血液透析患者中醫辨證分型與血清生化值之研究

STUDIES ON THE CLASSICAL DIFFERENTIAL DIAGNOSIS OF TRADITIONAL CHINESE MEDICINE AND BIOCHEMICAL PARAMETERS IN HEMODIALYSIS PATIENTS

本研究之目的在探討尿毒症血液透析患者之中醫辨證分型：脾腎氣虛、脾腎陽虛、肝腎陰虛、氣陰兩虛、陰陽兩虛及非虛型共六型之偏向性，暨各個中醫證型與尿毒症的病因、罹患智能障礙、以及其血清生化值變化作分析研究。研究結果發現脾腎陽虛及陰陽兩虛型分佈在病患年紀較大（65.7±13.2；65.7±10.1歲），血液透析時間較長者（76.5±35.5；81.1±60.3個月），而且此兩型的血液透析患者較其他中醫證型之簡易智能測驗分數較低（MMSE score：23.9±5.4；23.4±4.7） （p<0.05）。又分析血液透析患者之中醫證型與血清生化值，發現各證型間之血清生化值並無顯著差異，但是血清白蛋白（albumin）與肌酐酸（creatinine）在脾腎陽虛及陰陽兩虛者有顯著之低落現象（血清白蛋白：3.5±0.4；3.3±0.3g/dl；肌酐酸：8.3±1.8；7.8±1.7mg/dl），顯示此兩型病患之營養狀況較差。綜合以上結果，顯示患者年齡愈大，血液透析時間愈長，愈會出現脾腎陽虛及陰陽兩虛之表現，而且較容易罹患智能障礙，及出現營養不良狀況。本研究結果可供中醫師臨床上對血液透析患者就診時診斷及處方用藥之參考。The syndrome types of Traditional Chinese Medicine (TCM) in hemodialysis (HD) patients are divided into Chi deficiency of Spleen and Kidney (CDSK), Yang deficiency of Spleen and Kidney (YDSK), Yin deficiency of Liver and Kidney (YDLK), deficiencies of Chi and Yin (DCY), deficiencies of Yin and Yang (DYY), and Non-deficiency (ND). The aim of the present study is to investigate the six syndrome types of TCM in HD patients and the etiology of uremia, the condition of dementia, and the changes in the serum biochemical parameters. The result showed that both YDSK and DYY types of HD patients were elder, longer dialysis times and lower Mini-Mental Status Examination (MMSE) score than the other types of HD patients. The levels of albumin and creatinine in YDSK and DYY types of HD patients were significantly lower compared to the other types of HD patients. The other serum biochemical parameters were not significantly different among the six syndrome types of HD patients. The lower serum creatinine and albumin levels suggested that YDSK and DYY types of HD patients were malnutritioned. Therefore, we concluded that the YDSK and DYY types of HD patients were elder and had received longer dialysis times. They also appeared to have intelligent impairment and malnutrition. These results could be used as references of diagnosis and treatment by the TCM physicians in clinic.