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Article(id=1322927447875911697, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.07.021, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340082376, onlineDateStr=2026-10-30, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340082376, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340082376, creator=13701087609, updateTime=1793340082376, updator=13701087609, issue=Issue{id=1322925862630339452, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='7', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1752076800000', pubDateStr='2025-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339704424, creator='13701087609', updateTime=1793340532184, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929334587105328, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929334587105329, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322925862630339452, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=94, endPage=97, ext={EN=ArticleExt(id=1322927448073043986, articleId=1322927447875911697, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Characteristics of Traditional Chinese Medicine Syndromes in Patients with Hemodialysis Complicated with Vascular Calcification, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the characteristics of traditional Chinese medicine syndromes in patients with hemodialysis complicated with vascular calcification.

Methods

A total of 108 end-stage renal disease patients with vascular calcification treated with maintenance hemodialysis were selected，and a questionnaire survey and traditional Chinese medicine syndrome differentiation were conducted by a dedicated person.

Results

All 108 patients were diagnosed as deficiency syndrome，102 patients（94.44%）can be identified as the combination of root deficiency syndrome and manifestation excess syndrome. This root deficiency syndrome was mainly characterized by Yang deficiency of spleen and kidney syndrome（42 cases，38.89%）. Secondly，there were Qi-Yin deficiency syndrome（30 cases，27.78%），Yin-Yang deficiency syndrome（18 cases，16.67%），Qi deficiency of spleen and kidney syndrome（12 cases，11.11%），and Yin deficiency of liver and kidney syndrome（6 cases，5.56%）. The manifestation excess syndrome was mainly characterized by blood stasis syndrome（42 cases，38.89%）. Secondly，there were damp-heat syndrome（33 cases，30.56%），damp-turbidity syndrome（20 cases，18.52%），water retention syndrome（4 cases，3.70%）and stirring wind syndrome（3 cases，2.78%）. The combined syndrome types of the manifestation excess syndrome：blood stasis syndrome was more common in Yang deficiency of spleen and kidney syndrome，Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome，while damp-heat syndrome and damp-turbidity syndrome were more common in Yang deficiency of spleen and kidney syndrome and Qi-Yin deficiency syndrome.stirring wind syndrome and water retention syndrome only appeared in patients with Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome. There were differences in the distribution of traditional Chinese medicine syndrome types among patients of different ages and dialysis ages，and the differences were statistically significant（P<0.05）. The patients aged more than 65 years old and with dialysis age more than 5 years with deficiency syndrome were more likely to experience Yang deficiency of spleen and kidney syndrome，followed by Qi-Yin deficiency syndrome，damp-heat syndrome was more common in excess syndrome，followed by damp-turbidity syndrome. The patients aged more than 65 years old and with dialysis age less than 5 years with deficiency syndrome were more likely to experience Qi-Yin deficiency syndrome，followed by Yang deficiency of spleen and kidney syndrome，damp-heat syndrome was more common in excess syndrome，followed by blood stasis syndrome. There was no statistical difference in the distribution of traditional Chinese medicine syndrome types among patients of different genders and primary diseases（P>0.05）.

Conclusion

The patients with hemodialysis complicated with vascular calcification merged with identified as the combination of root deficiency syndrome and manifestation excess syndrome. This root deficiency syndrome was mainly characterized by Yang deficiency of spleen and kidney syndrome. The manifestation excess syndromewas mainly characterized by blood stasis syndrome. Blood stasis syndrome was more common in Yang deficiency of spleen and kidney syndrome，Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome，while damp-heat syndrome and damp-turbidity syndrome were more common in Yang deficiency of spleen and kidney syndrome and Qi-Yin deficiency syndrome. Age and dialysis age can affect the distribution of traditional Chinese medicine syndrome types in patients.

