终末期糖尿病肾病中医证素辨证调查研究
|
摘要
目的：糖尿病(diabetes mellitus, DM)最常见的慢性微血管并发症之一是糖尿病肾病(diabetic nephropathy, DN),同时也是终末期肾衰竭的首要原因。目前为止西医很难实现延缓糖尿病肾病发展进程的目的。中医药对DN的研究仍存在着辨证分型不规范、辨证分型难以体现糖尿病肾病自身独有的特点,缺乏流行病学研究等诸多缺点。本研究的目的是运用证素辨证方法观察终末期糖尿病肾病的病位、病性分布规律及病位、病性与各项西医化验指标的相关性分析,来探讨终末期糖尿病肾病的中医发展规律及临床病变特点,以此为中医辨证施治提供统一、规范的辨证标准,提高中医治疗效果,改善终末期糖尿病肾病患者生存质量,有效缓解症状,提供全面、客观的新的理论依据。
方法：严格纳入福建中医药大学附属第二人民医院和南京军区福州总院血液透析室符合纳入标准的血液透析患者,分为终末期糖尿病肾病组与终末期非糖尿病肾病组,病例采集时间2008年10月至2010年01月。运用朱文峰教授证素辨证理论观察两组患者病位、病性辨证规律及病位、病性与各项西医化验指标的相关性分析。
结果：以糖尿病为原发病的终末期肾病患者进入血液透析时血肌酐水平明显低于非糖尿病组；甲状旁腺激素、磷、胆固醇、脑利钠肽(brain natriuretic peptide, BNP)等指标糖尿病肾病组明显高于非糖尿病组；糖尿病肾病组血浆白蛋白、血红蛋白等指标明显低于非糖尿病组；糖尿病肾病组肾小球滤过率减退和肾小管功能受损程度较非糖尿病组严重；糖尿病肾病血液透析患者均已出现左心室肥大且左室重构,其中以向心性肥厚为主,依次为离心性肥厚、向心性重构,只有少数正常。
终末期糖尿病肾病显证病位以肾为主,其次为脾、肝、心、肺、肌肤、心神、胃。终末期糖尿病肾病显证病性以气虚为多见,其次为血虚、阳虚、阴虚、湿、痰、水停、津亏、热、精亏、气滞、血瘀；终末期糖尿病肾病前证病位以心为主,其次为肝、心神、肌肤、胃、胆、肺、脾、表、大肠。终末期糖尿病肾病前证病性以精亏为多见,其次为痰、寒、热、气滞、血瘀、燥、湿、动风、外风、水停、阳亢、津亏、阳虚、阴虚、血热。
各项西医化验指标与病位相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与肾、脾有显著相关性；血浆白蛋白与肾、脾有显著相关性；血红蛋白均与脾有显著相关性；血浆纤维蛋白原与肝、脾有显著相关性；BNP与心有显著相关性；胆固醇与脾有显著相关性。
各项西医化验指标与病性相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与气虚、血虚、阳虚、湿有显著相关性；血浆白蛋白与气虚、血虚有显著相关性；血红蛋白与气虚、血虚有显著相关性；血浆纤维蛋白原与气虚、血虚有显著相关性；BNP与气虚、阳虚有显著相关性。
结论：终末期糖尿病肾病证素辨证涉及的病位、病性明显多于非糖尿病组,故相关的临床表现更多,而某些病位或病性证素积分明显高于非糖尿病组,故相应的症状病变程度较非糖尿病组更严重。西医生化指标与某些病位、病性有显著相关性。因此,证素辨证能准确辨识当前病变病位证素和病性证素,将其客观化、规范化,是临床辨证的根本目的,对临床辨证论治有重要的意义。
Objective:Diabetes mellitus(DM)of the most common chronic micro vascular complic-ation of diabetic nephropathy(DN), is also the leading cause of end-stage renal failure. Western difficult to achieve so far delayed the purpose of the development process of diabetic nephropathy. DN of traditional Chinese medicine on syndrome differentiation still exist are not standardized, syndrome differentiation of diabetic nephropathy is difficult to reflect its own unique features, the lack of epidemiological studies and many other shortcomings. The purpose of this study is to use the card to observe the differentiation factors of diabetic nephropathy patients with end-stage position, disease distribution and disease-bit sexual, disease resistance and various indicators of the relevance of Western laboratory analysis in order to provide a unified, Differentiation Standard specification to improve effectiveness of Chinese medicine to improve the life of patients with end-stage diabetic nephropathy quality, effective symptom relief, to provide comprehensive and objective of the new theoretical basis.
