糖尿病肾病证候动态变化与肾功會I生存质量关系及中医药干预研究
|
摘要
目的：研究早期和临床期糖尿病肾病(diabetic nephropathy, DN)证候动态变化与重要的肾功能指标和生存质量的关系,以及不同干预方案对糖尿病肾病各证素(证候要素)中每个症状动态变化的影响,为揭示糖尿病肾病中医证候内涵提供依据,为糖尿病肾病中医证候变化及规范化研究提供更多比较可靠的数据。
方法：依托国家“十一五”科技支撑计划--《中医药全程干预糖尿病肾病进程综合方案研究》,病例来源自北京中医药大学东直门医院、北京大学第一医院等10家研究单位,按照严格制定的调查表对早期和临床DN患者的一般情况、合并症、0时点和中西医干预后8个时点(共2年)的中医四诊信息、生化指标等及生存质量评分进行收集,录入数据库,并审核无误。
研究一：研究两种不同干预后早期和临床期DN7个证素的34个症状在9个时点的变化趋势；包括积分差值(开始入组时得分与每个时点得分的差值)检验和秩和检验。
研究二：对早期和临床期DN证候9个时点的动态变化与生存质量评分变化的关系进行研究,生存质量量表用糖尿病特异性生存质量量表修订版(Adjusted Diabetes of Life Measure, A-DQOL),并用线性混合效应模型对多次重复测量的纵向数据进行回归分析,在考虑的变量中,除了中医证候积分之外,也加入了年龄、性别、并发症等变量,一起进行了分析
研究三：对早期和临床期DN证候9个时点的动态变化与主要肾功能指标变化之间的关系进行研究,用线性混合效应模型对多次重复测量的纵向数据进行回归分析,变量中加入了年龄、性别、并发症等可能影响肾功能指标的变量,一起进行了分析。
结果：
研究一：
1在9个时点,两种不同干预对早期和临床期糖尿病肾病34个症状(7个证素)积分的变化对比显示,中医治疗组和西药厄贝沙坦组均能改善中医症状积分,而在不少时点,中医药组的改善程度优于厄贝沙坦组,两组比较有显著差异；而在其他时点(进行治疗后),两组比较无显著差异。在观察结束时点(8时点),有18个症状的积分改善中药组优于厄贝沙坦组,两组比较有显著差异。
2对一些症状积分的改善,中药组明显优于厄贝沙坦组。症状积分差值研究中,在治疗后所有8个时点,中药组对痰湿4(全身困倦)的改善均优于厄贝沙坦组,两组比较有显著差异；在第5个疗程结束之外的7个时点中药组对血瘀2(口唇舌紫,或紫暗、瘀斑、舌下络脉色紫怒张)的改善均优于厄贝沙坦组,两组比较有显著差异
3在第2、3、4疗程期间,只有6个症状在共6个时点,中药组的改善程度优于厄贝沙坦组,在各时点两组比较有显著差异；而在第6、7、8疗程期间,有24个症状在共47个时点,中药组的改善程度优于厄贝沙坦组,在各时点两组比较有显著差异
研究二：
1DN证候总积分变化与DQOL量表总评分变化的相关性：DN证候总积分变化与DQOL量表总评分的变化呈正相关,患有高脂血症与DQOL量表总评分变化呈负相关
2DN证候总积分变化与DQOL量表四个分功能评分变化的相关性：(1)DN证候总积分变化与DQOL量表生理功能影响评分变化呈正相关。(2)DN证候总积分变化与DQOL量表心理/精神影响评分变化呈正相关,年龄、患有高脂血症与心理/精神影响评分变化呈负相关。(3)DN证候总积分变化与DQOL量表社会关系影响评分变化呈正相关,患有冠心病、高脂血症与社会关系影响评分变化呈负相关。(4)DN证候总积分变化与DQOL量表治疗对患者的影响评分变化呈正相关
研究三：
1DN证候总积分变化与肾功能指标变化的相关性：(1)年龄、患有高血压与GFR的变化呈负相关。DN证候总积分变化与GFR的变化关系密切度不足(2)证候总积分变化、年龄与BUN的变化呈正相关。(3)年龄、患有高血压与Scr的变化呈正相关。性别与Scr变化呈负相关。DN证候总积分变化与Scr变化关系密切度不足。(4)DN证候总积分变化、患有高血压与UAER的变化呈正相关
2DN各证素总积分变化与肾功能指标变化的相关性：(1)阳虚证素的总积分变化、年龄、患有高血压与GFR的变化呈负相关。(2)气虚证素、血虚证素、阳虚证素、痰湿证素、湿浊证素的总积分变化、年龄与BUN的变化呈正相关。(3)气虚证素与阳虚证素的总积分变化、年龄、患有高血压与Scr的变化呈正相关,性别与Scr的变化呈负相关。(4)患有高血压与UAER的变化呈正相关,所有各证素总积分变化与UAER的变化关系密切度不足
结论：
1在9个时点,对比了两种不同干预方案对糖尿病肾病34个症状的积分变化,在症状积分研究层面证实了饮食治疗、现代医学对症治疗基础上的中医药治疗比厄贝沙坦治疗组有优势,与证候疗效结果相符合。另外,症状动态变化研究显示,中医药治疗并非在所有时点,对所有症状的改善均优于厄贝沙坦组,而对某些症状的改善程度更突出,值得进一步深入研究。分析中医药组改善更加突出的时间分布,在后半疗程明显多见,提示应该重视中医药的长疗程治疗。
2本研究提示,DN证候总积分变化与DQOL量表评分变化相关,表明了中医证候的改善能体现患者生存质量的改善,说明相关生存质量研究可以作为中医证候研究的重要补充,有助于中医药疗效的客观评价以及中医证候的规范化。
3DN证候变化与肾功能指标变化的相关性研究提示,BUN、Scr等代谢产物与气虚证素与阳虚证素等正虚证候也可能相关,与把代谢产物更多与痰湿、湿浊相关的传统认识不同。说明在糖尿病肾病的后期可能因虚致实的病机比较突出,治疗中不仅要重视泄浊解毒,而且也要强调固护正气,以达到扶正祛邪的目的；也说明了在重视扶助正气的基础上泄浊解毒、化瘀散结的治疗组处方组方思想的合理性和科学性。本研究也有助于糖尿病肾病中医证候本质的进一步的探索。
Objective:To investigate the relationship between dynamic changes of syndromes in the early and clinical stages of diabetic nephropathy (DN) and important parameters of renal function and quality of life, and the effects of different intervention protocols on dynamic changes of each symptom in the elements of syndromes of DN, in order to provide evidence for the understanding of the nature of traditional Chinese medicine (TCM) syndromes in DN, and provide more reliable evidence for the study on standardization and changes of TCM syndromes in DN.
Methods:With the support from "11th five-year" National Key
Technology Research and Development Program-the Study on the Comprehensive Protocol of Whole-course TCM Intervention for the Development of DN, the cases were enrolled from10institutions (Dongzhimen Hospital of Beijing University of Chinese Traditional Medicine and Peking University First Hospital etc.); according to survey forms established strictly, the general condition, comorbidities, the information of four TCM diagnostic methods at zero time point and8time points after interventions of TCM and western med i c ine(a total of2years), biochemical indexes and scores of quality of life in patients at early and clinical stages of DN were collected, input into the database, and examined and verified unmistakably.
First study:The change trend of34symptoms of7syndrome elements at the early and clinical stages of DN after two different kinds of intervention at9time points was examined, including score differences (the difference between the score at the enrollment and that at each time point) and rank sum test.
Second study:the relationship between dynamic changes of syndromes in early and clinical stages of DN at9time points and score changes of quality of life were examined. The ad justed diabetes of life measure (A-DQOL) was used as the scale for quality of life, and linear mixed effects model was used for regression analysis of longitudinal data being measured repeatedly; in terms of variables being considered, besides score of TCM syndromes, other variables, such as age, sex and complications, were also analyzed together.
Third study:the relationship between dynamic changes of syndromes in early and clinical stages of DN at9time points and changes of major parameters of renal function was examined. Linear mixed effects model was used for regression analysis of longitudinal data being measured repeatedly, and variables that may affect the parameters of renal function, such as age, sex and complications, were also analyzed together.
Results
First study:
1At9time points, the comparison of score changes of34symptoms at early and clinical stages of DN (7syndrome elements) by two different interventions showed that, the symptom scores of TCM were improved in both groups, but at some time points, the improvement was greater in TCM group than that in the irbesartan group with significant differences between the two groups; but at other time points (after treatment), there was no significant difference between these two groups. At the time point of the end of observation (time point of8), the improvement of scores of18symptoms in TCM group was greater than that in irbesartan group, with significant difference.
2The score improvement of some symptoms in TCM group was greater than that in irbesartan group. In terms of score difference of symptoms, the improvement of phlegm-dampness4(fatigue of whole body) in TCM group was greater than that in irbesartan group, with significant difference, at all of8time points after treatment; at7time points after the end of the fifth course of treatment, the improvement of blood stasis(purple or dark purple lips and tongue, petechia, purple and engorged sublingual collaterals) in TCM group was greater than that in irbesartan group, with significant difference.
3During the2nd, third and fourth course of treatment, the improvement of only6symptoms in TCM group was greater than that in irbesartan group at6time points, with significant differences at each time point; however, during the6th,7th and8th course of treatment, the improvement of24symptoms in TCM group was greater than that in irbesartan group at47time points, with significant differences at each time point.
Second Study:
1The correlation between the change of total score of DN syndromes and that of DQOL:The change of total score of DN syndromes was positively correlated with that of DQOL, and hyper1ipidemia in patients was negatively correlated with the change of total score of DQOL.
