基于不同虚证分型的ESRD患者的营养和精神状态分析
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摘要
目的:调查不同虚证分型的终末期肾病(ESRD)患者营养状况、焦虑及抑郁状态情况,为临床治疗提供客观依据。方法:连续采集2012年10月—2016年10月在天津中医药大学第一附属医院及第二附属医院透析中心最新确诊ESRD患者201例,参照2002年《中药新药临床研究指导原则》将本证虚证组分为脾肾气虚证(32例)、脾肾阳虚证(59例)、肝肾阴虚证(50例)、阴阳两虚证(35例)、气阴两虚证(25例);并随机选取同时期在中医二附院体检中心体检的健康人群50例作为本研究的对照组。检测尿素氮及肌酐,电解质、血脂、蛋白、血色素等水平,计算肌酐清除率,体重指数,用SAS及PHQ-9量表采集患者的焦虑及抑郁评分,分析不同虚证分型的ESRD患者营养及精神状态的不同。结果:各虚证组钾、磷离子、TC、TG、LDL-C、SAS评分及PHQ-9评分均明显升高,钠、钙离子、HDL-C、TP、ALB、Hb和RBC明显降低;与脾肾气虚组相比,阴阳两虚组的钾、磷、镁离子、TG明显升高,钙离子、TP、ALB、Hb和RBC明显降低,气阴两虚组的TP、ALB、RBC明显降低,肝肾阴虚组、阴阳两虚组、气阴两虚组SAS评分及PHQ-9评分均明显升高;与肝肾阴虚组比较,阴阳两虚及气阴两虚组的TG均明显升高,阴阳两虚组SAS评分明显升高;与脾肾阳虚组比较,阴阳两虚及气阴两虚组的SAS评分均明显升高。结论:本研究显示不同虚证分型的ESRD患者的营养状况及精神状态不同,一方面为我们临床辨证施治提供了理论基础,一方面为ESRD患者提供了治疗思路,从而能够提高患者的生活质量及治疗效果。
Objective:To investigate the nutritional,anxiety and depression status of end-stage renal disease patients with different types of deficiency syndromeso as to provide an objective basis for clinical treatment.Methods:A total of 201 ESRD patients who were willing to cooperate were selected from October 2012 to October 2016 at The First and Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. A total of 201 cases of patients were divided into different study groups according to the diagnosis of chronic renal failure,syndrome differentiation and efficacy evaluation suggested by 2002 Guiding Principles of Clinical Research on New Drugs of TCM. TCM symptoms:The deficiency syndromes were divided into spleen-kidney Qi deficiency syndrome(32),spleen-kidney Yang deficiency syndrome(59),liver-kidney Yin deficiency syndrome(50),Yin-Yang deficiency syndrome(35),Qi-Yin deficiency syndrome(25). Fifty healthy patients were randomly selected in Physical Examination Center of The Second Affiliated Hospital were selected as the control group. At the same time,urea nitrogen,creatinine,electrolyte,protein and hemachrome were measured. Creatinine clearance rate and body mass index were calculated. The patients were followed by PHQ-9 and SAS score scale,and the symptom scores of the patient were calculated. The nutritional and mental status of ESRD patients with different syndrome differentiation was analyzed.Results:The potassium,phosphorus,TC,TG,LDL-C,SAS and PHQ-9 scores of all deficiency syndrome groups increased significantly. The levels of sodium,calcium,HDL-C,TP,ALB,Hb and RBC in each group were significantly decreased.Compared with spleen-kidney Qi deficiency group,in Yin-Yang deficiency group,the levels of potassium,phosphorus,magnesian and TG increased significantly.At the same time,calcium,TP,ALB,Hb and RBC decreased significantly. The levels of TP,ALB and RBC in Qi-Yin deficiency group decreased obviously. The SAS score and PHQ-9 score in liver-kidney Yin deficiency group,Yin-Yang deficiency group,Qi-Yin deficiency group increased significantly. Compared with liver-kidney Yin deficiency group,TG in Yin-Yang deficiency group and Qi-Yin deficiency group increased significantly,and SAS score in Yin-Yang deficiency group increased significantly.Compared with spleen-kidney Yang deficiency,SAS scores in Yin-Yang deficiency and Qi-Yin deficiency groups increased significantly.Conclusion:This study showed that the nutritional status and mental state of ESRD patients with different types of deficiency syndrome were different. On one hand,it provides a theoretical basis for clinical treatment based on syndrome differentiation. On the other hand,it provides treatment ideas for ESRD patients. Therefore,it can improve the quality of life of patients and the effect of treatment.