Method:Strictly included in the Second People Hospital, and from Fujian Province, Fuzhou General Hospital of Nanjing Military Region, met the inclusion criteria hemodialysis center hemodialysis patients, case acquisition time from October 2008 to January 2010.Profe-ssor Zhu Wenfeng permit the use of dialectical theory of observation elements with end stage renal disease location, disease and disease-bit sexual differentiation rules, disease resistance and the Western analysis of the relevance of laboratory markers.
Result:With end-stage diabetic renal disease entering hemodialysis patients with serum creatinine levels were significantly lower than the control group; parathyroid hormone, phosphorus, cholesterol, BNP and other indicators of diabetic nephropathy was significantly higher than non-diabetic nephropathy group; diabetic nephropathy serum albumin, hemoglob-in and other indicators were significantly lower than non-diabetic nephropathy group; diabetic nephropathy decreased glomerular filtration rate and renal tubular function in the serious extent of the damage than the control group; diabetic nephropathy have appeared in hemodialysis patients left ventricular hypertrophy, and left ventricular remodeling and dominated by concentric hypertrophy, followed by eccentric hypertrophy, concentric remodeling, only a small number of normal.
End-stage diabetic nephropathy significant permit spaces to kidney disease mainly, followed by spleen, liver, heart, lung, skin, mind and stomach. End-stage diabetic nephropathy sexually explicit license to qi as a more common disease, followed by blood deficiency, yang and yin, wet, sputum, water stop, tianjin loss, heat, refined losses, qi stagnation, blood stasis; end-stage diabetic nephropathy spaces to heart disease before the card-based, followed by liver, mind, skin, stomach, gallbladder, lung, spleen, table, large intestine.
End-stage diabetic nephropathy patients before the certificate of loss with precision as the more common, followed by sputum, cold, heat, qi stagnation, blood stasis, dry, wet, moving wind, outside the wind, the water stop, yang kang, jin loss, yang, yin deficiency, blood heat.Laboratory indicators of the Western position correlation with disease:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine are kidney, spleen and heart were significantly correlated; serum albumin were with the kidney, spleen, significant correlation; hemoglobin and spleen were significantly correlated; plasma fibrinogen were liver and spleen were significantly correlated; BNP and heart were significantly correlated; cholesterol and spleen were significantly correlated.
Laboratory indicators of the Western analysis and disease-related:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine were qi deficiency, blood deficiency, yang deficiency, a significant correlation between wet; serum albumin were and qi, blood deficiency have significant correlation; hemoglobin and qi deficiency, blood deficiency significantly correlated; plasma fibrinogen were with qi deficiency, blood deficiency significantly correlated; BNP are and qi, yang and a significant correlation.
Conclusion:End stage renal disease syndrome factor differentiation involves bit sick of significantly more than non-diabetic group, it is more related to clinical manifestations, disease location or disease in some elements of evidence points higher than non-diabetic group, so the corresponding symptom severity than non-diabetic group, even more serious. Traditional biochemical and certain disease location, disease has significant correlation. Therefore, the card can accur-ately identify the current prime differentiation disease diseases slip proof factors and disease factors, be objective, standardized, clinical differentiation is the fundamental purpose of the clinical syndrome differentiation has important significance.
