陕西中医2026，Vol.47Issue(1)：34-39,6.DOI:10.3969/j.issn.1000-7369.2026.01.006
2型糖尿病肾病脾肾阳虚证Ⅲ-Ⅴ期临床证候及治法特点研究
Clinical presentation and treatment characteristics of spleen-kidney yang deficiency syndrome in type 2 diabetic kidney disease across mogensen stages Ⅲ-Ⅴ
摘要
Abstract
Objective:To analyze the clinical characteristics,evolution patterns of laboratory parameters,and characteristics of traditional Chinese medicine(TCM)prescriptions in patients with type 2 diabetic kidney disease(DKD)presenting with spleen-kidney yang deficiency syndrome across different Mogensen stages.Methods:Seventy-three patients with type 2 DKD and spleen-kidney yang deficiency syndrome were enrolled.They were divided into three groups based on Mogensen stage:stage Ⅲ group(n=13),stage Ⅳ group(n=55),and stage Ⅴ group(n=5).Data including baseline information,TCM symptoms,laboratory parameters,and TCM prescriptions were collected.SPSS software was used to compare the characteristics of TCM symptoms,laboratory parameters,and prescription patterns among the groups.Results:Seventy-three patients with type 2 diabetic kidney disease presenting spleen-kid-ney yang deficiency syndrome were classified according to Mogensen staging into Stage Ⅲ(13 cases),Stage Ⅳ(55 cases),and Stage Ⅴ(5 cases).The majority of patients were male(72.60%).The median age was 67.0(55.0,72.0)years,median duration of diabetes was 10.0(8.5,21.0)years,and median duration of hypertension was 10.0(5.0,20.0)years.No statistically significant differences were observed among the groups in these baseline character-istics(all P>0.05).Comparative analysis of symptom distribution across Stages Ⅲ-Ⅴ showed that the prevalence of aversion to cold(Group Ⅲ:38.5%to Group Ⅴ:80.0%),edema(7.7%to 40.0%),chest tightness(0.0%to 40.0%),shortness of breath(0.0%to 60.0%),and poor appetite(7.7%to 40.0%)rose markedly with disease progression.Foamy urine,fatigue,and frequent nocturia were highly prevalent across all stages(Ⅲ-Ⅴ).Significant differences(P<0.05)were observed among at least two stages in cystatin C,glomerular filtration rate(GFR),24-hour urine protein quantification,total bilirubin,and total cholesterol.Specifically,cystatin C,total bilirubin,and albumin showed significant differences between Stage Ⅲ and Stage Ⅳ(P<0.05).24-hour urine protein and total cholesterol differed significantly between Stage Ⅲ and Stage Ⅳ,as well as between Stage Ⅲ and Stage Ⅴ(P<0.05).GFR in Stage Ⅴ differed significantly compared to both Stage Ⅲ and Stage Ⅳ(P<0.05).A total of 63 Chi-nese herbal prescriptions were included(11 from Stage Ⅲ,47 from Stage Ⅳ,and 5 from Stage Ⅴ),involving 66 dis-tinct herbs.The top 20 most frequently used herbs comprised 14 entities.In Stage Ⅲ,the most common herbs were Poria(90.91%),Salvia miltiorrhiza(81.82%),and Astragalus root(63.64%).In Stage Ⅳ,the most frequently pre-scribed were Astragalus root(82.98%),Cornus officinalis(70.21%),and Poria(65.96%).In Stage Ⅴ,the domi-nant herbs were Codonopsis root(80%),Astragalus root(60%),and Atractylodes macrocephala(60%).Astragalus root was highly used across all stages.Conclusion:Type 2 DKD patients with spleen-kidney yang deficiency syndrome were predominantly concentrated in Mogensen stages Ⅲ-Ⅴ(Stage Ⅳ accounting for 75.3%).Symptoms,laboratory parameters,and TCM treatment strategies dynamically evolved with disease stage progression.The core clinical treatment principle should be"warming and tonifying the spleen and kidney,supplementing qi and supporting yang",supplemented by"promoting blood circulation and resolving stasis,promoting diuresis and excreting dampness".This study provides a basis for optimizing precise stage-specific diagnosis and treatment.关键词
2型糖尿病肾病/脾肾阳虚证/临床分期/补脾益肾/活血利水/中药频次分析Key words
Type 2 diabetic kidney disease/Spleen-kidney yang deficiency syndrome/Clinical staging/Tonify-ing spleen-kidney/Promoting blood circulation and diuresis/Herb frequency analysis分类
医药卫生引用本文复制引用
HUYAN Xiaoting,QU Kai,LIU Hongfeng,ZHANG Ziqing,SHEN Xia,ZHANG Nan,ZHAO Yafeng,LI Xiancheng,YU Lili,WANG Junwen..2型糖尿病肾病脾肾阳虚证Ⅲ-Ⅴ期临床证候及治法特点研究[J].陕西中医,2026,47(1):34-39,6.基金项目
国家自然科学基金资助项目(81603454) （81603454）
陕西省科技厅重点产业链项目(2024SF-ZDCYL-03-04) （2024SF-ZDCYL-03-04）
陕西省中医药管理局"双链融合"创新团队项目(2022-SLRH-LJ-003) （2022-SLRH-LJ-003）