Objective:To investigate the nutritional,anxiety and depression status of end-stage renal disease patients with different types of deficiency syndromeso as to provide an objective basis for clinical treatment.Methods:A total of 201 ESRD patients who were willing to cooperate were selected from October 2012 to October 2016 at The First and Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. A total of 201 cases of patients were divided into different study groups according to the diagnosis of chronic renal failure,syndrome differentiation and efficacy evaluation suggested by 2002 Guiding Principles of Clinical Research on New Drugs of TCM. TCM symptoms:The deficiency syndromes were divided into spleen-kidney Qi deficiency syndrome(32),spleen-kidney Yang deficiency syndrome(59),liver-kidney Yin deficiency syndrome(50),Yin-Yang deficiency syndrome(35),Qi-Yin deficiency syndrome(25). Fifty healthy patients were randomly selected in Physical Examination Center of The Second Affiliated Hospital were selected as the control group. At the same time,urea nitrogen,creatinine,electrolyte,protein and hemachrome were measured. Creatinine clearance rate and body mass index were calculated. The patients were followed by PHQ-9 and SAS score scale,and the symptom scores of the patient were calculated. The nutritional and mental status of ESRD patients with different syndrome differentiation was analyzed.Results:The potassium,phosphorus,TC,TG,LDL-C,SAS and PHQ-9 scores of all deficiency syndrome groups increased significantly. The levels of sodium,calcium,HDL-C,TP,ALB,Hb and RBC in each group were significantly decreased.Compared with spleen-kidney Qi deficiency group,in Yin-Yang deficiency group,the levels of potassium,phosphorus,magnesian and TG increased significantly.At the same time,calcium,TP,ALB,Hb and RBC decreased significantly. The levels of TP,ALB and RBC in Qi-Yin deficiency group decreased obviously. The SAS score and PHQ-9 score in liver-kidney Yin deficiency group,Yin-Yang deficiency group,Qi-Yin deficiency group increased significantly. Compared with liver-kidney Yin deficiency group,TG in Yin-Yang deficiency group and Qi-Yin deficiency group increased significantly,and SAS score in Yin-Yang deficiency group increased significantly.Compared with spleen-kidney Yang deficiency,SAS scores in Yin-Yang deficiency and Qi-Yin deficiency groups increased significantly.Conclusion:This study showed that the nutritional status and mental state of ESRD patients with different types of deficiency syndrome were different. On one hand,it provides a theoretical basis for clinical treatment based on syndrome differentiation. On the other hand,it provides treatment ideas for ESRD patients. Therefore,it can improve the quality of life of patients and the effect of treatment.
引文
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[3] National Kidney Foudation.DOQI Kidney diease outcome quality initiative[J].Am J Kidney Dis,2002,39(Suppl 1):S1-S266.
[4] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:163-164.
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[14] 徐逸霖,徐震宇,卢嫣,等.246例血液透析患者中医证型分析研究[J].吉林中医药,2010,30(11):953-955.
[15] 韩佳瑞,孙新宇,左振慢.慢性肾衰竭中医辨证分型与红细胞及血红蛋白含量的关系[J].中国中医药科技,2010,17(5):396.
[16] 肖长虹,白显明,张愍,等.尿毒症中医辨证分型与血清脂蛋白亚组分胆固醇含量关系[J].中国中西医结合杂志,1995(11):684.