方法：严格纳入福建中医药大学附属第二人民医院和南京军区福州总院血液透析室符合纳入标准的血液透析患者,分为终末期糖尿病肾病组与终末期非糖尿病肾病组,病例采集时间2008年10月至2010年01月。运用朱文峰教授证素辨证理论观察两组患者病位、病性辨证规律及病位、病性与各项西医化验指标的相关性分析。
结果：以糖尿病为原发病的终末期肾病患者进入血液透析时血肌酐水平明显低于非糖尿病组；甲状旁腺激素、磷、胆固醇、脑利钠肽(brain natriuretic peptide, BNP)等指标糖尿病肾病组明显高于非糖尿病组；糖尿病肾病组血浆白蛋白、血红蛋白等指标明显低于非糖尿病组；糖尿病肾病组肾小球滤过率减退和肾小管功能受损程度较非糖尿病组严重；糖尿病肾病血液透析患者均已出现左心室肥大且左室重构,其中以向心性肥厚为主,依次为离心性肥厚、向心性重构,只有少数正常。
终末期糖尿病肾病显证病位以肾为主,其次为脾、肝、心、肺、肌肤、心神、胃。终末期糖尿病肾病显证病性以气虚为多见,其次为血虚、阳虚、阴虚、湿、痰、水停、津亏、热、精亏、气滞、血瘀；终末期糖尿病肾病前证病位以心为主,其次为肝、心神、肌肤、胃、胆、肺、脾、表、大肠。终末期糖尿病肾病前证病性以精亏为多见,其次为痰、寒、热、气滞、血瘀、燥、湿、动风、外风、水停、阳亢、津亏、阳虚、阴虚、血热。
各项西医化验指标与病位相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与肾、脾有显著相关性；血浆白蛋白与肾、脾有显著相关性；血红蛋白均与脾有显著相关性；血浆纤维蛋白原与肝、脾有显著相关性；BNP与心有显著相关性；胆固醇与脾有显著相关性。
各项西医化验指标与病性相关性分析：糖尿病肾病血液透析组及非糖尿病肾病组血肌酐与气虚、血虚、阳虚、湿有显著相关性；血浆白蛋白与气虚、血虚有显著相关性；血红蛋白与气虚、血虚有显著相关性；血浆纤维蛋白原与气虚、血虚有显著相关性；BNP与气虚、阳虚有显著相关性。
结论：终末期糖尿病肾病证素辨证涉及的病位、病性明显多于非糖尿病组,故相关的临床表现更多,而某些病位或病性证素积分明显高于非糖尿病组,故相应的症状病变程度较非糖尿病组更严重。西医生化指标与某些病位、病性有显著相关性。因此,证素辨证能准确辨识当前病变病位证素和病性证素,将其客观化、规范化,是临床辨证的根本目的,对临床辨证论治有重要的意义。
Objective:Diabetes mellitus(DM)of the most common chronic micro vascular complic-ation of diabetic nephropathy(DN), is also the leading cause of end-stage renal failure. Western difficult to achieve so far delayed the purpose of the development process of diabetic nephropathy. DN of traditional Chinese medicine on syndrome differentiation still exist are not standardized, syndrome differentiation of diabetic nephropathy is difficult to reflect its own unique features, the lack of epidemiological studies and many other shortcomings. The purpose of this study is to use the card to observe the differentiation factors of diabetic nephropathy patients with end-stage position, disease distribution and disease-bit sexual, disease resistance and various indicators of the relevance of Western laboratory analysis in order to provide a unified, Differentiation Standard specification to improve effectiveness of Chinese medicine to improve the life of patients with end-stage diabetic nephropathy quality, effective symptom relief, to provide comprehensive and objective of the new theoretical basis.
Method:Strictly included in the Second People Hospital, and from Fujian Province, Fuzhou General Hospital of Nanjing Military Region, met the inclusion criteria hemodialysis center hemodialysis patients, case acquisition time from October 2008 to January 2010.Profe-ssor Zhu Wenfeng permit the use of dialectical theory of observation elements with end stage renal disease location, disease and disease-bit sexual differentiation rules, disease resistance and the Western analysis of the relevance of laboratory markers.