, authors=Fei YU, Jianfeng LI, Ming'ai SONG, authorsList=Fei YU, Jianfeng LI, Ming'ai SONG, authorCompany=null, correspAuthors=Ming'ai SONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927448454725652, articleId=1322927447875911697, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=血液透析伴血管钙化中医证候特征研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

探讨血液透析伴血管钙化患者中医特征。

方法

选取维持性血液透析治疗伴有血管钙化的108例终末期肾病患者，专人进行问卷调查及中医证候辨证。

结果

108例患者均辨证为虚证，其中102例（94.44%）患者可辨为本虚证合并标实证。本虚证以脾肾阳虚证为主，其次为气阴两虚证、阴阳两虚证、脾肾气虚证、肝肾阴虚证，分别为42例（38.89%）、30例（27.78%）、18例（16.67%）、12例（11.11%）、6例（5.56%）；标实证以血瘀证为主，其次为湿热证、湿浊证、水汽证、风动证，分别为42例（38.89%）、33例（30.56%）、20例（18.52%）、4例（3.70%）、3例（2.78%）；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，风动证及水气证仅在气阴两虚证及阴阳两虚证患者中出现。不同年龄、透析龄患者中医证型分布存在差异，比较差异有统计学意义（P<0.05）；年龄≥65岁及透析龄≥5年的患者虚证以脾肾阳虚证多见，其次为气阴两虚证，实证则以血瘀证多见，其次为湿浊证，年龄<65岁及透析龄<5年的患者虚证以气阴两虚证多见，其次为脾肾阳虚证，实证以湿热证多见，其次为血瘀证；不同性别及原发疾病患者中医证型分布差异无统计学意义（P>0.05）。

结论

血液透析伴血管钙化患者多为本虚证合并标实证，本虚证以脾肾阳虚证为主，标实证以血瘀证为主；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，年龄、透析龄会影响到患者的中医证型分布。

, authors=余斐, 李建锋, 宋明爱, authorsList=余斐, 李建锋, 宋明爱, authorCompany=null, correspAuthors=宋明爱, authorNote=

余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

, correspAuthorsNote=
宋明爱（1972-），女，河南南阳人，主任医师，学士，研究方向：肾内科。E-mail：。
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余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

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余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

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证型无兼证兼证分布合计
湿浊证水气证湿热证风动证血瘀证
脾肾气虚2（1.85）2（1.85）0（0.00）3（2.78）0（0.00）5（4.63）12（11.11）
脾肾阳虚2（1.85）9（8.33）0（0.00）14（12.96）0（0.00）17（15.74）42（38.89）
气阴两虚1（0.93）6（5.56）2（1.85）10（9.26）1（0.93）10（9.26）30（27.78）
阴阳两虚0（0.00）2（1.85）2（1.85）4（3.70）2（1.85）8（7.41）18（16.67）
肝肾阴虚1（0.93）1（0.93）0（0.00）2（1.85）0（0.00）2（1.85）6（5.56）
合计6（5.56）20（18.52）4（3.70）33（30.56）3（2.78）42（38.89）108（100.00）
), ArticleFig(id=1322927452036661298, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927447875911697, language=CN, label=表1, caption=