[17] 詹文彦,魏福玲,张军华,等.慢性肾衰竭患者钙磷代谢、血肌酐、尿素氮与中医辨证分型的关系探讨[J].中国现代医药杂志,2017,19(4):30-33.
[18] 韩佳瑞,左振魁,张琪.慢性肾衰竭中医辨证分型与血清钙、磷水平的关系[J].光明中医,2011,26(8):1570-1571.
[19] 王永炎,严世芸.实用中医内科学[M].上海:上海科学技术出版社,2009:432.
[20] 朱刚,孙伟,张沙丽.138例血液透析患者抑郁状态与中医虚证的调查[J].中国中西医结合肾病杂志,2011,12(2):132-134.
[2] 吴国伟,徐文君,傅声武,等.慢性肾脏病并发心血管疾病的中医病机及治法探析[J].浙江中医杂志,2010,45(7):472-474.
[3] National Kidney Foudation.DOQI Kidney diease outcome quality initiative[J].Am J Kidney Dis,2002,39(Suppl 1):S1-S266.
[4] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:163-164.
[5] Spitzer RL,Kroenke K,Williams JB.Validation and utility of a self-report version of PRIME-MD:the PHQ primary care study.Primary Care Evaluation of Mental Disorders.Patient Health Questionnaire[J].JAMA,1999,282:1737-1744.
[6] Deleyiannis FW,Weymuller EA,Coltrera MD.Quality of life of disease free survivors of advanced(stage III or IV)oropharyngeal cancer[J].Head Neck,1997,19:466-473.
[7] 闫丽娟.血液透析患者营养不良的原因及护理对策[J].中国医药指南,2015,13(12):199-200.
[8] Anderson CAM,Nguyen HA.Nutrition education in the care of patients with chronic kidney disease and end-stage renal disease[J].Semin Dial,2018,31(2):115-121.
[9] 向英歌,邓国林.慢性肾功能衰竭病因病机与治法探析[J].山西中医,2010,26(12):55-57.
[10] 马济佩,何立群,郑平东.慢性肾衰患者尿毒症毒素水平与中医辨证分型之间关系的临床研究[J].四川中医,2005,23(2):21-22.
[11] 苏庆民,王琦.肥胖人痰湿型体质血脂、血糖、胰岛素及红细胞Na+-K+-ATP酶活性的检测及特征[J].中国中医基础医学杂志,1995,1(2):39-41.
[12] 沈维增,李俊彪,伍新林,等.温肾泄浊汤对慢性肾衰竭患者脂质代谢及肾功能的影响[J].中国中西医结合肾病杂志,2004,5(3):166-168.
[13] 杨永铭,刘冠贤,钟伟强.人参养营汤对慢性肾功能衰竭腹膜透析患者生活质量提高的观察[J].中国中西医结合急救杂志,2002,9(3):148-149.
[14] 徐逸霖,徐震宇,卢嫣,等.246例血液透析患者中医证型分析研究[J].吉林中医药,2010,30(11):953-955.
[15] 韩佳瑞,孙新宇,左振慢.慢性肾衰竭中医辨证分型与红细胞及血红蛋白含量的关系[J].中国中医药科技,2010,17(5):396.
[16] 肖长虹,白显明,张愍,等.尿毒症中医辨证分型与血清脂蛋白亚组分胆固醇含量关系[J].中国中西医结合杂志,1995(11):684.
[17] 詹文彦,魏福玲,张军华,等.慢性肾衰竭患者钙磷代谢、血肌酐、尿素氮与中医辨证分型的关系探讨[J].中国现代医药杂志,2017,19(4):30-33.
[18] 韩佳瑞,左振魁,张琪.慢性肾衰竭中医辨证分型与血清钙、磷水平的关系[J].光明中医,2011,26(8):1570-1571.
[19] 王永炎,严世芸.实用中医内科学[M].上海:上海科学技术出版社,2009:432.
[20] 朱刚,孙伟,张沙丽.138例血液透析患者抑郁状态与中医虚证的调查[J].中国中西医结合肾病杂志,2011,12(2):132-134.