Result:With end-stage diabetic renal disease entering hemodialysis patients with serum creatinine levels were significantly lower than the control group; parathyroid hormone, phosphorus, cholesterol, BNP and other indicators of diabetic nephropathy was significantly higher than non-diabetic nephropathy group; diabetic nephropathy serum albumin, hemoglob-in and other indicators were significantly lower than non-diabetic nephropathy group; diabetic nephropathy decreased glomerular filtration rate and renal tubular function in the serious extent of the damage than the control group; diabetic nephropathy have appeared in hemodialysis patients left ventricular hypertrophy, and left ventricular remodeling and dominated by concentric hypertrophy, followed by eccentric hypertrophy, concentric remodeling, only a small number of normal.
End-stage diabetic nephropathy significant permit spaces to kidney disease mainly, followed by spleen, liver, heart, lung, skin, mind and stomach. End-stage diabetic nephropathy sexually explicit license to qi as a more common disease, followed by blood deficiency, yang and yin, wet, sputum, water stop, tianjin loss, heat, refined losses, qi stagnation, blood stasis; end-stage diabetic nephropathy spaces to heart disease before the card-based, followed by liver, mind, skin, stomach, gallbladder, lung, spleen, table, large intestine.
End-stage diabetic nephropathy patients before the certificate of loss with precision as the more common, followed by sputum, cold, heat, qi stagnation, blood stasis, dry, wet, moving wind, outside the wind, the water stop, yang kang, jin loss, yang, yin deficiency, blood heat.Laboratory indicators of the Western position correlation with disease:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine are kidney, spleen and heart were significantly correlated; serum albumin were with the kidney, spleen, significant correlation; hemoglobin and spleen were significantly correlated; plasma fibrinogen were liver and spleen were significantly correlated; BNP and heart were significantly correlated; cholesterol and spleen were significantly correlated.
Laboratory indicators of the Western analysis and disease-related:diabetic nephropathy hemodialysis group and non-diabetic nephropathy and serum creatinine were qi deficiency, blood deficiency, yang deficiency, a significant correlation between wet; serum albumin were and qi, blood deficiency have significant correlation; hemoglobin and qi deficiency, blood deficiency significantly correlated; plasma fibrinogen were with qi deficiency, blood deficiency significantly correlated; BNP are and qi, yang and a significant correlation.
Conclusion:End stage renal disease syndrome factor differentiation involves bit sick of significantly more than non-diabetic group, it is more related to clinical manifestations, disease location or disease in some elements of evidence points higher than non-diabetic group, so the corresponding symptom severity than non-diabetic group, even more serious. Traditional biochemical and certain disease location, disease has significant correlation. Therefore, the card can accur-ately identify the current prime differentiation disease diseases slip proof factors and disease factors, be objective, standardized, clinical differentiation is the fundamental purpose of the clinical syndrome differentiation has important significance.
引文
[1]黎磊石.进一步重视糖尿病肾病的防治研究[J].中华医学杂志.1999,79.327—328.
[2]吕仁和.糖尿病肾病临床研究评述.北京中医药大学学报,1994：17(2)：2-6.
[3]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[4]成玉斌,罗仁,胡志飞.糖尿病肾病中医辨证分型荟萃分析[J].中国中医基础医学杂志,2000,6(5)：49.
[5]梁炜,李世华.糖尿病肾病的发病机理和辨治思路[J].四川中医,2003,21(7)：7—8.
[6]赵进喜,邓德强,李靖.糖尿病肾病相关中医病名考辩[J].南京中医药大学学报,2005,21(5)：288.
[7]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[8]李小会,董正华.糖尿病肾病病因病机的探讨[J].陕西中医.2005,26(6)：552—553.
[9]赵宗江,叶传蕙教授.治疗糖尿病肾病的思路与方法[J].中国中西医结合肾病杂志,2006,7(3)：129—132.
[10]王光义,中西医结合治疗糖尿病肾病的临床观察[J].时珍国医国药,2008,19(4)：1031—1032.
[11]韩吉淼,徐文清,刘春荣.程益春教授治疗糖尿病肾病的用药经验[J].中国中医药信息杂志,2001,8(8)：72.
[12]陈筱云,赵莉娟.从瘀论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[13]王长闵,高军,梁桂芳.中西医结合治疗糖尿病肾病肾功能不全[J].中医药研究,2000,16(4)：8—9.