血液透析伴血管钙化患者中医证候分布

, figureFileSmall=null, figureFileBig=null, tableContent=
证型无兼证兼证分布合计
湿浊证水气证湿热证风动证血瘀证
脾肾气虚2（1.85）2（1.85）0（0.00）3（2.78）0（0.00）5（4.63）12（11.11）
脾肾阳虚2（1.85）9（8.33）0（0.00）14（12.96）0（0.00）17（15.74）42（38.89）
气阴两虚1（0.93）6（5.56）2（1.85）10（9.26）1（0.93）10（9.26）30（27.78）
阴阳两虚0（0.00）2（1.85）2（1.85）4（3.70）2（1.85）8（7.41）18（16.67）
肝肾阴虚1（0.93）1（0.93）0（0.00）2（1.85）0（0.00）2（1.85）6（5.56）
合计6（5.56）20（18.52）4（3.70）33（30.56）3（2.78）42（38.89）108（100.00）
), ArticleFig(id=1322927452103770163, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927447875911697, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
证型例数年龄χ2值P值性别χ2值P值
<65岁（49例）≥65岁（59例）男（61例）女（47例）
脾肾气虚128（16.33）4（6.78）11.2400.0247（11.48）5（10.64）0.7150.950
脾肾阳虚4212（24.49）30（50.85）22（36.07）20（42.55）
气阴两虚3014（28.57）16（27.12）18（29.51）12（25.53）
阴阳两虚1810（20.41）8（13.56）10（16.39）8（17.02）
肝肾阴虚65（10.20）1（1.69）4（6.56）2（4.26）
证型例数透析龄χ2值P值原发疾病χ2值P值
<5年（38例）≥5年（70例）慢性肾小球肾炎（38例）糖尿病肾病（26例）多囊肾（15例）慢性间质性肾炎（14例）急进性肾炎（10例）高血压肾损害（5例）
脾肾气虚123（7.89）9（12.86）14.5060.0064（10.53）3（11.54）2（13.33）2（14.29）1（10.00）0（0.00）8.6070.978
脾肾阳虚429（23.68）33（47.14）14（36.84）11（42.31）3（20.00）7（50.00）5（50.00）2（40.00）
气阴两虚3010（26.32）20（28.57）10（26.32）6（23.08）6（40.00）3（21.43）3（30.00）2（40.00）
阴阳两虚1812（31.58）6（8.57）6（15.79）5（19.23）3（20.00）2（14.29）1（10.00）1（20.00）
肝肾阴虚64（10.53）2（2.86）4（10.53）1（3.85）1（6.67）0（0.00）0（0.00）0（0.00）
), ArticleFig(id=1322927452183461940, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927447875911697, language=CN, label=表2, caption=

不同年龄、性别及透析龄、原发疾病患者的中医虚证分布情况

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证型例数年龄χ2值P值性别χ2值P值
<65岁（49例）≥65岁（59例）男（61例）女（47例）
脾肾气虚128（16.33）4（6.78）11.2400.0247（11.48）5（10.64）0.7150.950
脾肾阳虚4212（24.49）30（50.85）22（36.07）20（42.55）
气阴两虚3014（28.57）16（27.12）18（29.51）12（25.53）
阴阳两虚1810（20.41）8（13.56）10（16.39）8（17.02）
肝肾阴虚65（10.20）1（1.69）4（6.56）2（4.26）
证型例数透析龄χ2值P值原发疾病χ2值P值
<5年（38例）≥5年（70例）慢性肾小球肾炎（38例）糖尿病肾病（26例）多囊肾（15例）慢性间质性肾炎（14例）急进性肾炎（10例）高血压肾损害（5例）
脾肾气虚123（7.89）9（12.86）14.5060.0064（10.53）3（11.54）2（13.33）2（14.29）1（10.00）0（0.00）8.6070.978
脾肾阳虚429（23.68）33（47.14）14（36.84）11（42.31）3（20.00）7（50.00）5（50.00）2（40.00）
气阴两虚3010（26.32）20（28.57）10（26.32）6（23.08）6（40.00）3（21.43）3（30.00）2（40.00）
阴阳两虚1812（31.58）6（8.57）6（15.79）5（19.23）3（20.00）2（14.29）1（10.00）1（20.00）
肝肾阴虚64（10.53）2（2.86）4（10.53）1（3.85）1（6.67）0（0.00）0（0.00）0（0.00）
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证型例数年龄χ2值P值性别χ2值P值
<65岁（44例）≥65岁（58例）男（59例）女（43例）
湿浊证207（15.91）13（22.41）11.1840.02512（20.34）8（18.60）0.7720.942
水气证41（2.27）3（5.17）3（5.08）1（2.33）
湿热证3322（50.00）11（18.97）18（30.51）15（34.88）
风动证31（2.27）2（3.45）2（3.39）1（2.33）
血瘀证4213（29.55）29（50.00）24（40.68）18（41.86）
证型例数透析龄χ2值P值原发疾病χ2值P值
<5年（33例）≥5年（69例）慢性肾小球肾炎（37例）糖尿病肾病（24例）多囊肾（14例）慢性间质性肾炎（14例）急进性肾炎（9例）高血压肾损害（4例）
湿浊证202（6.06）18（26.09）13.8000.0089（24.32）6（25.00）2（14.29）2（14.29）1（11.11）0（0.00）14.9300.780
水气证41（3.03）3（4.35）2（5.41）1（4.17）1（7.14）0（0.00）0（0.00）0（0.00）
湿热证3318（54.55）15（21.74）13（35.14）8（33.33）6（42.86）2（14.29）2（22.22）2（50.00）
风动证30（0.00）3（4.35）2（5.41）1（4.17）0（0.00）0（0.00）0（0.00）0（0.00）
血瘀证4212（36.36）30（43.48）11（29.73）8（33.33）5（35.71）10（71.43）6（66.67）2（50.00）
), ArticleFig(id=1322927452342845494, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927447875911697, language=CN, label=表3, caption=

