赵清琼;卢晶晶;韦芳宁;李正胜;谢娟;周恬;杨一楠;李明娜;
ZHAO Qingqiong;LU Jingjing;WEI Fangning;LI Zhengsheng;XIE Juan;ZHOU Tian;YANG Yinan;LI Mingna;Department of Nephrology,the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine;Department of Nephrology,the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine;

• 1:贵州中医药大学第二附属医院肾内科
• 2:广州中医药大学第二附属医院肾内科

摘要(Abstract)：

目的探讨慢性肾功能衰竭(肾衰)的中医证候分布特点及其与血管内膜增生的关系。方法对139例慢性肾衰自体动静脉内瘘成型术患者通过问卷调查进行中医证侯分型,术前采用血管彩超检查手术侧上肢动静脉,并在术中留取患者结扎AVF瘘处约5 mm的静脉血管行HE染色观察血管内膜等组织学改变,分析中医证型分布特点及其与血管内膜增生的关系。结果 139例慢性肾衰患者按中医证候分为脾肾阳虚夹湿热组38例、脾肾阳虚夹水湿组42例、脾肾阴虚组41例及其他证候组18例,4组患者一般资料比较差异无统计学意义(P> 0.05);血管彩超示内膜厚度比较,脾肾阴虚组、脾肾阳虚夹水湿组均较脾肾阳虚夹湿热组、其他证候组增加(P<0.05);中膜厚度比较,脾肾阴虚组最大(P<0.05),脾肾阳虚组、其他证候组均大于脾肾阳虚夹湿热组(P<0.05);HE染色可见4组血管内膜均有不同程度增生,其中脾肾阳虚夹水湿组增生最明显,与其他3组比较,差异有统计学意义(P<0.05)。结论慢性肾功能衰竭患者的血管内膜存在不同程度的增生,脾肾阳虚夹水湿患者的血管内膜增生最为严重。
Objective To investigate the distribution characteristics of TCM syndromes of chronic renal failure(kidney failure) and its relationship with vascular intimal hyperplasia.Methods TCM syndrome classification was obtained from questionnaire surveys which was run on 139 patients with chronic renal failure who underwent autologous arteriovenous fistulas(AVF).Before AVF surgery,color Doppler ultrasound was used to examine the arteries and veins of the upper extremity on the ongoing surgery side.The vein vessels at 5 mm away from AVF ligation during the operation was taken to be stained with H&E to observe the histological changes of the vascular intima.The relationship between the distribution characteristics of TCM syndrome types and vascular intimal hyperplasia were analyzed.Results Based on TCM syndrome,139 patients with chronic renal failure were divided into Spleen-kidney yang deficiency plus damp-heat group(n=38),spleen-kidney yang deficiency plus water dampness group(n=42),spleen-kidney yin deficiency group(n=41) and other syndrome group(n=18).There was no statistically significant differences in the general data of the above 4 groups(P>0.05).Color Doppler ultrasound showed that vascular intimal thickness in spleen-kidney yin deficiency group and spleen-kidney yang deficiency plus water dampness group were greater than those in spleen-kidney yang deficiency plus damp-heat group and other syndrome groups(P <0.05);while the thickness of vascular media was the largest in spleen-kidney yin deficiency group(P <0.05).The thickness of vascular media in spleen-kidney yang deficiency group and other syndrome group were larger than in spleen-kidney yang deficiency plus damp-heat group(P <0.05).H&E staining showed that the vascular intima of the 4 groups had hyperplasia at different degrees,of which spleen-kidney yang deficiency plus water dampness group had the most obvious hyperplasia(P <0.05).Conclusion Patients with chronic renal failure have hyperplasia of the vascular intima at different degrees.Spleen-kidney yang deficiency plus water dampness group have the most serious hyperplasia of vascular intimal.

关键词(KeyWords)： 慢性肾功能衰竭;血液透析;血管内膜增生;相关性;自体动静脉内瘘;血管彩超;中医证候;病理改变
chronic renal failure;hemodialysis;vascular intimal hyperplasia;correlation;autologous arteriovenous fistula;color Doppler ultrasound;TCM syndrome;pathological change

Abstract:

Keywords:

基金项目(Foundation): 贵阳市科技局大健康合作项目[筑科合同（2019）-9-4-10];; 贵州省中医药管理局中医药、民族医药科学技术研究课题（QZYY-2018-030）;; 贵阳中医学院科研项目[（2017）64];; 贵州中医药大学科研项目[贵中医院内（2019）73]

作者(Authors): 赵清琼;卢晶晶;韦芳宁;李正胜;谢娟;周恬;杨一楠;李明娜;
ZHAO Qingqiong;LU Jingjing;WEI Fangning;LI Zhengsheng;XIE Juan;ZHOU Tian;YANG Yinan;LI Mingna;Department of Nephrology,the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine;Department of Nephrology,the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine;

DOI: 10.19367/j.cnki.2096-8388.2021.11.015

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