[14]林志刚.温肾胶囊治疗糖尿病肾病31例[J].福建中医药,2001,32(3)：8.
[15]薛晓彤.糖尿病肾病辨证分型与客观指标研究概述[J].中国中医基础医学杂志,2006,12(12)：923.
[16]董荣芬.中老年2型糖尿病胰岛素敏感指数与中医辨证分型的研究[J].北京中医,2005,24(5)：299.
[17]宋美铃.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究[J].中国中医基础医学杂志,2005,11(3)：215.
[18]李桂芝.中医辨证治疗糖尿病肾病100例疗效观察[J].云南中医中药杂志,2007,28(1)：17.
[19]陈彼云,赵莉娟.从“瘀”论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[20]詹锐文.糖尿病肾病析义[J].辽宁中医杂志,2004.31(7)：566—567.
[21]叶任高.中西医结合肾脏病学[M].北京：人民卫生出版社,2003：305-307.
[22]王国芝,张莉,屈云.糖尿病肾病的中西医结合治疗的临床研究[J].现代中医药,2003,23(4)：36-38.
[23]谢宗昌.糖尿病肾病辨证施治心得[J].浙江中医,2003,47(3)：38—39.
[24]张庚良.糖尿病肾病的辨证治疗[J].河北中医,2005,27(8)：594—595.
[25]康红,刘志敏.辨证分型治疗糖尿病肾病84例[J].中国现代实用医学杂志,2005,4(3)：78-79.
[26]中华中医药学会肾病分会.《糖尿病肾病诊断、辨证分型及疗效评定标准(试行方案)》.
[27]王海燕.肾脏病学[M].第二版.北京：人民卫生出版社,1998：1388.
[28]国家技术监督局.中华人民共和国国家标准.中医临床诊疗术语疾病部分(GB/T16751.1-1997)9.14.2,肾系病类,P15.
[29]朱文峰.证素辨证学.北京：人民卫生出版社.2008.
[30]王生余.血清胱抑素C-评价肾功能的新指标[J].肾脏病与透析肾移植杂志,2006,4(15)：367.
[31]RobertsWL, Mouton L, Law TC, et al. Evaluation of nine antomated High-sensitivity C-reactive protein methods:implication for clinical and epidemiological application[J]. Clin Chem,2001,47(3):418-423.
[32]王梅.重视透析患者钙磷代谢紊乱及其骨病的控制[J].中国血液净化.2006；7(5)：349-350.
[33]刘为民,张名均,王宁.重庆医学[J].α1-微球蛋白、β2-微球蛋白、尿微量白蛋白测定对高血压病肾损害的评估[J].2002；2(31)：151-152.
[34]王青,刘卫红,冷峰.BNP在糖尿病肾病患者血浆中的变化[J].大连医科大学学报,2008,3(30).
[35]高艳霞,朝桂仙.浅析心肾相交.山西中医,1998,14(5)：6.
[36]郭晶晶,宋立群,宋业旭.运用心肾相关理论浅析慢性肾病心脏病变[J].长春中医药大学学报,2009,25(1)：5-6.
[37]赵岩,高权国,陈士铎.直接交通心肾法[J].中医药信息,2004,21(4)：42-44.
[38]吴成长.《内经》五脏阴阳区分的内涵及临床意义浅析[J].中医药学刊,2004,2(22).
[1]LIU ZHI-HONG.Diabetic nephropathy[J].Chin J Nephrol,2000.16:126-131.
[2]孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会[J].江苏中医,2002.23(5)：18
[3]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[4]林善锬.当代肾脏病学[M].上海：上海科技教育出版社,2001.581.
[5]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[6]成玉斌,罗仁,胡志飞.糖尿病肾病中医辨证分型荟萃分析[J].中国中医基础医学杂志,2000,6(5)：49.
[7]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[8]赵宗江,叶传蕙教授.治疗糖尿病肾病的思路与方法[J].中国中西医结合肾病杂志,2006,7(3)：129—132.
[9]李小会,董正华.糖尿病肾病病因病机的探讨[J].陕西中医.2005,26(6)：552—553.