不同年龄、性别及透析龄、原发疾病患者的中医实证分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
证型例数年龄χ2值P值性别χ2值P值
<65岁（44例）≥65岁（58例）男（59例）女（43例）
湿浊证207（15.91）13（22.41）11.1840.02512（20.34）8（18.60）0.7720.942
水气证41（2.27）3（5.17）3（5.08）1（2.33）
湿热证3322（50.00）11（18.97）18（30.51）15（34.88）
风动证31（2.27）2（3.45）2（3.39）1（2.33）
血瘀证4213（29.55）29（50.00）24（40.68）18（41.86）
证型例数透析龄χ2值P值原发疾病χ2值P值
<5年（33例）≥5年（69例）慢性肾小球肾炎（37例）糖尿病肾病（24例）多囊肾（14例）慢性间质性肾炎（14例）急进性肾炎（9例）高血压肾损害（4例）
湿浊证202（6.06）18（26.09）13.8000.0089（24.32）6（25.00）2（14.29）2（14.29）1（11.11）0（0.00）14.9300.780
水气证41（3.03）3（4.35）2（5.41）1（4.17）1（7.14）0（0.00）0（0.00）0（0.00）
湿热证3318（54.55）15（21.74）13（35.14）8（33.33）6（42.86）2（14.29）2（22.22）2（50.00）
风动证30（0.00）3（4.35）2（5.41）1（4.17）0（0.00）0（0.00）0（0.00）0（0.00）
血瘀证4212（36.36）30（43.48）11（29.73）8（33.33）5（35.71）10（71.43）6（66.67）2（50.00）
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血液透析伴血管钙化中医证候特征研究
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余斐 , 李建锋 , 宋明爱
中华中医药学刊 | 国家项目点击 2025,43(7): 94-97
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中华中医药学刊 |国家项目点击 2025 , 43 (7) : 94 -97
血液透析伴血管钙化中医证候特征研究
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余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

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余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

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余斐, 李建锋, 宋明爱
作者信息
  • 南阳市第一人民医院，河南 南阳 473000
通讯作者:
宋明爱（1972-），女，河南南阳人，主任医师，学士，研究方向：肾内科。E-mail：。
作者简介:

余斐（1988-），女，河南南阳人，主治医师，硕士，研究方向：肾内科。

Characteristics of Traditional Chinese Medicine Syndromes in Patients with Hemodialysis Complicated with Vascular Calcification
Fei YU, Jianfeng LI, Ming'ai SONG
Affiliations
  • First People's Hospital of Nanyang，Nanyang 473000，Henan，China
出版时间: 2025-07-10 doi: 10.13193/j.issn.1673-7717.2025.07.021
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摘要
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目的

探讨血液透析伴血管钙化患者中医特征。

方法

选取维持性血液透析治疗伴有血管钙化的108例终末期肾病患者，专人进行问卷调查及中医证候辨证。

结果

108例患者均辨证为虚证，其中102例（94.44%）患者可辨为本虚证合并标实证。本虚证以脾肾阳虚证为主，其次为气阴两虚证、阴阳两虚证、脾肾气虚证、肝肾阴虚证，分别为42例（38.89%）、30例（27.78%）、18例（16.67%）、12例（11.11%）、6例（5.56%）；标实证以血瘀证为主，其次为湿热证、湿浊证、水汽证、风动证，分别为42例（38.89%）、33例（30.56%）、20例（18.52%）、4例（3.70%）、3例（2.78%）；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，风动证及水气证仅在气阴两虚证及阴阳两虚证患者中出现。不同年龄、透析龄患者中医证型分布存在差异，比较差异有统计学意义（P<0.05）；年龄≥65岁及透析龄≥5年的患者虚证以脾肾阳虚证多见，其次为气阴两虚证，实证则以血瘀证多见，其次为湿浊证，年龄<65岁及透析龄<5年的患者虚证以气阴两虚证多见，其次为脾肾阳虚证，实证以湿热证多见，其次为血瘀证；不同性别及原发疾病患者中医证型分布差异无统计学意义（P>0.05）。

