袁丽莎　肖永华　钟剑　国凤霞　窦仲萍　关静　曹钋　任可　李建军　马迎春　魏宇　裴志行

摘要 目的：研究慢性腎脏病（CKD）5期进行维持性血液透析（MHD）患者的中医证候要素特征。方法：选取2019年1月至2019年5月多中心调查的MHD患者286例作为研究对象，采用流行病学方法，收集一般资料及中医症状信息，同时采用舌象仪采集舌象信息，运用因子分析的方法对症状及舌象数据进行统计分析，在中医理论指导下，综合公因子中医证候含义。结果：共提取12个公因子，病位证素有肾、脾、肝、心、胃，以肾、脾、肝为主，病性证素有气虚、阴虚、阳虚，以气虚、阴虚为主，病邪证素有湿、热、血瘀、风动，以湿、热、血瘀为主。结论：CKD5期MHD患者本虚标实并见，本虚包括脾肾气虚、脾肾阳虚、肝肾阴虚、气阴两虚，实证包括肾络瘀热、肝胆湿热，虚实夹杂包括脾虚湿浊、肾虚湿热、气虚血瘀、阴虚风动。

关键词 慢性肾脏病5期;尿毒症;维持性血液透析;横断面研究;多元统计分析;因子分析;舌象;证候要素;中医证型

Exploration of TCM Syndrome Elements in Hemodialysis Patients Based on Factor Analysis

YUAN Lisha1，XIAO Yonghua2，ZHONG Jian2，GUO Fengxia2，DOU Zhongping2，GUAN Jing3，CAO Po2，REN Ke4，LI Jianjun5，MA Yingchun6，WEI Yu2，PEI Zhihang1

（1 The First Medical College，Beijing University of Chinese Medicine，Beijing 100029，China; 2 Department of Nephrology，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100700，China; 3 College of Basic Medicine，Beijing University of Chinese Medicine，Beijing 100029，China; 4 Department of Nephrology，Dongfang Hospital，Beijing University of Chinese Medicine，Beijing，100078，China; 5 Dialysis Room，East District of Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 101121，China; 6 Department of Nephrology，China Rehabilitation Medical Research Center-Beijing Boai Hospital Beijing，100068，China）

Abstract Objective：To study the characteristics of TCM syndrome elements in patients with maintenance hemodialysis （MHD） during chronic kidney disease stage 5 （CKD5）.Methods：By epidemiological methods，a total of 286 MHD patients from a multi-center survey from January 2019 to May 2019 were selected as the research objects to collect general information and TCM symptom information.At the same time，tongue image information was collected by tongue imager.Factor analysis was used to statistically analyze the symptoms and tongue image data.The meaning of the common factor of TCM syndrome was summarized according to the theory of traditional Chinese medicine.Results：A total of 12 common factors were extracted.The disease location elements included the kidney，the spleen，the liver，the heart and the stomach.The kidney，the spleen and the liver were the main factors.The syndrome elements of the disease nature were qi deficiency，yin deficiency and yang deficiency，in which the main factors were the qi deficiency and yin deficiency.The syndrome elements of pathogenic factors were dampness，heat，blood stasis，stiring wind，with dampness，heat，blood stasis as the main elements.Conclusion：MHD patients in CKD5 5 stage was deficient in origin and excessive in superficiality.The origin deficiency includes spleen-kidney qi deficiency，spleen-kidney yang deficiency，liver-kidney yin deficiency and qi-yin deficiency.While excessive superficiality includes kidney collateral blood stasis-heat，dampness-heat of liver and gallbladder，intermingled deficiency and excess includes spleen deficiency due to dampness and turbidity，kidney deficiency due to dampness and heat，blood stasis due to qi deficiency and stirring wind due to yin deficiency.

Keywords Chronic kidney disease stage 5; Uremia; Maintenance hemodialysis; Cross-sectional study; Multivariate statistical analysis; Factor analysis; Tongue image; Syndrome elements; TCM Syndrome type

中图分类号：R289.5;R541文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.15.026

维持性血液透析（Maintenance Hemodialysis，MHD）是进入慢性肾脏病（Chronic Kidney Disease，CKD）5期的患者最为主要的肾脏替代治疗方式[1]。对于规律行血液透析的患者，虽然体内的代谢产物及水分可被透析清除，但透析间期仍会蓄积[2]，使得患者仍然可能存在诸如水肿，乏力，腰酸，恶心呕吐，尿少等尿毒症的临床症状。中医多将其归于“水肿”“癃闭”“关格”等病范畴[3]。CKD5期的MHD患者多经历了漫长的病程，病性虚实夹杂，证候复杂多样[4]。尽管针对MHD患者的证候已做过许多研究调查，但目前尚无统一的辨证分型共识，且既往研究多依据既定的慢性肾功能衰竭证型分类，以对号入座的方式判定患者证型，并不能完全符合临床实际复杂的证候。……