布及相关因素分析

目的:探讨Ⅳ型心肾综合征(CRS)中医证候分布特点及规律,尝试临床理化指标与中医辨证理论相结合,探索两者之间是否存在内在联系,为Ⅳ型CRS中医辨证论治提供理论依据。方法:本研究选取2011年01月~2016年12月在北京中医药大学东直门医院肾病科及心血管科住院符合纳入标准的Ⅳ型CRS患者154例,分为正虚和邪实各5个证型。归纳Ⅳ型CRS中医证候分布规律及与临床指标之间的相关性。结果:Ⅳ型CRS在正虚证候中:气虚证在CKD2期、心功能Ⅱ级多见,阳虚证在CKD5期、心功能Ⅲ级多见,气阴两虚证在CKD3期、心功能Ⅳ级多见,阴阳两虚在CKD5期、心功能Ⅳ级多见;在标实证候中:湿浊证、水气证、血瘀证、痰饮证在CKD5期、心功能Ⅳ多见,湿热证在CKD3期、心功能Ⅱ级多见。正虚证积分与心、肾功能相关性分析表明:阳虚证积分与e GFR(P=0.002<0.05)呈负相关,气阴两虚证积分、阴阳两虚证积分与BNP(P=0.000<0.05)呈正相关。标实证积分与心、肾功能相关性分析表明:湿浊证积分、水气证积分、血瘀证积分均与e GFR呈负相关(P<0.05),水气证积分、血瘀证积分与BNP呈正相关,与射血分数呈负相关(P<0.05)。结论:气虚证是心肾综合征患者早期发病的主要证候表现,晚期以阳虚证及阴阳两虚证为主要证候表现,湿浊、水气、血瘀互结是造成病情恶化主要病因;CRS患者以肾功能加重为主时,阳虚证表现明显,以心功能加重为主时,气阴两虚证及阴阳两虚证表现明显;水气证、血瘀证候贯穿疾病各个阶段,加速心、肾功能恶化。

Clinical Observation of TCM Syndrome Distribution and Related Factors in TypeⅣCardio Renal Syndrome

Objective:To investigate the distribution characteristics and regularity of TCM syndromes of typeⅣcardio-renal syndrome,and to explore the combination of clinical physical and chemical indicators and TCM syndrome differentiation theory,to explore whether there is an intrinsic relationship between them,and to treat the typeⅣcardio-renal syndrome with TCM syndrome differentiation.And treatment provides a theoretical basis.Methods:From January 2011 to December 2016,154 patients with typeⅣcardio-renal syndrome who met the inclusion criteria in the Department of Nephrology and Cardiovascular Surgery,Dongzhimen Hospital,Beijing University of Chinese Medicine,were selected from Zhengxu and Xieshi5 cards.The distribution of TCM syndromes of typeⅣCRS and the correlation with clinical indicators were summarized.Results:(1)TypeⅣCRS in Zhengxu syndrome:qi deficiency syndrome is more common in CKD2 stage and cardiac function levelⅡ,yang deficiency syndrome is more common in CKD5 stage and cardiac function levelⅢ,Qi and Yin deficiency syndrome is more common in CKD3 and cardiac functionⅣ,Yin and Yang deficiency are more common in CKD5 and cardiac functionⅣ;in the standard evidence:Wet turbidity syndrome,water-qi syndrome,blood stasis syndrome,phlegm-dampness syndrome are more common in CKD5 and cardiac functionⅣ,and damp-heat syndrome is more common in CKD3 and cardiac functionⅡ.(2)The correlation between the scores of stagnation syndrome and heart and kidney indicators showed that the score of yang deficiency syndrome was negatively correlated with e GFR(P=0.002<0.05),the score of qi and yin deficiency syndrome,the score of yin and yang deficiency syndrome and BNP(P=0.000<0.05)was positively correlated.(3)The correlation between the index and the heart and kidney indicators showed that the wet turbidity syndrome score,the water vapor syndrome score and the blood stasis syndrome score were negatively correlated with e GFR(P<0.05),and the water vapor syndrome score,blood stasis syndrome score and BNP were positive.Correlation was negatively correlated with ejection fraction(P<0.05).Conclusion:(1)Qi deficiency syndrome is the main syndrome manifestation of early onset of heart and kidney syndrome patients.In the late stage,yang deficiency syndrome and yin and yang deficiency syndrome are the main syndromes.The wet turbidity,water vapor and blood stasis are the main causes of the disease.(2)When patients with CRS are mainly aggravated by renal function,the yang deficiency syndrome is obvious.When the heart function is aggravated,the syndrome of qi and yin deficiency and the syndrome of yin and yang deficiency are obvious;the syndrome of water and gas and the syndrome of blood stasis syndrome occur in various stages of the disease,which are associated with the accelerated heart and kidney failure.