结论

血液透析伴血管钙化患者多为本虚证合并标实证，本虚证以脾肾阳虚证为主，标实证以血瘀证为主；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，年龄、透析龄会影响到患者的中医证型分布。

血液透析  /  血管钙化  /  中医证候  /  特征
Objective

To investigate the characteristics of traditional Chinese medicine syndromes in patients with hemodialysis complicated with vascular calcification.

Methods

A total of 108 end-stage renal disease patients with vascular calcification treated with maintenance hemodialysis were selected，and a questionnaire survey and traditional Chinese medicine syndrome differentiation were conducted by a dedicated person.

Results

All 108 patients were diagnosed as deficiency syndrome，102 patients（94.44%）can be identified as the combination of root deficiency syndrome and manifestation excess syndrome. This root deficiency syndrome was mainly characterized by Yang deficiency of spleen and kidney syndrome（42 cases，38.89%）. Secondly，there were Qi-Yin deficiency syndrome（30 cases，27.78%），Yin-Yang deficiency syndrome（18 cases，16.67%），Qi deficiency of spleen and kidney syndrome（12 cases，11.11%），and Yin deficiency of liver and kidney syndrome（6 cases，5.56%）. The manifestation excess syndrome was mainly characterized by blood stasis syndrome（42 cases，38.89%）. Secondly，there were damp-heat syndrome（33 cases，30.56%），damp-turbidity syndrome（20 cases，18.52%），water retention syndrome（4 cases，3.70%）and stirring wind syndrome（3 cases，2.78%）. The combined syndrome types of the manifestation excess syndrome：blood stasis syndrome was more common in Yang deficiency of spleen and kidney syndrome，Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome，while damp-heat syndrome and damp-turbidity syndrome were more common in Yang deficiency of spleen and kidney syndrome and Qi-Yin deficiency syndrome.stirring wind syndrome and water retention syndrome only appeared in patients with Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome. There were differences in the distribution of traditional Chinese medicine syndrome types among patients of different ages and dialysis ages，and the differences were statistically significant（P<0.05）. The patients aged more than 65 years old and with dialysis age more than 5 years with deficiency syndrome were more likely to experience Yang deficiency of spleen and kidney syndrome，followed by Qi-Yin deficiency syndrome，damp-heat syndrome was more common in excess syndrome，followed by damp-turbidity syndrome. The patients aged more than 65 years old and with dialysis age less than 5 years with deficiency syndrome were more likely to experience Qi-Yin deficiency syndrome，followed by Yang deficiency of spleen and kidney syndrome，damp-heat syndrome was more common in excess syndrome，followed by blood stasis syndrome. There was no statistical difference in the distribution of traditional Chinese medicine syndrome types among patients of different genders and primary diseases（P>0.05）.

Conclusion

The patients with hemodialysis complicated with vascular calcification merged with identified as the combination of root deficiency syndrome and manifestation excess syndrome. This root deficiency syndrome was mainly characterized by Yang deficiency of spleen and kidney syndrome. The manifestation excess syndromewas mainly characterized by blood stasis syndrome. Blood stasis syndrome was more common in Yang deficiency of spleen and kidney syndrome，Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome，while damp-heat syndrome and damp-turbidity syndrome were more common in Yang deficiency of spleen and kidney syndrome and Qi-Yin deficiency syndrome. Age and dialysis age can affect the distribution of traditional Chinese medicine syndrome types in patients.

hemodialysis  /  vascular calcification  /  traditional Chinese medicine syndrome  /  characteristics
余斐, 李建锋, 宋明爱. 血液透析伴血管钙化中医证候特征研究. 中华中医药学刊, 2025 , 43 (7) : 94 -97 . DOI: 10.13193/j.issn.1673-7717.2025.07.021
Fei YU, Jianfeng LI, Ming'ai SONG. Characteristics of Traditional Chinese Medicine Syndromes in Patients with Hemodialysis Complicated with Vascular Calcification[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (7) : 94 -97 . DOI: 10.13193/j.issn.1673-7717.2025.07.021
正文
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慢性肾功能衰竭（chronic renal failure，CRF）是各种慢性肾脏疾病最终的发展结局，患者从肾功能减退到最终衰竭，目前针对慢性肾功能衰竭的失代偿期治疗主要采取血液透析或腹膜透析治疗，其中血液透析最为常用，可延缓患者生命。心血管疾病是慢性肾脏病（chronic kidney disease，CKD）患者的最常见并发症[1-3]，是导致患者死亡的主要诱因，其中以血管钙化（vascular calcification，VC）最为常见，血管钙化也是慢性肾脏病患者并发心血管事件及全因死亡的独立预测因子[1-3]。血管钙化在规律性的血液透析患者中发病率相对低于非规律性血液透析患者[4]，但是随着患者的病情最终发展，血管钙化的发生率也随之升高，主要发生于血管内膜、中膜、心脏瓣膜等位置。因此，有效防治血管钙化是提高血液透析患者生存率的重要途径之一，但是目前针对血管钙化并无特效的防治方法。肾功能衰竭、慢性肾脏病等在中医学上并无此概念，但是可将其归纳在“水肿”“虚劳”“溺毒”“溺毒”“关格”“癃闭”“水肿”等范畴，为本虚标实之证[5-7]，血管钙化可归于中医学的“胸痹”“脉痹”等范畴[8-9]，中医药治疗慢性肾功能衰竭及心血管疾病具有悠久的历史，但是对血液透析伴血管钙化的患者相对中医证候分布临床研究较少。本研究对血液透析伴血管钙化患者的中医证候特征进行了研究，旨在为中医药治疗提供理论参考基础，现将相关研究结果报道如下。
1　资料与方法
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1.1　研究对象
选取我院2019年1月1日—2023年6月30日进行维持性血液透析治疗伴有血管钙化的108例终末期肾病患者。纳入标准：（1）患者年龄≥18周岁。（2）维持性血液透析时间≥3个月。（3）意识清楚，可配合进行研究者。排除标准：（1）有精神异常、失语、听力异常等无法配合研究者。（2）病危者。（3）合并有急慢性感染、代谢性酸中毒、心力衰竭等情况未纠正者。（4）双手臂行内瘘者。（5）肿瘤或近3个月内手术史。（6）肾移植史。108例患者中男61例、女47例；年龄（62.86±8.19）岁，其中≥65岁者59例；透析龄（77.45±11.23）个月，其中≥5年者70例；原发疾病：38例为慢性肾小球肾炎，26例为糖尿病肾病，15例为多囊肾，14例为慢性间质性肾炎，10例为急进性肾炎，5例为高血压肾损害；血管钙化分布：单纯心脏瓣膜钙化者83例（其中单纯主动脉瓣钙化52例、二尖瓣钙化10例、合并主动脉瓣和二尖瓣钙化21例），单纯腹主动脉钙化11例，合并心脏瓣膜和腹主动脉钙化者14例。本研究经过南阳市第一人民医院医学伦理委员会审核通过。
1.2　诊断标准
（1）血管钙化的诊断标准依据2017年改善全球肾脏病预后（Kidney disease：improving global outcomes，KDIGO）组织的慢性肾脏病矿物质和骨异常（Chronic kidney disease-mineral and bone disorder，CKD-MBD）指南建议及标准进行诊断[10]，患者进行X线片或CT检查评估腹主动脉钙化，超声心动图评估心脏瓣膜钙化。（2）终末期肾病的中医辨证及证候标准：参照《中药新药临床研究指导原则》的证候标准[11]。本虚证：脾肾气虚、脾肾阳虚、气阴两虚、阴阳两虚、肝肾阴虚。标实证：湿浊证、水气证、湿热证、风动证、血瘀证。
1.3　方法
制定血液透析伴血管钙化患者中医证候分布表，内容包括患者性别、年龄、透析时间、原发疾病、中医证候等，对于满足纳入标准的相关病例，专人进行问卷调查及中医证候辨证，患者主症属于多个证型的情况则诊断为包含最多主症的证型，中医证候辨证诊断则依据患者症状、舌脉等由2位中医副主任医师和（或）主任医师进行诊断。
1.4　统计学方法
采用SPSS 20.0软件分析。计数资料以率表示，采用卡方检验。以P<0.05为差异有统计学意义。
2　结果
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2.1　中医证候分布
108例患者均辨证为虚证，其中102例（94.44%）患者可辨为本虚证合并标实证。本虚证以脾肾阳虚证为主，其次为气阴两虚证、阴阳两虚证、脾肾气虚证、肝肾阴虚证，分别为42例（38.89%）、30例（27.78%）、18例（16.67%）、12例（11.11%）、6例（5.56%）；标实证以血瘀证为主，其次为湿热证、湿浊证、水汽证、风动证，分别为42例（38.89%）、33例（30.56%）、20例（18.52%）、4例（3.70%）、3例（2.78%）；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，风动证及水气证仅在气阴两虚证及阴阳两虚证患者中出现。见表1。
2.2　不同年龄、性别及透析龄、原发疾病患者的中医证型分布情况
不同年龄、透析龄患者中医证型分布存在差异，比较差异有统计学意义（P<0.05）；年龄≥65岁及透析龄≥5年的患者虚证以脾肾阳虚证多见，其次为气阴两虚证，实证则以血瘀证多见，其次为湿浊证，年龄<65岁及透析龄<5年的患者虚证以气阴两虚证多见，其次为脾肾阳虚证，实证以湿热证多见，其次为血瘀证；不同性别及原发疾病患者中医证型分布差异无统计学意义（P>0.05）。见表2、表3。
3　讨论
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终末期肾病患者机体长期处于慢性缺血缺氧及炎症状态[12-15]，这是引起血管钙化的主要病理机制[16-18]，导致终末期肾病的慢性肾小球肾炎、糖尿病肾病、慢性间质性肾炎、高血压肾损害等原发疾病加速血管钙化病程，终末期肾病患者的钙物质骨代谢紊乱、氧化应激等也是促进血管钙化的危险因素[19-21]。血液透析是终末期肾病主要治疗方法，血液透析伴有血管钙化常见，而且随着肾功能的下降血管钙化的发生率会随之增高，血管钙化患者临床症状主要与受累血管部位相关，如发生在心脏瓣膜，则可出现胸闷气短等症状，如累及腹主动脉则可出现腹痛等症状，严重时可导致猝死。
肾功能衰竭、慢性肾脏病在中医学中归纳在“水肿”“虚劳”“溺毒”“溺毒”“关格”“癃闭”“水肿”等范畴，其为本虚标实之证。肾为先天之本，藏精，精可化生髓，髓可生血，在《黄帝内经》中首次提出肾藏精，被认为是人体生命活动基础物质；《诸病源候论·虚劳病诸候下》云：“肾藏精。精者，血之所成也”。水谷精微和肾精都是化生血源的基础物质。肾脏疾病普遍病程较长，病情反复缠绵或日久迁延可引起患者肾气日益损害，肾失于主水，气化失职，最终气损而及阳，血虚及阴，最终五脏、阴阳均损，正气衰败，气化失司，症状上可出现浮肿、乏力、气短等症状。血液透析属于治疗方法，在中医学中可归纳在“祛邪”的范畴，通过血液透析可将患者体内代谢产生的有害物质排出体外，改善患者病情，但是此方法治疗也可加剧患者正气的损失，导致精微和肾精的流失。血管钙化属于“胸痹”“脉痹”等范畴，其病因多为“痰”“瘀”两邪，其根本为“脉道不利”。因此，血液透析伴血管钙化的终末期肾病患者其中医证候较为复杂，单一证候较少见，大部分患者为本虚合并标实证。
本研究显示患者的中医证候均为虚证，94.44%患者可辨为本虚证合并标实证，本虚证的分布规律则以脾肾阳虚证为主，其次为气阴两虚证、阴阳两虚证、脾肾气虚证、肝肾阴虚证，标实证以血瘀证为主，其次为湿热证、湿浊证、水汽证、风动证，标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，风动证及水气证仅在气阴两虚证及阴阳两虚证患者中出现。郝岩等学者报道认为尿毒症维持性血液透析患者以阴阳两虚证最多[22]，其次为气阴两虚证及脾肾阳虚证；刘琳娜等[23]报道结果认为维持性血液透析合并血管钙化患者以肝肾阴虚证及脾肾阳虚证多见；周建芳等[24]研究发现维持性血液透析患者以脾肾气阴两虚为主；姜晨等[25]研究显示尿毒症腹膜透析伴有血管钙化患者以脾肾阳虚证为主，其次为气阴两虚证。可以看出，不同学者研究结果显示血液透析患者中医证候并不完全相同，存在一定差异性，伴有血管钙化者脾肾阳虚证更多见，说明伴有血管钙化会对血液透析患者的中医证候形成影响。在标实证中，普遍认为湿热证、瘀血证及湿浊证多见，但是前后顺序也存在差异，这可能是因为不同学者选择的研究对象的病程、是否合并血管钙化等因素影响有关，但是共识普遍发现水气证以及风动证较为少见，这也与肾病、血液透析、血管钙化的病因病机较为相符。此外，本研究结果显示随着年龄及透析龄的增加，患者脾肾阳虚证表现更为多见，标实证则在年龄<65岁及透析龄<5年患者中以湿热证多见，其次为瘀血证，老年人及透析龄≥5年患者中血瘀证为主，其次为湿浊证。肾是先天之本，脾为后天之本，脾运化水谷之精，肾脏蕴藏的元阴以及元阳养脾气、脾阳，可调节水液代谢及促进气血运行，因此肾虚则脾损[26]，气血运行无力，“土不生水”，水湿内生。随着年龄及透析龄的增加，患者脏腑功能虚损日益严重，在疾病早期水液停滞，化湿生热，湿热内蕴，因此主要以湿热证多见，随着透析龄及年龄增加，脏腑功能衰败，阳气亏虚伤本，无力推动气血运行，瘀血、痰浊内滞，内滞的痰浊及瘀血又可反过来损伤正气，形成恶性循环，有脾肾阳虚、脾肾气虚、肝肾阴虚的患者容易发生血瘀证，气虚到一定程度则可出现阳虚，气、血两两相依，气虚血液也会瘀滞，水液运化脾胃相关[27]，“土不制水”会导致水湿，可见湿浊证、湿热证及血瘀证。
本研究结果表明，血液透析伴血管钙化患者多为本虚证合并标实证，本虚证以脾肾阳虚证为主，标实证以血瘀证为主；标实兼证以血瘀证在脾肾阳虚证、气阴两虚证、阴阳两虚证多见，湿热证及湿浊证在脾肾阳虚证、气阴两虚证多见，年龄、透析龄会影响到患者的中医证型分布。本研究通过分析血液透析伴血管钙化患者的中医证候特征，初步探索了本病的证候规律，但血液透析伴血管钙化患者的临床表现多样，病机复杂，而且本研究所选对象皆来自同一家医院，仅能够反映我院就诊的血液透析伴血管钙化患者在中医证候方面的特征，具有一定局限性。此外，中医证候辨别容易受到临床中医师辨证施治的主观因素影响，因此，本研究结果尚需要进行进一步多中心大样本数据研究结果进行论证。
基金
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  • 国家中医药管理局中医药科学技术研究专项(2019ZX796)
  • 河南省医学科技攻关联合共建项目(LHGJ20221042)
文献
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2025年第43卷第7期
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doi: 10.13193/j.issn.1673-7717.2025.07.021
  • 首发时间：2026-10-30
  • 出版时间：2025-07-10
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国家中医药管理局中医药科学技术研究专项(2019ZX796)
河南省医学科技攻关联合共建项目(LHGJ20221042)
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    南阳市第一人民医院，河南 南阳 473000

通讯作者:

宋明爱（1972-），女，河南南阳人，主任医师，学士，研究方向：肾内科。E-mail：。
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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