[10]王光义,中西医结合治疗糖尿病肾病的临床观察[J].时珍国医国药,2008,19(4)：1031—1032.
[11]韩吉淼,徐文清,刘春荣,程益春教授治疗糖尿病肾病的用药经验[J].中国中医药信息杂志,2001,8(8)：72.
[12]陈筱云,赵莉娟.从瘀论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[13]王长闵,高军,梁桂芳.中西医结合治疗糖尿病肾病肾功能不全[J].中医药研究,2000,16(4)：8—9.
[14]林志刚.温肾胶囊治疗糖尿病肾病31例[J].福建中医药,2001,32(3)：8.
[15]刘绍屏.中医药治疗糖尿病肾病临床进展[J].吉林中医药,2003,3(4)：50.
[16]薛晓彤.糖尿病肾病辨证分型与客观指标研究概述[J].中国中医基础医学杂志,2006,12(12)：923.
[17]董荣芬.中老年2型糖尿病胰岛素敏感指数与中医辨证分型的研究[J].北京中医,2005,24(5)：299.
[18]宋美铃.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究[J].中国中医基础医学杂志,2005,11(3)：215.
[19]李桂芝.中医辨证治疗糖尿病肾病100例疗效观察[J].云南中医中药杂志,2007,28(1)：17.
[20]陈彼云,赵莉娟.从“瘀”论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[21]梁炜,李世华.糖尿病肾病的发病机理和辨治思路[J].四川中医,2003,21(7)：7—8.
[22]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[23]张泽生,袁遵宇,杨新军,等.益肾扶脾化瘀降浊法治疗糖尿病肾病64例临床观察[J].新中医,2001,33(11)：36—37.
[24]詹锐文.糖尿病肾病析义[J].辽宁中医杂志,2004.31(7)：566—567.
[25]叶任高.中西医结合肾脏病学[M].北京：人民卫生出版社,2003：305-307.
[26]王国芝,张莉,屈云.糖尿病肾病的中西医结合治疗的临床研究[J].现代中医药,2003,23(4)：36-38.
[27]谢宗昌.糖尿病肾病辨证施治心得[J].浙江中医,2003,47(3)：38—39.
[28]张庚良.糖尿病肾病的辨证治疗[J].河北中医,2005,27(8)：594—595.
[29]康红,刘志敏.辨证分型治疗糖尿病肾病84例[J].中国现代实用医学杂志,2005,4(3)：78-79.
[30]张万祥.消渴益肾汤治疗糖尿病肾病临床观察[J].辽宁中医药大学学报,2007,9(2)：12.
[31]党兰玉.益肾蠲毒汤治疗Ⅳ期糖尿病性肾病52例[J].陕西中医,2006,27(8)：916.
[32]周晓伶.滋阴益气丸对糖尿病肾病的治疗作用[J].长春中医药大学学报,2007,23(1)：35.
[33]张敏,张毅.保肾延本汤对糖尿病肾病尿蛋白含量的影响[J].中华实用中西医杂志,2006, 19(24)：2913.
[34]冉颖卓.益肾泄浊方治疗糖尿病肾病及对尿酸水平的影响[J].陕西中医,2006,27(12)：1482.
[2]吕仁和.糖尿病肾病临床研究评述.北京中医药大学学报,1994：17(2)：2-6.
[3]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[4]成玉斌,罗仁,胡志飞.糖尿病肾病中医辨证分型荟萃分析[J].中国中医基础医学杂志,2000,6(5)：49.
[5]梁炜,李世华.糖尿病肾病的发病机理和辨治思路[J].四川中医,2003,21(7)：7—8.
[6]赵进喜,邓德强,李靖.糖尿病肾病相关中医病名考辩[J].南京中医药大学学报,2005,21(5)：288.
[7]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[8]李小会,董正华.糖尿病肾病病因病机的探讨[J].陕西中医.2005,26(6)：552—553.
[9]赵宗江,叶传蕙教授.治疗糖尿病肾病的思路与方法[J].中国中西医结合肾病杂志,2006,7(3)：129—132.
