王小兰 肖永华 任传云 曹钋 刘勇国 杨淑铭 尹迪 钟剑

[摘要] 目的 探讨维持性血液透析患者舌象分布规律与部分心衰指标的相关性。 方法 选取2016年8月～2017年4月北京中医药大学东直门医院、北京市第一中西医结合医院肾病透析科进行规律血液透析（≥3个月）的MHD患者77例，应用便携式舌象仪统一采集患者舌象资料。将舌象图片导入计算机软件《中医舌诊专家系统》，由3位副主任医师级别以上的专家对舌神、舌色、舌形、齿痕、裂纹、舌苔等16项指标进行定量赋值，分析透析患者舌象分布规律，同时留取舌象拍摄当日透前血标本，包括：血常规，透前肾功、离子，血清白蛋白、B型利钠肽（BNP），并计算尿素清除指数（Kt/V）、尿素下降速率（URR）、透析间期体重增长率（IDWG%）等，分析以上指标与客观化舌象的相关性，并从中发现规律。 结果 77例维持性血液透析患者中，男41例，女36例。齒痕舌定量化评分与透析间期体重增长率呈正相关（r = 0.488）。紫舌、暗舌、瘀斑、厚苔定量化评分与BNP呈正相关，即瘀血舌与BNP呈正相关（r = 0.532、0.491、0.525、0.332，均P < 0.01）。 结论 维持性血液透析患者齿痕舌与透析间期体重增长率呈正相关关系，瘀血舌与血清BNP呈正相关关系，因此瘀血舌伴齿痕可作为透析患者并发心衰的一项参考依据。

[关键词] 维持性血液透析；舌象；便携式舌象仪；心衰

[中图分类号] R541.61 [文献标识码] A [文章编号] 1673-7210（2018）04（a）-0110-04

[Abstract] Objective To investigate the correlation between the distribution of tongue image in patients with maintenance hemodialysis and some indices of the heart failure. Methods From August 2016 to April 2017， 77 cases of MHD patients （≥3 months） from Dongzhimen Hospital of Beijing University of Chinese Medicine and the First Integrated Traditional Chinese and Western Medicine Hospital were collected tongue information uniformly with the portable tongue image instrument. The tongue image was imported into the computer software "TCM expert system of tongue diagnosis". Three experts who are over deputy director of the physician level quantitated the 16 parameters of tongue image including the tongue spirit， the tongue color， the tongue shape， the teeth marks， cracks and etc to analyze MHD patients' distribution features of tongue manifestations； at the same time， the blood samples were took on the first day of tongue shooting， including blood routine， renal function， ion detection， serum albumin， BNP before hemodialysis， and the urea clearance index （Kt/V）， the rate of urea decline （URR）， the rate of interdialysis weight growth were calculated， then the correlation between tongue manifestations and objective indices was analyzed and the rules from it was found. Results Among the 77 patients undergoing maintenance hemodialysis， 41 cases were male and 36 cases were female. The score of teeth-marked tongue was positively associated with the rate of interdialysis weight growth （r = 0.488）. The score of purple tongue， dark tongue， ecchymosis and thick coating were positively associated with BNP， which was positively correlated with congestion tongue （the value of r was in turn 0.532， 0.491， 0.525， 0.332， all P < 0.01）. Conclusion There is a positive correlation between the teeth-marked tongue and the rate of interdialysis weight growth in the maintenance hemodialysis patients. The congestion tongue is positively associated with the serum BNP. So the congestion tongue with teeth marks can be used as a reference for the hemodialysis patients with potential heart failure.

[Key words] Maintenance hemodialysis； Tongue image； Portable tongue image instrument； Heart failure

维持性血液透析（MHD）是目前最常用、最重要的肾脏替代治疗方式之一[1]。长期维持血透的患者不可避免地会出现很多并发症如心血管事件、营养不良、肾性骨病、肾性贫血等。调查发现，心血管事件是血液透析患者最常见且最严重的并发症，也是MHD首位死亡原因。其中，充血性心力衰竭作为MHD患者心血管系统的重要并发症发生率非常高，占终末期肾脏病死因的20%～30%[2]。……