2The correlation between the change of total score of DN syndromes and the score changes of four sub-functions of DQOL:1.The change of total score of DN syndrome was positively correlated with the score change of effects of physiologic function in DQOL.2. The change of total score of DN syndromes was positively correlated with the score change of psychological/mental effects in DQOL, and age, hyper1ipidemia in patients were negatively correlated with the score change of psychological/mental effects.3. The change of total score of DN syndromes was positively correlated with the score change of effects of social relationship in DQOL, and age, hyperlipidemia and coronary heart disease in patients were negatively correlated with the score change of effects of social relationship.4. The change of total score of DN syndromes was positively correlated with the effects of treatment on patients in DQOL
Third Study:
1The correlation between the change of total score of DN syndromes and changes of parameters of renal function:1. Age, and hypertension in patients were negatively correlated with the change of GFR. The change of total score of DN syndromes was not closely related with the change of GFR.2. The change of total score of syndromes and age were positively correlated with the change of BUN.3. Age and hypertension in patients were positively correlated with the change of Scr. Sex was negatively correlated with the change of Scr. The change of total score of DN syndromes was not closely related with the change of Scr.4. The change of total score of DN syndromes and hypertension in patients were positively correlated with the change of urinary albumin excretion rate (UAER).
2The correlation between the changes of total scores of DN syndrome elements and the changes of parameters of renal function:1. The change of total score of yang-deficiency syndrome elements, age and hypertension in patients were negatively correlated with the change of GFR.2. The total score changes of syndrome elements of qi-deficiency, blood-deficiency, yang-deficiency, phlegm-dampness and damp-turbidity, sex, and hypertension in patients were positively correlated with the change of BUN.3. The total score change of syndrome elements of qi-deficiency and yang-deficiency, age and hypertension in patients were positively correlated with the change of Scr, and sex was negatively correlated with the change of Scr.4. Hypertension in patients was positively correlated with the change of UAER, and the change of total score of all syndrome elements was not closely related with the change of UAER.
Conclus ion:
1In terms of symptom score, the comparison of score changes of34DN symptoms by two different intervention protocols at9time points demonstrated that TCM treatment was better than irbesartanon the basis of diet therapy and symptomatic treatment of modern medicine, which was in accordance with the results of syndrome efficacy. In addition, the study on the dynamic changes of symptoms showed that the improvement of all symptoms by TCM was not greater than that by irbesartan at all time points, but the improvement of some symptoms by TCM was more prominent, which should be further investigated. In terms of the temporal distribution of the improvement by TCM, it was more often significant during the latter half of treatment course, which indicated that the long-term treatment of TCM should be emphasized.
2The study indicated that the change of total score of DN syndromes was correlated with the score change of DQOL, which demonstrated that the improvement of TCM syndromes could reflect that of quality of life in patients and related study on quality of life could be used as important supplement for the study of TCM syndrome and be helpful for the objective evaluation of TCM efficacy and standardization of TCM syndrome.
3The correlational study between the change of DN syndromes and the change of parameters of renal function indicated that, the metabolites, such as BUN and Scr may also be related with syndromes of healthy energy deficiency, such as qi-deficiency and yang-deficiency, which was different from the traditional concept that the metabolites were more related with phlegm-dampness and damp-turbidity. This showed that the pathogenesis of excess due to deficiency was more prominent in the late stage of DN, so during the treatment not only dispelling turbidity and detoxification should be emphasized, but also strengthening healthy-qi should be stressed, in order to strengthen vital qi to eliminate pathogenic factors; it also demonstrated the rationality and scientificness of the concept of prescription that the treatment of dissolving stasis and softening lump should be established with the emphasis on the strengthening of health-qi. The study is also helpful for further investigation into the nature of TCM syndromes of DN.
方法：依托国家“十一五”科技支撑计划--《中医药全程干预糖尿病肾病进程综合方案研究》,病例来源自北京中医药大学东直门医院、北京大学第一医院等10家研究单位,按照严格制定的调查表对早期和临床DN患者的一般情况、合并症、0时点和中西医干预后8个时点(共2年)的中医四诊信息、生化指标等及生存质量评分进行收集,录入数据库,并审核无误。
研究一：研究两种不同干预后早期和临床期DN7个证素的34个症状在9个时点的变化趋势；包括积分差值(开始入组时得分与每个时点得分的差值)检验和秩和检验。
研究二：对早期和临床期DN证候9个时点的动态变化与生存质量评分变化的关系进行研究,生存质量量表用糖尿病特异性生存质量量表修订版(Adjusted Diabetes of Life Measure, A-DQOL),并用线性混合效应模型对多次重复测量的纵向数据进行回归分析,在考虑的变量中,除了中医证候积分之外,也加入了年龄、性别、并发症等变量,一起进行了分析
研究三：对早期和临床期DN证候9个时点的动态变化与主要肾功能指标变化之间的关系进行研究,用线性混合效应模型对多次重复测量的纵向数据进行回归分析,变量中加入了年龄、性别、并发症等可能影响肾功能指标的变量,一起进行了分析。
结果：
研究一：
1在9个时点,两种不同干预对早期和临床期糖尿病肾病34个症状(7个证素)积分的变化对比显示,中医治疗组和西药厄贝沙坦组均能改善中医症状积分,而在不少时点,中医药组的改善程度优于厄贝沙坦组,两组比较有显著差异；而在其他时点(进行治疗后),两组比较无显著差异。在观察结束时点(8时点),有18个症状的积分改善中药组优于厄贝沙坦组,两组比较有显著差异。
2对一些症状积分的改善,中药组明显优于厄贝沙坦组。症状积分差值研究中,在治疗后所有8个时点,中药组对痰湿4(全身困倦)的改善均优于厄贝沙坦组,两组比较有显著差异；在第5个疗程结束之外的7个时点中药组对血瘀2(口唇舌紫,或紫暗、瘀斑、舌下络脉色紫怒张)的改善均优于厄贝沙坦组,两组比较有显著差异
3在第2、3、4疗程期间,只有6个症状在共6个时点,中药组的改善程度优于厄贝沙坦组,在各时点两组比较有显著差异；而在第6、7、8疗程期间,有24个症状在共47个时点,中药组的改善程度优于厄贝沙坦组,在各时点两组比较有显著差异
研究二：
1DN证候总积分变化与DQOL量表总评分变化的相关性：DN证候总积分变化与DQOL量表总评分的变化呈正相关,患有高脂血症与DQOL量表总评分变化呈负相关
2DN证候总积分变化与DQOL量表四个分功能评分变化的相关性：(1)DN证候总积分变化与DQOL量表生理功能影响评分变化呈正相关。(2)DN证候总积分变化与DQOL量表心理/精神影响评分变化呈正相关,年龄、患有高脂血症与心理/精神影响评分变化呈负相关。(3)DN证候总积分变化与DQOL量表社会关系影响评分变化呈正相关,患有冠心病、高脂血症与社会关系影响评分变化呈负相关。(4)DN证候总积分变化与DQOL量表治疗对患者的影响评分变化呈正相关
研究三：
1DN证候总积分变化与肾功能指标变化的相关性：(1)年龄、患有高血压与GFR的变化呈负相关。DN证候总积分变化与GFR的变化关系密切度不足(2)证候总积分变化、年龄与BUN的变化呈正相关。(3)年龄、患有高血压与Scr的变化呈正相关。性别与Scr变化呈负相关。DN证候总积分变化与Scr变化关系密切度不足。(4)DN证候总积分变化、患有高血压与UAER的变化呈正相关
2DN各证素总积分变化与肾功能指标变化的相关性：(1)阳虚证素的总积分变化、年龄、患有高血压与GFR的变化呈负相关。(2)气虚证素、血虚证素、阳虚证素、痰湿证素、湿浊证素的总积分变化、年龄与BUN的变化呈正相关。(3)气虚证素与阳虚证素的总积分变化、年龄、患有高血压与Scr的变化呈正相关,性别与Scr的变化呈负相关。(4)患有高血压与UAER的变化呈正相关,所有各证素总积分变化与UAER的变化关系密切度不足
结论：
1在9个时点,对比了两种不同干预方案对糖尿病肾病34个症状的积分变化,在症状积分研究层面证实了饮食治疗、现代医学对症治疗基础上的中医药治疗比厄贝沙坦治疗组有优势,与证候疗效结果相符合。另外,症状动态变化研究显示,中医药治疗并非在所有时点,对所有症状的改善均优于厄贝沙坦组,而对某些症状的改善程度更突出,值得进一步深入研究。分析中医药组改善更加突出的时间分布,在后半疗程明显多见,提示应该重视中医药的长疗程治疗。
2本研究提示,DN证候总积分变化与DQOL量表评分变化相关,表明了中医证候的改善能体现患者生存质量的改善,说明相关生存质量研究可以作为中医证候研究的重要补充,有助于中医药疗效的客观评价以及中医证候的规范化。
3DN证候变化与肾功能指标变化的相关性研究提示,BUN、Scr等代谢产物与气虚证素与阳虚证素等正虚证候也可能相关,与把代谢产物更多与痰湿、湿浊相关的传统认识不同。说明在糖尿病肾病的后期可能因虚致实的病机比较突出,治疗中不仅要重视泄浊解毒,而且也要强调固护正气,以达到扶正祛邪的目的；也说明了在重视扶助正气的基础上泄浊解毒、化瘀散结的治疗组处方组方思想的合理性和科学性。本研究也有助于糖尿病肾病中医证候本质的进一步的探索。
Objective:To investigate the relationship between dynamic changes of syndromes in the early and clinical stages of diabetic nephropathy (DN) and important parameters of renal function and quality of life, and the effects of different intervention protocols on dynamic changes of each symptom in the elements of syndromes of DN, in order to provide evidence for the understanding of the nature of traditional Chinese medicine (TCM) syndromes in DN, and provide more reliable evidence for the study on standardization and changes of TCM syndromes in DN.
Methods:With the support from "11th five-year" National Key
Technology Research and Development Program-the Study on the Comprehensive Protocol of Whole-course TCM Intervention for the Development of DN, the cases were enrolled from10institutions (Dongzhimen Hospital of Beijing University of Chinese Traditional Medicine and Peking University First Hospital etc.); according to survey forms established strictly, the general condition, comorbidities, the information of four TCM diagnostic methods at zero time point and8time points after interventions of TCM and western med i c ine(a total of2years), biochemical indexes and scores of quality of life in patients at early and clinical stages of DN were collected, input into the database, and examined and verified unmistakably.
First study:The change trend of34symptoms of7syndrome elements at the early and clinical stages of DN after two different kinds of intervention at9time points was examined, including score differences (the difference between the score at the enrollment and that at each time point) and rank sum test.
Second study:the relationship between dynamic changes of syndromes in early and clinical stages of DN at9time points and score changes of quality of life were examined. The ad justed diabetes of life measure (A-DQOL) was used as the scale for quality of life, and linear mixed effects model was used for regression analysis of longitudinal data being measured repeatedly; in terms of variables being considered, besides score of TCM syndromes, other variables, such as age, sex and complications, were also analyzed together.
Third study:the relationship between dynamic changes of syndromes in early and clinical stages of DN at9time points and changes of major parameters of renal function was examined. Linear mixed effects model was used for regression analysis of longitudinal data being measured repeatedly, and variables that may affect the parameters of renal function, such as age, sex and complications, were also analyzed together.
Results
First study:
1At9time points, the comparison of score changes of34symptoms at early and clinical stages of DN (7syndrome elements) by two different interventions showed that, the symptom scores of TCM were improved in both groups, but at some time points, the improvement was greater in TCM group than that in the irbesartan group with significant differences between the two groups; but at other time points (after treatment), there was no significant difference between these two groups. At the time point of the end of observation (time point of8), the improvement of scores of18symptoms in TCM group was greater than that in irbesartan group, with significant difference.
2The score improvement of some symptoms in TCM group was greater than that in irbesartan group. In terms of score difference of symptoms, the improvement of phlegm-dampness4(fatigue of whole body) in TCM group was greater than that in irbesartan group, with significant difference, at all of8time points after treatment; at7time points after the end of the fifth course of treatment, the improvement of blood stasis(purple or dark purple lips and tongue, petechia, purple and engorged sublingual collaterals) in TCM group was greater than that in irbesartan group, with significant difference.
3During the2nd, third and fourth course of treatment, the improvement of only6symptoms in TCM group was greater than that in irbesartan group at6time points, with significant differences at each time point; however, during the6th,7th and8th course of treatment, the improvement of24symptoms in TCM group was greater than that in irbesartan group at47time points, with significant differences at each time point.
Second Study:
1The correlation between the change of total score of DN syndromes and that of DQOL:The change of total score of DN syndromes was positively correlated with that of DQOL, and hyper1ipidemia in patients was negatively correlated with the change of total score of DQOL.
2The correlation between the change of total score of DN syndromes and the score changes of four sub-functions of DQOL:1.The change of total score of DN syndrome was positively correlated with the score change of effects of physiologic function in DQOL.2. The change of total score of DN syndromes was positively correlated with the score change of psychological/mental effects in DQOL, and age, hyper1ipidemia in patients were negatively correlated with the score change of psychological/mental effects.3. The change of total score of DN syndromes was positively correlated with the score change of effects of social relationship in DQOL, and age, hyperlipidemia and coronary heart disease in patients were negatively correlated with the score change of effects of social relationship.4. The change of total score of DN syndromes was positively correlated with the effects of treatment on patients in DQOL
Third Study:
1The correlation between the change of total score of DN syndromes and changes of parameters of renal function:1. Age, and hypertension in patients were negatively correlated with the change of GFR. The change of total score of DN syndromes was not closely related with the change of GFR.2. The change of total score of syndromes and age were positively correlated with the change of BUN.3. Age and hypertension in patients were positively correlated with the change of Scr. Sex was negatively correlated with the change of Scr. The change of total score of DN syndromes was not closely related with the change of Scr.4. The change of total score of DN syndromes and hypertension in patients were positively correlated with the change of urinary albumin excretion rate (UAER).
2The correlation between the changes of total scores of DN syndrome elements and the changes of parameters of renal function:1. The change of total score of yang-deficiency syndrome elements, age and hypertension in patients were negatively correlated with the change of GFR.2. The total score changes of syndrome elements of qi-deficiency, blood-deficiency, yang-deficiency, phlegm-dampness and damp-turbidity, sex, and hypertension in patients were positively correlated with the change of BUN.3. The total score change of syndrome elements of qi-deficiency and yang-deficiency, age and hypertension in patients were positively correlated with the change of Scr, and sex was negatively correlated with the change of Scr.4. Hypertension in patients was positively correlated with the change of UAER, and the change of total score of all syndrome elements was not closely related with the change of UAER.
Conclus ion:
1In terms of symptom score, the comparison of score changes of34DN symptoms by two different intervention protocols at9time points demonstrated that TCM treatment was better than irbesartanon the basis of diet therapy and symptomatic treatment of modern medicine, which was in accordance with the results of syndrome efficacy. In addition, the study on the dynamic changes of symptoms showed that the improvement of all symptoms by TCM was not greater than that by irbesartan at all time points, but the improvement of some symptoms by TCM was more prominent, which should be further investigated. In terms of the temporal distribution of the improvement by TCM, it was more often significant during the latter half of treatment course, which indicated that the long-term treatment of TCM should be emphasized.
2The study indicated that the change of total score of DN syndromes was correlated with the score change of DQOL, which demonstrated that the improvement of TCM syndromes could reflect that of quality of life in patients and related study on quality of life could be used as important supplement for the study of TCM syndrome and be helpful for the objective evaluation of TCM efficacy and standardization of TCM syndrome.
3The correlational study between the change of DN syndromes and the change of parameters of renal function indicated that, the metabolites, such as BUN and Scr may also be related with syndromes of healthy energy deficiency, such as qi-deficiency and yang-deficiency, which was different from the traditional concept that the metabolites were more related with phlegm-dampness and damp-turbidity. This showed that the pathogenesis of excess due to deficiency was more prominent in the late stage of DN, so during the treatment not only dispelling turbidity and detoxification should be emphasized, but also strengthening healthy-qi should be stressed, in order to strengthen vital qi to eliminate pathogenic factors; it also demonstrated the rationality and scientificness of the concept of prescription that the treatment of dissolving stasis and softening lump should be established with the emphasis on the strengthening of health-qi. The study is also helpful for further investigation into the nature of TCM syndromes of DN.
引文
[1]Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In:Gan D (ed). Diabetes Atlas,3rd edition. International Diabetes Federation,Brussels; 2006. p.15-109.
[2]Yoon K et al. Epidemic obesity and type 2 diabetes in Asia. Lancet.2006; 368: 1681-1688.
[3]Reutens AT, Prentice L, Atkins R. The Epidemiology of Diabetic Kidney Disease. In:Ekoe J et al.(eds). The pidemiology of Diabetes Mellitus,2nd ed. Chichester: John Wiley & Sons
[4]McDonald S, Excell L, Livingston B (eds). Appendix II, in ANZDATA Registry Report 2008.Adelaide:Australia and New Zealand Dialysis and Transplant Registry 2008. p.1-97. Ltd.,2008. p.499-518.
[5]Yamagata K et al. Chronic kidney disease perspectives in Japan and the importance of urinalysis screening. Clin Exp Nephrol.2008; 12:1-8.
[6]Wenying Yang, M.D et al.Prevalence of Diabetes among Men and Women in China.N Engl J Med 2010; 362:1090-101.
[7]黎磊石,刘志红.糖尿病肾病的治疗.中华老年多器官疾病杂志,2002,1(3)：171-173.
[8]陆菊明,潘长玉.糖尿病肾病的流行病学和诊断标准.中华老年多器官疾病杂志,2002,1(3)：163-165.
[9]Adler Al, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR:Development and progression of nephropathy in type 2 diabetes:the United Kingdom Prospective Diabetes Study (UKPDS 64).Kidney Int 63:225-232,2003
[10]American Diabetes Association:Nephropathy in diabetes (Position Statement).Diabetes Care 27 (Suppl.1):S79-S83,2004
[11]Caramori ML, Fioretto P, Mauer M:Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients is associated with more advanced diabetic lesions. Diabetes 52:1036-1040,2003
[12]Maclsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G:Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care 27:195-200,2004
[13]彭万年,罗仁主编.糖尿病肾病研究[M],北京：中国科学技术出版社,2006,1：40.
[14]Ruggenenti P et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med.2004; 351:1941-1951.
[15]Parving H et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med.2001; 345: 870-878.
[16]Edmund J. lewis, Lawrence G. Hunsicker,William R. Clarke,Tomas Berl,Marc A Pohl,Julia B Lewis, et al.Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. The New England Journal of Medicine.2001,345(12):851-861.
[17]Hans-Henrik Parving,Hendrik Lehnert,Jens Brochner-Mortensen,Ramon Gomis,Steen Andersen,Peter Arner.The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.The New England Journal of Medicine[J].2001,345(12):870-878.
[18]The Diabetes Control and Complications (DCCT) Research Group:Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 47:1703-1720,1995
[19]Bakris G, Viberti G, Weston WM, Heise M, Porter LE, Freed MI:Rosiglitazone reduces urinary albumin excretion in type II diabetes. J Hum Hypertens 17:7-12,2003
[20]GoyalA, Crook ED. Thiazolidinediones and Progression of renal disease in Patients with diabetes. J investing Med,2006 Mar; 54(2):56-61.
[21]Sarafidis PA Bakris GL. Protection of the kidney by thiazolidinediones:An assessment from bench to bedside. Kidney Int,2006,70(7):1223-1233.
[22]赵从军,陈玉堂.高血压对糖尿病肾病的影响.中华肾脏病杂志,2005,21(9)：547.
[23]OSterby R, Bangstad HJ, Nyberg G, et al. On glomerular structural alte rations in type-1 diabetes. ComPanions of early diabetic glomeruloPathy. Virchows Arch,2001,438(2):129-135.
[24]Brenner BM, Cooper ME, de Zeeuw D,Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S:Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N Engl J Med 345:861-869,2001
[25]Andersen S, Jacobsen P, Tarnow L, Rossing P, Juhl TR, Parving HH:Time course of the antiproteinuric and antihypertensive effct of losartan in diabetic nephropathy.Nephrol Dial Transplant 18:293-297,2003
[26]傅祖植.糖尿病与高血压.中华内分泌代谢杂志,2005,21(5)：15-17.
[27]Saklayen MG, Gyebi LK, Tasosa J, et al. Effects of Additive Therapy With SPironolactone on Proteinuria in Diabetic Patients Already on ACE Inhibitor or ARB Therapy:Results of a Randomized, Placebo-Controlled, Double-Blind, Crossover Trial. J Investig Med,2008,56(4):714-719.
[28]Cha DR, Kang YS, HanSY, et al. ROle of aldosterone in diabetic nePhroPathy. NePhrology(Carlton),2005,10(S2):S37-S39.
[29]Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH:The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases:ameta-analysis. Ann Intern Med 124:627-632,1996
[30]. Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH:Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int 62:220-228,2002
[31]Azadbakht L, Atabak S, EsmaillZadeh A. Soy protein intake, cardiorenal indices, and C-reactive protein in type 2 diabetes with nephropathy:a longitudinal randomized clinical trial. Diabetes Care,2008,31(4):648-654.
[32]Hsu CC, Hwang SJ,Tai TY, et al. Cigarette smoking and proteinuria in Taiwanese men with Type 2 diabetes mellitus. Diabet Med,2010, 27(3):295-302.
[33]牟新,姜淼,宋美铃.赵进喜教授治疗糖尿病肾病经验.新中医,2005,37(11)：15.
[34]Endo K, Miyashita Y, SasakiH, et al. Probucol delays Progression of diabetic nePhroPathy. Diabetes Res Clin Pract.2005:8.
[35]Ota T, Takamura T, Ando H, et al. Preventive effect of cerivastatin on diabetic nephropathy through suppression of glomerular macrophage recruitment in a rat model. Diabetologia,2003;46(6):843-851.
[36]Yang T, Chen JW, Liu CP. Combination of simvastation and cilazapril have Preventive effect on diabetic nephropathy in diabetic rat and cultured mesangial cells. Diabetologia,2001,44(suppl):A265.
[37]Williams ME, Bolton WK, K halifah RG et al. Effects of Pyridoxamine in combined Phase 2 studies of Patients with type 1 and type 2 diabetes and overt nephropathy. Am J Nephrol,2007,27(6):605-614.
[38]Bolton WK, Cattran DC, Williams ME, et al. Wuerth JP:Randomized trial of an inhibitor of formation of advanced glycation end Products indiabetic nePhroPathy. Am J Nephrol,2002,24:32-40.
[39]刘长山,王秀军,柳林,等.氨基肌、黄芩苷对糖尿病大鼠组织非酶糖化及肾脏细胞凋亡的影响.中国慢性病预防与控制,2009,17(4)：342-344.
[40]Tsugawa T, Shinohara R, Nagasaka A, etal. Alteration of urinary Sorbitol excretion in WBN-kob diabetic rats-treatment with an aldose reductase inhibitor. J Endocrinol,2004,181(3):429-35.
[41]lso K, Tada H, Kuboki K, et al. Long-term effect of epalrestat, an aldose reductase inhibitor, on the development of incipient diabeticnephropathy in Type 2 diabetic Patients. J Diabetes ComPlications,2001,15(5):241-4.
[42]Tuttle KR, Bakris GL, Toto RD, et ai. The effect of ruboxistaurin on nephropathy in type 2 diabetes. Diabetes Care,2005,28(11):2686-2690.
[43]Kelly DJ, Chanty A, Gow RM, et al. Prote in kinase Cbetain hibition Attenuates osteopontin expression, maerophage recruitment, and Tubulointerstitial injury in advanced experimental diabetic nephropathy. J Am Soc Nephrol, 2005,16(6):1654-60.
[44]唐焕文,胡大林,梁海荣,等.PJ34对糖尿病大鼠肾脏的保护作用.广东医学院学报,2009,27(1)：1-8.
[45]舒囧,曾龙骚,林可意,等.舒洛地特对糖尿病大鼠肾脏的保护作用及抗氧化反应机制.南方医科大学学报,2009,29(4)：778-784.
[46]Lee EY, Lee MY, Hong SW, et al. Blockade of oxidative stress by vitamin C ameliorates albuminuria and renal sclerosis in experimental diabetic rats.Yonsei Med J,2007,48(5):847-855.
[47]王丽,吴晨光,方春钱,等.左旋精氨酸对糖尿病大鼠的肾脏保护作用.江苏大学学报(医学版),2010,20(1)：32-35.
[48]刘同强,冯曦,李娟娟,等.N-乙酰半胱氨酸对糖尿病肾病大鼠炎症反应的抑制作用.南京医科大学学报(自然科学版),2009,29(11)：1530-1533.
[49]Zhengzhou M, Ye S, Zhai Z, et al. Rosiglitazone protects diabetic rats Against kidney disease through the suppression of renal moncyte Chemoattractant protein --1 exPression. J Diabetes Complications,2009,23(2):124-129.
[1]邓铁涛.中医证候规范[M].见：邓铁涛.邓铁涛医学文集.北京：人民卫生出版社,2001.
[2]王明三. 应重视症状规范化的研究[J]. 山东中医杂志,2008,27(5)：692.
[3]成福春,方肇勤,朱抗美,等.利用信息技术促进中医证型的规范化[J].中国中医基础医学杂志,2007,13(4)：24 1-242.
[4]李先涛,张伯礼.证候诊断标准研究的迫切性和可行性[J].天津中医药,2007,24(1)：36-38.
[5]闫丽芳.试论中医症状的规范[J].新中医,2008,3(7)：427-428.
[6]梁茂新,洪治平.中医症状量化的方法初探—附虚证30症的量化法.中国医药学报,1994,9(3)：37-39.
[7]潘毅,徐志伟,严灿,等.频数优势法对心理应激人群中四个中医常见证型的计量诊断.江西中医学院学报,2006,1 8(4)：63-65.
[8]侯风刚,赵钢,刘庆,等.原发性肝癌血瘀证量化标准的方法学研究.中医药学刊,2005,23(3)：477-478,480.
[9]王学伟,瞿海滨,王阶,等.一种基于数据挖掘的定量诊断方法.北京中医药大学学报,2005,28(1)：4-7.
[10]李建生,胡金亮,余学庆,等.基于神经网络的中医证候量化诊断模型探索.河南中医学院学报,2005,20(118)：6-8.
[11]全国中医病名与证候规范研讨会述要[J].中国医药学报,1990,5(5)：3-6.
[12]潘文奎.证之内涵论[J].南京中医学院学报,1985,(2)：5.
[13]张枢明整理.证的专家谈一孟庆云[J].中医杂志,1996,37(7)：430.
[14]郭蕾.关于证候概念的诠释.北京中医药大学学报,2003,26(2)：5-8.
[15]李梢.从维度与阶度探讨中医证候的特征及标准化方法[J].北京中医药 大学学报,2003,26(3)：1-4.
[16]危北海.有关证的实质探讨.中国医药学报.1998,13(4)：6-8.
[17]唐农.中医证候经典定义的探讨与意义.广西中医药.1995,18(3)：35-37.
[18]秦玉龙.从信息学的角度论中医证候规范化研究[J]. 天津中医药,2003,20(6)：35-38.
[19]徐涛,吴承玉. 中医脾系证候的规范化研究思路与设想[J].南京中医药大学学报,2002,18(5)：264-265.
[20]申春悌. 中医临床脏腑辩证研究的思路和方法探讨[J]. 江苏中医,2001,22(4)：123-126.
[21]朱永华,朱文锋. 中医症状的规范化研究[J]. 湖南中医学院学报,2002,22(3)：35-37.
[22]张震.证候探微.北京中医学院学报,1984,(5)：2-4.
[23]朱文锋.证名规范研究之我见[J].辽宁中医杂志,1987,(2)：17-19.
[24]王庆其.对证候若干问题的探讨[J].中国医药学报,1995,(6)：4-7.
[25]韩丽萍.建立统一分类体系的探讨[J].陕西中医,1998,19(8)：353-354.
[26]朱文峰.《证素辨证学》[M].北京：人民卫生出版社,2008：1-9.
[27]朱文锋.创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6)：38-39.
[28]陈易新,陈家旭,季绍良.脾气虚证基础研究的理论探讨[J].中国医药学报,2002,17(7)：401-403.
[29]尹必武.证候临床诊断标准规范刍议[J].中国医药学报,2000,(3)：6-9.
[30]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1)：55.
[31]朱莹杰,杨金坤,郑坚,等.进展期胃癌患者脾虚证等级的计量诊断研究[J].辽宁中医杂志,2006,33(9)：1057-1059.
[32]马玉慧,王波,张斌,等.数据挖掘技术在中医小儿肺炎辨证规范中的应用[J].中医儿科杂志,2006,2(6)：11-14.
[33]李方玲,梁嵘.对中医证候规范化研究的探讨[J].辽宁中医杂志,2006,33(4)：683-684.
[34]龚燕冰,倪青,王永炎. 中医证候研究的现代方法学述评(二)—中医证候的量化及数理统计方法[J].北京中医药大学学报,2007,3 0(1)：5-8.
[35]张志斌,王永炎,封静. 现代证候规范研究述评. 中国中医基础医学杂志,2005,11(9)：641-644.
[36]赵进喜,牟新,王世东,等.止消温肾宁颗粒治疗糖尿病肾病肾功能不全代偿期31例临床观察.中医杂志,2005,46(9)：677.
[37]赵进喜,牟新,王世东,等.中西医结合治疗糖尿病肾病肾功能不全失代偿期临床分析.中医药学刊,2005,23(3)：440.
[38]牟新,张丽芬,白云静,等.止消通脉宁系列颗粒剂对糖尿病肾病肾功能不全 患者生存质量的影响.山东中医药大学学报,2005,29(5)：355.
[39]刘尚全.中医辨证分型在糖尿病肾病早期诊断中的价值.安徽中医临床杂志,2001,13(2)：79-81.
[40]张迎华,朱晓玲.糖尿病肾病实验室指标与中医辨证分型的关系[J].浙江中医学院学报,2001,25(6)：21.
[41]赵晓山,罗仁,吕建勇,等.肾虚型糖尿病肾病患者尿白蛋白排泄变化的规律的研究[J].中华实用中西医结合杂志,2004,4(17)：567-568.
[42]何成诗.糖尿病肾病辨证分型与部分免疫指标的关系[J].成都中医药大学学报,1999,22(1)：29.
[43]宋美铃,张丽芬,牟新,等.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究.中国中医基础医学杂志,2005,11(3)：215-216.
[44]牟新,周旦阳,赵进喜.265例糖尿病肾病肾功能不全患者中医证候与实验室指标的典型相关性研究.中华中医药杂志,2008,23(12)：1057-1060.
[45]温韶,林瑜,唐志英,等.糖尿病肾病患者中医证型与血浆内皮素和心钠素关系的研究[J].新中医,2002,34(2)：36-39.
[46]林哲章,陈瑶,黄培基,等.糖尿病肾病及中医证型与尿表皮生长因子关系的探讨[J].深圳中西医结合杂志,2000,10(6)：253-254.
[47]陈小燕,严惠芳,杨春燕.糖尿病肾病肾阴虚证与内皮素-1相关性的临床研究.中国厂矿医学,2007,20(4)：416-417.
[48]成玉斌,罗仁,薛耀明,等.肾虚型糖尿病肾病与ACE基因多态性相关研究[J].中国中医基础医学杂志,2002,8(5)：29-30
[49]唐红,徐蓉娟,胡健炜,等.糖尿病肾病中医证型与血浆TXB：6-keto-PGnn的关系探讨[J].辽宁中医杂志,1997,24(1)：3-4.
[50]唐红,徐蓉娟,李红,等.血小板及纤溶活性与糖尿病肾病中医辨证分型关系研究[J].上海中医药杂志,2003,37(7)：18-20.
[51]张奕民,陈岱.肾动脉血流灌注与糖尿病.肾病中医辨证分型的相关性研究[J].中国中西医结合肾病杂志,2003,4(9)：550-551.
[52]林兰,倪青,董彦敏.糖尿病肾病中西医结合治疗热点问题述评[J].中西医结合,2000,7：50.
[53]施赛珠,陈剑秋,张茂花,等.糖尿病血瘀证与血栓前状态分子标志物关系的研究[J].中医研究,1996,9(2)：21.
[54]曾庆祥.糖尿病肾病从瘀论治[J].吉林中医药,2001,21(3)：14.
[55]沈志祥.糖尿病患者高凝状态的临床研究[J].中华内分泌杂志,1990,4：206.
[1]WHO.The Development of the WHO Quality of Life Assess-ment Intrument[M].Geneva,WHO,1993.1.
[2]项凤梅,符林春.生存质量与中医的关系及在中医中的运用.安徽中医学院学报.2004；23(3)：7-8.
[3]刘凤斌,方积乾,王建华.与健康相关的生存质量和中医学.中国中医基础医学杂志.1999；5(10)：13-16.
[4]刘凤斌,郎建英,赵利,等.中医健康状况量表(TCM-HSS)的研制.中华中医药学会脾胃病分会第十九次全国脾胃病学术交流会论文汇编.石家庄.2007：589-593.
[5]成燕萍,郝天军.中药配合免疫法对老年人非小细胞肺癌生存质量的影响[J].中国航天工业医药,2001,3(2)：56.
[6]陈伟强,陈富荣.松龄血脉康胶囊配合卡托普利对原发性高血压患者生存质量的影响[J].中国中西医结合杂志,2001,21(9)：660.
[7]张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10)：755-758.
[8]张玮.建立慢性乙型肝炎患者中医生存质量量表的设想.中西医结合肝病杂志2010；20(1)：53-55.
[9]刘凤斌.量表测评方法在中医临床疗效评价中的应用与展望.中国中西医结合杂志.2007；27(12)：1129-1132.
[10]单秀杰.2型糖尿病患者生存质量的对照研究[J]. 中国预防医学志.2010,11(7)：695-697.
[11]李鲁,王红妹,沈毅.SF-36健康调查量表中文版的研制及其性能测试[J]中华预防医学杂志,2002,36(2)：109-113.
[12]Garcia M, Rohlfs I, Vila J, et al. Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36).Gac Sanit,2005,19(6):433-439.
[13]Jacobson A, Barofsky I, Cleary P, er al. Reliability and validity of a dia-betes quality-of-life measure of the Diabetes Control and Complications Trial(DCCT) [J]. Diabetes Care,1988,11:725-732.
[14]Meadows K, Steen N, McColl E, et al. The Diabetes Health Profile (DHP):a new instrument Review article 11 □ 2002 Diabetes UK. Di-abetic Medicine, 19,1-11 for assessing the psychosocial profile of in-sulin requiring patients-development and paychometric evaluation [J]. Qual Life Res, 1996,5:242-254.
[15]Meadows KA, Abrams S, Sandbaek A. Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mel-litus: psychometric evaluation and cross-cultural comparison [J]. Dia-bet Med,2000,17:572-580.
[16]Bradley C,Speight J.Patient perceptions of diabetes and diabetes ther-apy:assessing quality of life [J].Diabetes Metab Res Rev,2002,18:S64-69.
[17]卫生部.关于下发《1996-2000年国家糖尿病防治规划纲要》的通知[J]中国糖尿病杂志,1996,4(2)：123-125.
[18]Fitzpatrick R, Davey C, Buxton MJ, et al. Evaluating patientbased out-come measures for use in clinical trials [J]. Health Technol Assess,1998,2:1-74.
[19]Hammond GS, Aoki TT. Measurement of health status in diabetic patients: diabetes impact measurement scales [J]. Diabetes Care,1992,15;469-477.
[20]冯正仪,戴宝珍,顾沛,等.糖尿病患者生活质量的评估研究[J].中国行为医学科学,1995,4(3)：137-139.
[21]范丽凤,黄玉荣,李海燕.糖尿病患者的生活质量及影响因素[J].中华护 理杂志,1996,31(10)：562-564.
[22]方积乾.生存质量测定方法及应用[M].北京：北京医科大学出版社2000,165-191.
[23]丁元林,倪宗瓒,张菊英,等.修订的糖尿病生命质量量表(A-DQOL)信度与效度初探[J].中国慢性病预防与控制,2000,8(4)：160-161.
[24]林旋,郎江明,魏爱生,等. 短期胰岛素泵强化治疗对2型糖尿病患者生存质量的影响[J]. 中国医药导报,2009,6(33)：55-56,58.
[25]郝云玲,吴红玲,陈立波,等.4种胰岛素制剂治疗急性心肌梗死合并高血糖疗效的对比研究[J]. 疑难病杂志,2010.9(3)：180-182.
[26]聂静涛,罗从容.中西医结合治疗对2型糖尿病患者生存质量及糖代谢的影响[J]. 中国现代医学杂志,2010,20(21)：3328-3330,3333.
[27]潘明政,李玲,庄晓明,等.糖尿病患者生存质量及其影响因素的探讨[J]. 实用医学杂志,2007,23(3)：414-416.
[28]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量对比调查研究[J]. 中国老年学杂志,2009,29(9)：2362-2364.
[29]吴敏强,梁执群,郭巍伟.社区2型糖尿病患者生存质量及其影响因素分析[J]. 中国健康心理学杂志,2009,17(5)：538-540.
[30]张妍,徐桂芳,赵宝龙.2型糖尿病合并抑郁症患者生存质量分析[J]. 现代预防医学.2009,36(8)：1422-1423.
[31]潘明政,李玲,范虹. 糖尿病患者生存质量及其与中医证型的关系[J]. 中国中西医结合杂志,2006,26(8)：702-705.
[32]刘焱,王学美.400例2型糖尿病患者中医证型与糖尿病慢性并发症、生存质量及实验室指标的相关研究[J]. 中国中西医结合急救杂志,2010,17(2)：76-79.
[1]李梢.从维度与阶度探讨中医证候的特征及标准化方法.北京中医药大学学报.2003；26(3)：1-4.
[2]高颖.关于构建中医临床评价体系若干问题的思考.中国中医基础医学杂志.2006；12(4)：256-258.
[3]马斌,高颖. 中风病发病第7天和第14天证候要素演变规律初步研究[J].辽宁中医杂志,2006,33(12)：1561-1563.
[4]张华,高颍.缺血性中风证候演变与神经功能缺损的相关性研究.北京中医药大学学报.2007；30(4)：275-278.
[5]《中风病证候学与临床诊断的研究》研究组；王顺道,杜梦华,解庆凡,贾滋欣,王永炎.中风病急性期证候演变规律的研究.中国中医急症.1996；5(3)：121-124.
[6]杨利,黄燕,蔡业峰,等.1418例中风患者痰瘀证候分布和演变规律探析.辽宁中医杂志.2004；31(6)：459-460.
[7]宋毅,裴建,刘志丹,等.针刺干预缺血性中风病证候动态化及相关研究.中西医结学报.2009；7(4)：334-341.
[8]白云静,申洪波,孟庆刚,等.基于复杂性科学的中医学发展取向与方略.中国中医药信息杂志.2005；12(1)：2-5.
[9]曲淼,唐启盛,包祖晓,等.贝叶斯网络模型在中医证候研究中的应用.中华中医药学刊.2008；26(7)：1497-1498.
[10]王阶,姚魁武.中医证候规范方法学研究探讨.中国中医基础医学杂志.2006；12(8)：570-572.
[11]张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10)：755-758.
[12]王世东,赵进喜,吕仁和,等.中医药对糖尿病肾病肾功能不全代偿期生存质量影响的研究.北京中医药大学学报.中医临床版,2007,14(3)：1-4.
[13]宋艳艳,何清波,苏炳华.分类数据的重复测量及其在临床试验中的应用.上海第二医科大学学报,2005；25(3)：297-300.
[14]Liang KY, Zeger ST. Longitudinal data ana ly sis using genera lized line-armodels. Biom etrics,1986,73 (1):13.
[15]Shun SC, Chiou JF, et al. Epub ahead of print changes in quality of life and its related factors in liver cancer patients receiv ing stereo tactic radi-ation therapy. Support Care Cancer, 2008,1,16[Epub ahead of print].
[16]王静,叶冬青.多水平统计模型简介及MLwiN软件的应用实例说明.疾病控制杂志,2006,10(5)：518-522.
[17]盖笑松,张向葵.多层线性模型在纵向研究中的运用[J].心理科 学,2005,28(2)：429-431.
[18]蒋莉,杨志明,姚树桥.学生高考语文成绩影响因素的多层线性分析[J].中国临床心理学杂志,2005,13(4)：414-416.
[19]田建辉,王琳,施志明.论生存质量与中医疗效评价[J].上海中医药大学学报,2002,16(4)：32-34.
[20]杨丽平,李平,杜金行,等.350例2型糖尿病肾病患者中医证候分布及其与实验室指标的相关分析. 中华中医药杂志,2010,25(5)：689.
[2]Yoon K et al. Epidemic obesity and type 2 diabetes in Asia. Lancet.2006; 368: 1681-1688.
[3]Reutens AT, Prentice L, Atkins R. The Epidemiology of Diabetic Kidney Disease. In:Ekoe J et al.(eds). The pidemiology of Diabetes Mellitus,2nd ed. Chichester: John Wiley & Sons
[4]McDonald S, Excell L, Livingston B (eds). Appendix II, in ANZDATA Registry Report 2008.Adelaide:Australia and New Zealand Dialysis and Transplant Registry 2008. p.1-97. Ltd.,2008. p.499-518.
[5]Yamagata K et al. Chronic kidney disease perspectives in Japan and the importance of urinalysis screening. Clin Exp Nephrol.2008; 12:1-8.
[6]Wenying Yang, M.D et al.Prevalence of Diabetes among Men and Women in China.N Engl J Med 2010; 362:1090-101.
[7]黎磊石,刘志红.糖尿病肾病的治疗.中华老年多器官疾病杂志,2002,1(3)：171-173.
[8]陆菊明,潘长玉.糖尿病肾病的流行病学和诊断标准.中华老年多器官疾病杂志,2002,1(3)：163-165.
[9]Adler Al, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR:Development and progression of nephropathy in type 2 diabetes:the United Kingdom Prospective Diabetes Study (UKPDS 64).Kidney Int 63:225-232,2003
[10]American Diabetes Association:Nephropathy in diabetes (Position Statement).Diabetes Care 27 (Suppl.1):S79-S83,2004
[11]Caramori ML, Fioretto P, Mauer M:Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients is associated with more advanced diabetic lesions. Diabetes 52:1036-1040,2003
[12]Maclsaac RJ, Tsalamandris C, Panagiotopoulos S, Smith TJ, McNeil KJ, Jerums G:Nonalbuminuric renal insufficiency in type 2 diabetes. Diabetes Care 27:195-200,2004
[13]彭万年,罗仁主编.糖尿病肾病研究[M],北京：中国科学技术出版社,2006,1：40.
[14]Ruggenenti P et al. Preventing microalbuminuria in type 2 diabetes. N Engl J Med.2004; 351:1941-1951.
[15]Parving H et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med.2001; 345: 870-878.
[16]Edmund J. lewis, Lawrence G. Hunsicker,William R. Clarke,Tomas Berl,Marc A Pohl,Julia B Lewis, et al.Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. The New England Journal of Medicine.2001,345(12):851-861.
[17]Hans-Henrik Parving,Hendrik Lehnert,Jens Brochner-Mortensen,Ramon Gomis,Steen Andersen,Peter Arner.The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.The New England Journal of Medicine[J].2001,345(12):870-878.
[18]The Diabetes Control and Complications (DCCT) Research Group:Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 47:1703-1720,1995
[19]Bakris G, Viberti G, Weston WM, Heise M, Porter LE, Freed MI:Rosiglitazone reduces urinary albumin excretion in type II diabetes. J Hum Hypertens 17:7-12,2003
[20]GoyalA, Crook ED. Thiazolidinediones and Progression of renal disease in Patients with diabetes. J investing Med,2006 Mar; 54(2):56-61.
[21]Sarafidis PA Bakris GL. Protection of the kidney by thiazolidinediones:An assessment from bench to bedside. Kidney Int,2006,70(7):1223-1233.
[22]赵从军,陈玉堂.高血压对糖尿病肾病的影响.中华肾脏病杂志,2005,21(9)：547.
[23]OSterby R, Bangstad HJ, Nyberg G, et al. On glomerular structural alte rations in type-1 diabetes. ComPanions of early diabetic glomeruloPathy. Virchows Arch,2001,438(2):129-135.
[24]Brenner BM, Cooper ME, de Zeeuw D,Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S:Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.N Engl J Med 345:861-869,2001
[25]Andersen S, Jacobsen P, Tarnow L, Rossing P, Juhl TR, Parving HH:Time course of the antiproteinuric and antihypertensive effct of losartan in diabetic nephropathy.Nephrol Dial Transplant 18:293-297,2003
[26]傅祖植.糖尿病与高血压.中华内分泌代谢杂志,2005,21(5)：15-17.
[27]Saklayen MG, Gyebi LK, Tasosa J, et al. Effects of Additive Therapy With SPironolactone on Proteinuria in Diabetic Patients Already on ACE Inhibitor or ARB Therapy:Results of a Randomized, Placebo-Controlled, Double-Blind, Crossover Trial. J Investig Med,2008,56(4):714-719.
[28]Cha DR, Kang YS, HanSY, et al. ROle of aldosterone in diabetic nePhroPathy. NePhrology(Carlton),2005,10(S2):S37-S39.
[29]Pedrini MT, Levey AS, Lau J, Chalmers TC, Wang PH:The effect of dietary protein restriction on the progression of diabetic and nondiabetic renal diseases:ameta-analysis. Ann Intern Med 124:627-632,1996
[30]. Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH:Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int 62:220-228,2002
[31]Azadbakht L, Atabak S, EsmaillZadeh A. Soy protein intake, cardiorenal indices, and C-reactive protein in type 2 diabetes with nephropathy:a longitudinal randomized clinical trial. Diabetes Care,2008,31(4):648-654.
[32]Hsu CC, Hwang SJ,Tai TY, et al. Cigarette smoking and proteinuria in Taiwanese men with Type 2 diabetes mellitus. Diabet Med,2010, 27(3):295-302.
[33]牟新,姜淼,宋美铃.赵进喜教授治疗糖尿病肾病经验.新中医,2005,37(11)：15.
[34]Endo K, Miyashita Y, SasakiH, et al. Probucol delays Progression of diabetic nePhroPathy. Diabetes Res Clin Pract.2005:8.
[35]Ota T, Takamura T, Ando H, et al. Preventive effect of cerivastatin on diabetic nephropathy through suppression of glomerular macrophage recruitment in a rat model. Diabetologia,2003;46(6):843-851.
[36]Yang T, Chen JW, Liu CP. Combination of simvastation and cilazapril have Preventive effect on diabetic nephropathy in diabetic rat and cultured mesangial cells. Diabetologia,2001,44(suppl):A265.
[37]Williams ME, Bolton WK, K halifah RG et al. Effects of Pyridoxamine in combined Phase 2 studies of Patients with type 1 and type 2 diabetes and overt nephropathy. Am J Nephrol,2007,27(6):605-614.