[10]王光义,中西医结合治疗糖尿病肾病的临床观察[J].时珍国医国药,2008,19(4)：1031—1032.
[11]韩吉淼,徐文清,刘春荣.程益春教授治疗糖尿病肾病的用药经验[J].中国中医药信息杂志,2001,8(8)：72.
[12]陈筱云,赵莉娟.从瘀论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[13]王长闵,高军,梁桂芳.中西医结合治疗糖尿病肾病肾功能不全[J].中医药研究,2000,16(4)：8—9.
[14]林志刚.温肾胶囊治疗糖尿病肾病31例[J].福建中医药,2001,32(3)：8.
[15]薛晓彤.糖尿病肾病辨证分型与客观指标研究概述[J].中国中医基础医学杂志,2006,12(12)：923.
[16]董荣芬.中老年2型糖尿病胰岛素敏感指数与中医辨证分型的研究[J].北京中医,2005,24(5)：299.
[17]宋美铃.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究[J].中国中医基础医学杂志,2005,11(3)：215.
[18]李桂芝.中医辨证治疗糖尿病肾病100例疗效观察[J].云南中医中药杂志,2007,28(1)：17.
[19]陈彼云,赵莉娟.从“瘀”论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[20]詹锐文.糖尿病肾病析义[J].辽宁中医杂志,2004.31(7)：566—567.
[21]叶任高.中西医结合肾脏病学[M].北京：人民卫生出版社,2003：305-307.
[22]王国芝,张莉,屈云.糖尿病肾病的中西医结合治疗的临床研究[J].现代中医药,2003,23(4)：36-38.
[23]谢宗昌.糖尿病肾病辨证施治心得[J].浙江中医,2003,47(3)：38—39.
[24]张庚良.糖尿病肾病的辨证治疗[J].河北中医,2005,27(8)：594—595.
[25]康红,刘志敏.辨证分型治疗糖尿病肾病84例[J].中国现代实用医学杂志,2005,4(3)：78-79.
[26]中华中医药学会肾病分会.《糖尿病肾病诊断、辨证分型及疗效评定标准(试行方案)》.
[27]王海燕.肾脏病学[M].第二版.北京：人民卫生出版社,1998：1388.
[28]国家技术监督局.中华人民共和国国家标准.中医临床诊疗术语疾病部分(GB/T16751.1-1997)9.14.2,肾系病类,P15.
[29]朱文峰.证素辨证学.北京：人民卫生出版社.2008.
[30]王生余.血清胱抑素C-评价肾功能的新指标[J].肾脏病与透析肾移植杂志,2006,4(15)：367.
[31]RobertsWL, Mouton L, Law TC, et al. Evaluation of nine antomated High-sensitivity C-reactive protein methods:implication for clinical and epidemiological application[J]. Clin Chem,2001,47(3):418-423.
[32]王梅.重视透析患者钙磷代谢紊乱及其骨病的控制[J].中国血液净化.2006；7(5)：349-350.
[33]刘为民,张名均,王宁.重庆医学[J].α1-微球蛋白、β2-微球蛋白、尿微量白蛋白测定对高血压病肾损害的评估[J].2002；2(31)：151-152.
[34]王青,刘卫红,冷峰.BNP在糖尿病肾病患者血浆中的变化[J].大连医科大学学报,2008,3(30).
[35]高艳霞,朝桂仙.浅析心肾相交.山西中医,1998,14(5)：6.
[36]郭晶晶,宋立群,宋业旭.运用心肾相关理论浅析慢性肾病心脏病变[J].长春中医药大学学报,2009,25(1)：5-6.
[37]赵岩,高权国,陈士铎.直接交通心肾法[J].中医药信息,2004,21(4)：42-44.
[38]吴成长.《内经》五脏阴阳区分的内涵及临床意义浅析[J].中医药学刊,2004,2(22).
[1]LIU ZHI-HONG.Diabetic nephropathy[J].Chin J Nephrol,2000.16:126-131.
[2]孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会[J].江苏中医,2002.23(5)：18
[3]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[4]林善锬.当代肾脏病学[M].上海：上海科技教育出版社,2001.581.
