中国医药指南

目的 探讨糖尿病肾病患者与其他原发病引起的血液透析患者在中医证型方面的差异，为临床中医辨证治疗提供参考依据。方法 本研究纳入厦门医学院附属第二医院于2023年1月至2024年6月收治的70例血液透析患者，根据不同疾病类型将其分为两组，其中糖尿病肾病组35例，其他原发病组35例。通过中医四诊合参辨证，依据中医理论对两组患者的证型进行分析，以及分析两组临床症状（乏力、口渴、水肿、贫血）、舌脉表现、尿蛋白、血糖、血肌酐等指标的差异。结果 气虚型患者占比，糖尿病肾病组高于其他原发病组，阳虚型患者占比，糖尿病肾病组低于其他原发病组（P<0.05），其他中医证型，两组差异无统计学意义（P > 0.05）；乏力、口渴发生率，糖尿病肾病组高于其他原发病组，水肿发生率，糖尿病肾病组低于其他原发病组（P<0.05），贫血发生率，两组差异无统计学意义（P > 0.05）；舌质偏淡、舌苔薄患者占比，糖尿病肾病组高于其他原发病组，脉象沉患者占比，糖尿病肾病组低于其他原发病组（P<0.05）；尿蛋白、血糖水平，糖尿病肾病组高于其他原发病组（P<0.05），血清肌酐水平，两组差异无统计学意义（P > 0.05）。结论 糖尿病肾病与其他原发病引起的终末期肾病患者在中医证型上存在显著差异，中医辨证论治应根据不同证型进行个性化治疗，以提高治疗效果。

Objective To explore the differences of TCM syndrome types between diabetic nephropathy patients and hemodialysis patients caused by other primary diseases, and to provide reference for clinical TCM syndrome differentiation treatment. Methods Seventy hemodialysis patients admitted to the Second Affiliated Hospital of Xiamen Medical College from January 2023 to June 2024 were enrolled in this study. According to different disease types, they were divided into two groups, including 35 cases in diabetic nephropathy group and 35 cases in other primary diseases group. According to the TCM theory, the syndrome types of the two groups of patients were analyzed, and the differences in clinical symptoms(fatigue, thirst, edema, anemia), tongue and pulse manifestations, urine protein, blood glucose, serum creatinine and other indicators were analyzed. Results The proportion of patients with qi deficiency type in diabetic nephropathy group was higher than that in other primary disease group, the proportion of patients with Yang deficiency type in diabetic nephropathy group was lower than that in other primary disease group(P<0.05), and there was no significant difference in other TCM syndrome types between the two groups(P>0.05). The incidence of fatigue and thirst in the diabetic nephropathy group was higher than that in the other primary disease group, the incidence of edema in the diabetic nephropathy group was lower than that in the other primary disease group(P<0.05). There was no significant difference in the incidence of anemia between the two groups(P>0.05). The proportion of patients with light tongue and thin tongue coating in the diabetic nephropathy group was higher than that in the other primary disease groups, and the proportion of patients with heavy pulse in the diabetic nephropathy group was lower than that in the other primary disease groups(P<0.05). The levels of urinary protein and blood glucose in diabetic nephropathy group were higher than those in other primary disease groups(P<0.05). There was no significant difference in serum creatinine level between the two groups(P>0.05). Conclusions There are significant differences in TCM syndrome types between patients with diabetic nephropathy and patients with end-stage renal disease caused by other primary diseases. TCM syndrome differentiation and treatment should be individualized according to different syndrome types to improve the therapeutic effect.