[38]Bolton WK, Cattran DC, Williams ME, et al. Wuerth JP:Randomized trial of an inhibitor of formation of advanced glycation end Products indiabetic nePhroPathy. Am J Nephrol,2002,24:32-40.
[39]刘长山,王秀军,柳林,等.氨基肌、黄芩苷对糖尿病大鼠组织非酶糖化及肾脏细胞凋亡的影响.中国慢性病预防与控制,2009,17(4)：342-344.
[40]Tsugawa T, Shinohara R, Nagasaka A, etal. Alteration of urinary Sorbitol excretion in WBN-kob diabetic rats-treatment with an aldose reductase inhibitor. J Endocrinol,2004,181(3):429-35.
[41]lso K, Tada H, Kuboki K, et al. Long-term effect of epalrestat, an aldose reductase inhibitor, on the development of incipient diabeticnephropathy in Type 2 diabetic Patients. J Diabetes ComPlications,2001,15(5):241-4.
[42]Tuttle KR, Bakris GL, Toto RD, et ai. The effect of ruboxistaurin on nephropathy in type 2 diabetes. Diabetes Care,2005,28(11):2686-2690.
[43]Kelly DJ, Chanty A, Gow RM, et al. Prote in kinase Cbetain hibition Attenuates osteopontin expression, maerophage recruitment, and Tubulointerstitial injury in advanced experimental diabetic nephropathy. J Am Soc Nephrol, 2005,16(6):1654-60.
[44]唐焕文,胡大林,梁海荣,等.PJ34对糖尿病大鼠肾脏的保护作用.广东医学院学报,2009,27(1)：1-8.
[45]舒囧,曾龙骚,林可意,等.舒洛地特对糖尿病大鼠肾脏的保护作用及抗氧化反应机制.南方医科大学学报,2009,29(4)：778-784.
[46]Lee EY, Lee MY, Hong SW, et al. Blockade of oxidative stress by vitamin C ameliorates albuminuria and renal sclerosis in experimental diabetic rats.Yonsei Med J,2007,48(5):847-855.
[47]王丽,吴晨光,方春钱,等.左旋精氨酸对糖尿病大鼠的肾脏保护作用.江苏大学学报(医学版),2010,20(1)：32-35.
[48]刘同强,冯曦,李娟娟,等.N-乙酰半胱氨酸对糖尿病肾病大鼠炎症反应的抑制作用.南京医科大学学报(自然科学版),2009,29(11)：1530-1533.
[49]Zhengzhou M, Ye S, Zhai Z, et al. Rosiglitazone protects diabetic rats Against kidney disease through the suppression of renal moncyte Chemoattractant protein --1 exPression. J Diabetes Complications,2009,23(2):124-129.
[1]邓铁涛.中医证候规范[M].见：邓铁涛.邓铁涛医学文集.北京：人民卫生出版社,2001.
[2]王明三. 应重视症状规范化的研究[J]. 山东中医杂志,2008,27(5)：692.
[3]成福春,方肇勤,朱抗美,等.利用信息技术促进中医证型的规范化[J].中国中医基础医学杂志,2007,13(4)：24 1-242.
[4]李先涛,张伯礼.证候诊断标准研究的迫切性和可行性[J].天津中医药,2007,24(1)：36-38.
[5]闫丽芳.试论中医症状的规范[J].新中医,2008,3(7)：427-428.
[6]梁茂新,洪治平.中医症状量化的方法初探—附虚证30症的量化法.中国医药学报,1994,9(3)：37-39.
[7]潘毅,徐志伟,严灿,等.频数优势法对心理应激人群中四个中医常见证型的计量诊断.江西中医学院学报,2006,1 8(4)：63-65.
[8]侯风刚,赵钢,刘庆,等.原发性肝癌血瘀证量化标准的方法学研究.中医药学刊,2005,23(3)：477-478,480.
[9]王学伟,瞿海滨,王阶,等.一种基于数据挖掘的定量诊断方法.北京中医药大学学报,2005,28(1)：4-7.
[10]李建生,胡金亮,余学庆,等.基于神经网络的中医证候量化诊断模型探索.河南中医学院学报,2005,20(118)：6-8.
[11]全国中医病名与证候规范研讨会述要[J].中国医药学报,1990,5(5)：3-6.
[12]潘文奎.证之内涵论[J].南京中医学院学报,1985,(2)：5.
[13]张枢明整理.证的专家谈一孟庆云[J].中医杂志,1996,37(7)：430.
[14]郭蕾.关于证候概念的诠释.北京中医药大学学报,2003,26(2)：5-8.
[15]李梢.从维度与阶度探讨中医证候的特征及标准化方法[J].北京中医药 大学学报,2003,26(3)：1-4.
[16]危北海.有关证的实质探讨.中国医药学报.1998,13(4)：6-8.
[17]唐农.中医证候经典定义的探讨与意义.广西中医药.1995,18(3)：35-37.
[18]秦玉龙.从信息学的角度论中医证候规范化研究[J]. 天津中医药,2003,20(6)：35-38.
[19]徐涛,吴承玉. 中医脾系证候的规范化研究思路与设想[J].南京中医药大学学报,2002,18(5)：264-265.
[20]申春悌. 中医临床脏腑辩证研究的思路和方法探讨[J]. 江苏中医,2001,22(4)：123-126.
[21]朱永华,朱文锋. 中医症状的规范化研究[J]. 湖南中医学院学报,2002,22(3)：35-37.
[22]张震.证候探微.北京中医学院学报,1984,(5)：2-4.
[23]朱文锋.证名规范研究之我见[J].辽宁中医杂志,1987,(2)：17-19.
[24]王庆其.对证候若干问题的探讨[J].中国医药学报,1995,(6)：4-7.
[25]韩丽萍.建立统一分类体系的探讨[J].陕西中医,1998,19(8)：353-354.
[26]朱文峰.《证素辨证学》[M].北京：人民卫生出版社,2008：1-9.
[27]朱文锋.创立以证素为核心的辨证新体系[J].湖南中医学院学报,2004,24(6)：38-39.
[28]陈易新,陈家旭,季绍良.脾气虚证基础研究的理论探讨[J].中国医药学报,2002,17(7)：401-403.
[29]尹必武.证候临床诊断标准规范刍议[J].中国医药学报,2000,(3)：6-9.
[30]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1)：55.
[31]朱莹杰,杨金坤,郑坚,等.进展期胃癌患者脾虚证等级的计量诊断研究[J].辽宁中医杂志,2006,33(9)：1057-1059.
[32]马玉慧,王波,张斌,等.数据挖掘技术在中医小儿肺炎辨证规范中的应用[J].中医儿科杂志,2006,2(6)：11-14.
[33]李方玲,梁嵘.对中医证候规范化研究的探讨[J].辽宁中医杂志,2006,33(4)：683-684.
[34]龚燕冰,倪青,王永炎. 中医证候研究的现代方法学述评(二)—中医证候的量化及数理统计方法[J].北京中医药大学学报,2007,3 0(1)：5-8.
[35]张志斌,王永炎,封静. 现代证候规范研究述评. 中国中医基础医学杂志,2005,11(9)：641-644.
[36]赵进喜,牟新,王世东,等.止消温肾宁颗粒治疗糖尿病肾病肾功能不全代偿期31例临床观察.中医杂志,2005,46(9)：677.
[37]赵进喜,牟新,王世东,等.中西医结合治疗糖尿病肾病肾功能不全失代偿期临床分析.中医药学刊,2005,23(3)：440.
[38]牟新,张丽芬,白云静,等.止消通脉宁系列颗粒剂对糖尿病肾病肾功能不全 患者生存质量的影响.山东中医药大学学报,2005,29(5)：355.
[39]刘尚全.中医辨证分型在糖尿病肾病早期诊断中的价值.安徽中医临床杂志,2001,13(2)：79-81.
[40]张迎华,朱晓玲.糖尿病肾病实验室指标与中医辨证分型的关系[J].浙江中医学院学报,2001,25(6)：21.
[41]赵晓山,罗仁,吕建勇,等.肾虚型糖尿病肾病患者尿白蛋白排泄变化的规律的研究[J].中华实用中西医结合杂志,2004,4(17)：567-568.
[42]何成诗.糖尿病肾病辨证分型与部分免疫指标的关系[J].成都中医药大学学报,1999,22(1)：29.
[43]宋美铃,张丽芬,牟新,等.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究.中国中医基础医学杂志,2005,11(3)：215-216.
[44]牟新,周旦阳,赵进喜.265例糖尿病肾病肾功能不全患者中医证候与实验室指标的典型相关性研究.中华中医药杂志,2008,23(12)：1057-1060.
[45]温韶,林瑜,唐志英,等.糖尿病肾病患者中医证型与血浆内皮素和心钠素关系的研究[J].新中医,2002,34(2)：36-39.
[46]林哲章,陈瑶,黄培基,等.糖尿病肾病及中医证型与尿表皮生长因子关系的探讨[J].深圳中西医结合杂志,2000,10(6)：253-254.
[47]陈小燕,严惠芳,杨春燕.糖尿病肾病肾阴虚证与内皮素-1相关性的临床研究.中国厂矿医学,2007,20(4)：416-417.
[48]成玉斌,罗仁,薛耀明,等.肾虚型糖尿病肾病与ACE基因多态性相关研究[J].中国中医基础医学杂志,2002,8(5)：29-30
[49]唐红,徐蓉娟,胡健炜,等.糖尿病肾病中医证型与血浆TXB：6-keto-PGnn的关系探讨[J].辽宁中医杂志,1997,24(1)：3-4.
[50]唐红,徐蓉娟,李红,等.血小板及纤溶活性与糖尿病肾病中医辨证分型关系研究[J].上海中医药杂志,2003,37(7)：18-20.
[51]张奕民,陈岱.肾动脉血流灌注与糖尿病.肾病中医辨证分型的相关性研究[J].中国中西医结合肾病杂志,2003,4(9)：550-551.
[52]林兰,倪青,董彦敏.糖尿病肾病中西医结合治疗热点问题述评[J].中西医结合,2000,7：50.
[53]施赛珠,陈剑秋,张茂花,等.糖尿病血瘀证与血栓前状态分子标志物关系的研究[J].中医研究,1996,9(2)：21.
[54]曾庆祥.糖尿病肾病从瘀论治[J].吉林中医药,2001,21(3)：14.
[55]沈志祥.糖尿病患者高凝状态的临床研究[J].中华内分泌杂志,1990,4：206.
[1]WHO.The Development of the WHO Quality of Life Assess-ment Intrument[M].Geneva,WHO,1993.1.
[2]项凤梅,符林春.生存质量与中医的关系及在中医中的运用.安徽中医学院学报.2004；23(3)：7-8.
[3]刘凤斌,方积乾,王建华.与健康相关的生存质量和中医学.中国中医基础医学杂志.1999；5(10)：13-16.
[4]刘凤斌,郎建英,赵利,等.中医健康状况量表(TCM-HSS)的研制.中华中医药学会脾胃病分会第十九次全国脾胃病学术交流会论文汇编.石家庄.2007：589-593.
[5]成燕萍,郝天军.中药配合免疫法对老年人非小细胞肺癌生存质量的影响[J].中国航天工业医药,2001,3(2)：56.
[6]陈伟强,陈富荣.松龄血脉康胶囊配合卡托普利对原发性高血压患者生存质量的影响[J].中国中西医结合杂志,2001,21(9)：660.
[7]张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10)：755-758.
[8]张玮.建立慢性乙型肝炎患者中医生存质量量表的设想.中西医结合肝病杂志2010；20(1)：53-55.
[9]刘凤斌.量表测评方法在中医临床疗效评价中的应用与展望.中国中西医结合杂志.2007；27(12)：1129-1132.
[10]单秀杰.2型糖尿病患者生存质量的对照研究[J]. 中国预防医学志.2010,11(7)：695-697.
[11]李鲁,王红妹,沈毅.SF-36健康调查量表中文版的研制及其性能测试[J]中华预防医学杂志,2002,36(2)：109-113.
[12]Garcia M, Rohlfs I, Vila J, et al. Comparison between telephone and self-administration of Short Form Health Survey Questionnaire (SF-36).Gac Sanit,2005,19(6):433-439.
[13]Jacobson A, Barofsky I, Cleary P, er al. Reliability and validity of a dia-betes quality-of-life measure of the Diabetes Control and Complications Trial(DCCT) [J]. Diabetes Care,1988,11:725-732.
[14]Meadows K, Steen N, McColl E, et al. The Diabetes Health Profile (DHP):a new instrument Review article 11 □ 2002 Diabetes UK. Di-abetic Medicine, 19,1-11 for assessing the psychosocial profile of in-sulin requiring patients-development and paychometric evaluation [J]. Qual Life Res, 1996,5:242-254.
[15]Meadows KA, Abrams S, Sandbaek A. Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mel-litus: psychometric evaluation and cross-cultural comparison [J]. Dia-bet Med,2000,17:572-580.
[16]Bradley C,Speight J.Patient perceptions of diabetes and diabetes ther-apy:assessing quality of life [J].Diabetes Metab Res Rev,2002,18:S64-69.
[17]卫生部.关于下发《1996-2000年国家糖尿病防治规划纲要》的通知[J]中国糖尿病杂志,1996,4(2)：123-125.
[18]Fitzpatrick R, Davey C, Buxton MJ, et al. Evaluating patientbased out-come measures for use in clinical trials [J]. Health Technol Assess,1998,2:1-74.
[19]Hammond GS, Aoki TT. Measurement of health status in diabetic patients: diabetes impact measurement scales [J]. Diabetes Care,1992,15;469-477.
[20]冯正仪,戴宝珍,顾沛,等.糖尿病患者生活质量的评估研究[J].中国行为医学科学,1995,4(3)：137-139.
[21]范丽凤,黄玉荣,李海燕.糖尿病患者的生活质量及影响因素[J].中华护 理杂志,1996,31(10)：562-564.
[22]方积乾.生存质量测定方法及应用[M].北京：北京医科大学出版社2000,165-191.
[23]丁元林,倪宗瓒,张菊英,等.修订的糖尿病生命质量量表(A-DQOL)信度与效度初探[J].中国慢性病预防与控制,2000,8(4)：160-161.
[24]林旋,郎江明,魏爱生,等. 短期胰岛素泵强化治疗对2型糖尿病患者生存质量的影响[J]. 中国医药导报,2009,6(33)：55-56,58.
[25]郝云玲,吴红玲,陈立波,等.4种胰岛素制剂治疗急性心肌梗死合并高血糖疗效的对比研究[J]. 疑难病杂志,2010.9(3)：180-182.
[26]聂静涛,罗从容.中西医结合治疗对2型糖尿病患者生存质量及糖代谢的影响[J]. 中国现代医学杂志,2010,20(21)：3328-3330,3333.
[27]潘明政,李玲,庄晓明,等.糖尿病患者生存质量及其影响因素的探讨[J]. 实用医学杂志,2007,23(3)：414-416.
[28]张文汉,胡素君,刘一心,等.深圳市社区老年2型糖尿病患者生存质量对比调查研究[J]. 中国老年学杂志,2009,29(9)：2362-2364.
[29]吴敏强,梁执群,郭巍伟.社区2型糖尿病患者生存质量及其影响因素分析[J]. 中国健康心理学杂志,2009,17(5)：538-540.
[30]张妍,徐桂芳,赵宝龙.2型糖尿病合并抑郁症患者生存质量分析[J]. 现代预防医学.2009,36(8)：1422-1423.
[31]潘明政,李玲,范虹. 糖尿病患者生存质量及其与中医证型的关系[J]. 中国中西医结合杂志,2006,26(8)：702-705.
[32]刘焱,王学美.400例2型糖尿病患者中医证型与糖尿病慢性并发症、生存质量及实验室指标的相关研究[J]. 中国中西医结合急救杂志,2010,17(2)：76-79.
[1]李梢.从维度与阶度探讨中医证候的特征及标准化方法.北京中医药大学学报.2003；26(3)：1-4.
[2]高颖.关于构建中医临床评价体系若干问题的思考.中国中医基础医学杂志.2006；12(4)：256-258.
[3]马斌,高颖. 中风病发病第7天和第14天证候要素演变规律初步研究[J].辽宁中医杂志,2006,33(12)：1561-1563.
[4]张华,高颍.缺血性中风证候演变与神经功能缺损的相关性研究.北京中医药大学学报.2007；30(4)：275-278.
[5]《中风病证候学与临床诊断的研究》研究组；王顺道,杜梦华,解庆凡,贾滋欣,王永炎.中风病急性期证候演变规律的研究.中国中医急症.1996；5(3)：121-124.
[6]杨利,黄燕,蔡业峰,等.1418例中风患者痰瘀证候分布和演变规律探析.辽宁中医杂志.2004；31(6)：459-460.
[7]宋毅,裴建,刘志丹,等.针刺干预缺血性中风病证候动态化及相关研究.中西医结学报.2009；7(4)：334-341.
[8]白云静,申洪波,孟庆刚,等.基于复杂性科学的中医学发展取向与方略.中国中医药信息杂志.2005；12(1)：2-5.
[9]曲淼,唐启盛,包祖晓,等.贝叶斯网络模型在中医证候研究中的应用.中华中医药学刊.2008；26(7)：1497-1498.
[10]王阶,姚魁武.中医证候规范方法学研究探讨.中国中医基础医学杂志.2006；12(8)：570-572.
[11]张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10)：755-758.
[12]王世东,赵进喜,吕仁和,等.中医药对糖尿病肾病肾功能不全代偿期生存质量影响的研究.北京中医药大学学报.中医临床版,2007,14(3)：1-4.
[13]宋艳艳,何清波,苏炳华.分类数据的重复测量及其在临床试验中的应用.上海第二医科大学学报,2005；25(3)：297-300.
[14]Liang KY, Zeger ST. Longitudinal data ana ly sis using genera lized line-armodels. Biom etrics,1986,73 (1):13.
[15]Shun SC, Chiou JF, et al. Epub ahead of print changes in quality of life and its related factors in liver cancer patients receiv ing stereo tactic radi-ation therapy. Support Care Cancer, 2008,1,16[Epub ahead of print].
[16]王静,叶冬青.多水平统计模型简介及MLwiN软件的应用实例说明.疾病控制杂志,2006,10(5)：518-522.
[17]盖笑松,张向葵.多层线性模型在纵向研究中的运用[J].心理科 学,2005,28(2)：429-431.
[18]蒋莉,杨志明,姚树桥.学生高考语文成绩影响因素的多层线性分析[J].中国临床心理学杂志,2005,13(4)：414-416.
[19]田建辉,王琳,施志明.论生存质量与中医疗效评价[J].上海中医药大学学报,2002,16(4)：32-34.
[20]杨丽平,李平,杜金行,等.350例2型糖尿病肾病患者中医证候分布及其与实验室指标的相关分析. 中华中医药杂志,2010,25(5)：689.
© 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 |