[5]封翠云.糖尿病肾病的中医病名探讨[J].国医论坛,2007,22(2)：22.
[6]成玉斌,罗仁,胡志飞.糖尿病肾病中医辨证分型荟萃分析[J].中国中医基础医学杂志,2000,6(5)：49.
[7]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[8]赵宗江,叶传蕙教授.治疗糖尿病肾病的思路与方法[J].中国中西医结合肾病杂志,2006,7(3)：129—132.
[9]李小会,董正华.糖尿病肾病病因病机的探讨[J].陕西中医.2005,26(6)：552—553.
[10]王光义,中西医结合治疗糖尿病肾病的临床观察[J].时珍国医国药,2008,19(4)：1031—1032.
[11]韩吉淼,徐文清,刘春荣,程益春教授治疗糖尿病肾病的用药经验[J].中国中医药信息杂志,2001,8(8)：72.
[12]陈筱云,赵莉娟.从瘀论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[13]王长闵,高军,梁桂芳.中西医结合治疗糖尿病肾病肾功能不全[J].中医药研究,2000,16(4)：8—9.
[14]林志刚.温肾胶囊治疗糖尿病肾病31例[J].福建中医药,2001,32(3)：8.
[15]刘绍屏.中医药治疗糖尿病肾病临床进展[J].吉林中医药,2003,3(4)：50.
[16]薛晓彤.糖尿病肾病辨证分型与客观指标研究概述[J].中国中医基础医学杂志,2006,12(12)：923.
[17]董荣芬.中老年2型糖尿病胰岛素敏感指数与中医辨证分型的研究[J].北京中医,2005,24(5)：299.
[18]宋美铃.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究[J].中国中医基础医学杂志,2005,11(3)：215.
[19]李桂芝.中医辨证治疗糖尿病肾病100例疗效观察[J].云南中医中药杂志,2007,28(1)：17.
[20]陈彼云,赵莉娟.从“瘀”论治糖尿病肾病[J].中国中医基础医学杂志,2002,8(7)：53—54.
[21]梁炜,李世华.糖尿病肾病的发病机理和辨治思路[J].四川中医,2003,21(7)：7—8.
[22]张振忠,豆小妮,赵宏波等.参芪糖肾安胶囊治疗糖尿病肾病的动物实验研究[J].现代中医药,2007,27(3)：69—71.
[23]张泽生,袁遵宇,杨新军,等.益肾扶脾化瘀降浊法治疗糖尿病肾病64例临床观察[J].新中医,2001,33(11)：36—37.
[24]詹锐文.糖尿病肾病析义[J].辽宁中医杂志,2004.31(7)：566—567.
[25]叶任高.中西医结合肾脏病学[M].北京：人民卫生出版社,2003：305-307.
[26]王国芝,张莉,屈云.糖尿病肾病的中西医结合治疗的临床研究[J].现代中医药,2003,23(4)：36-38.
[27]谢宗昌.糖尿病肾病辨证施治心得[J].浙江中医,2003,47(3)：38—39.
[28]张庚良.糖尿病肾病的辨证治疗[J].河北中医,2005,27(8)：594—595.
[29]康红,刘志敏.辨证分型治疗糖尿病肾病84例[J].中国现代实用医学杂志,2005,4(3)：78-79.
[30]张万祥.消渴益肾汤治疗糖尿病肾病临床观察[J].辽宁中医药大学学报,2007,9(2)：12.
[31]党兰玉.益肾蠲毒汤治疗Ⅳ期糖尿病性肾病52例[J].陕西中医,2006,27(8)：916.
[32]周晓伶.滋阴益气丸对糖尿病肾病的治疗作用[J].长春中医药大学学报,2007,23(1)：35.
[33]张敏,张毅.保肾延本汤对糖尿病肾病尿蛋白含量的影响[J].中华实用中西医杂志,2006, 19(24)：2913.
[34]冉颖卓.益肾泄浊方治疗糖尿病肾病及对尿酸水平的影响[J].陕西中医,2006,27(12)：1482.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |