老年糖尿病肾病病程演变中的关键证素可视化研究*

作者：陈秀敏1,2，王煜杰1,3，洪 靖2

单位：1.北京中医药大学，北京 100029； 2.中日友好医院，北京 100029； 3.北京中医药大学东直门医院，北京 100700

引用：引用：陈秀敏，王煜杰，洪靖.老年糖尿病肾病病程演变中的关键证素可视化研究[J].中医药导报,2025,31(11):62-67,73.

DOI：10.13862/j.cn43-1446/r.2025.11.011

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摘要：

目的：探讨老年糖尿病肾病（DN）患者病程演变过程中的关键证素，为改善DN的远期预后提供依据。方法：采用回顾性分析，纳入160例老年DN患者，以24 h尿蛋白定量水平作为分组依据，分为无尿蛋白组（<150 mg，n=50）、少量尿蛋白组（150~500 mg，n=44）和大量尿蛋白组（>500 mg，n=66）。采用加权阈值法计算证素积分，通过统计学方法和可视化分析探讨各组患者的证素动态演变规律，发现疾病进展过程中的关键证素。结果：随着患者病情加重，病位证素肾、脾、心的积分显著上升（P<0.05），肝、半表半里的积分显著下降（P<0.05）；病性证素气虚、阳虚、水停、毒的积分显著上升（P<0.05），燥、气滞的积分显著下降（P<0.05）。可视化分析显示，痰、湿、阴虚贯穿全程，肝、阴虚证素随着疾病进展逐渐趋于边缘，脾、肾证素权重上升。气虚在少量蛋白尿时期开始向中心靠近，最终在大量蛋白尿时期与阳虚、水停证素会聚中央。临床指标的相关性分析显示，病程与肾、水停、毒呈显著正相关（P<0.05），体质量指数（BMI）与脾、痰、湿、水停呈显著正相关（P<0.05），肌酐、尿素水平与肾、脾、水停、气虚、阳虚、毒呈显著正相关（P<0.05），肾小球滤过率（eGFR）则与这些证素呈显著负相关（P<0.05）。结论：痰、湿、阴虚为老年DN患者的基础证素，脾肾虚损是蛋白尿发生的重要环节，气虚、阳虚的加重引动湿浊毒邪的积聚，系DN进展、蛋白尿大量出现的关键证素。中医病机总体呈现因虚致实，“肝肾气阴两虚-脾肾虚损-湿浊瘀毒”的动态演变。

关键词：糖尿病肾病；老年患者；蛋白尿；证素辨证；可视化研究

Abstract：

Objective: To investigate key syndrome elements in the disease progression of elderly diabetic nephropathy (DN) and provide evidence for improving long-term prognosis. Methods: A retrospective analysis was conducted on 160 elderly DN patients, categorized into three groups by 24-hour urinary protein levels, including No proteinuria group (<150 mg, n=50), Mild proteinuria group (150-500 mg, n=44) and Severe proteinuria group (>500 mg, n=66). Syndrome element scores were calculated using weighted threshold method. Statistical analysis and visualization were performed to identify critical syndrome elements during disease progression. Results: For disease location elements, kidney, spleen and heart scores showed significant increases (P<0.05), while liver and half-exterior-half-interior scores decreased (P<0.05). In disease nature elements, Qi deficiency, Yang deficiency, water retention, and toxin scores significantly increased (P<0.05), whereas dryness and Qi stagnation scores decreased (P<0.05). Visualization analysis revealed that phlegm, dampness, and Yin deficiency persisted across all disease stages. Liver and Yin deficiency gradually migrated to peripheral nodes as the disease progressed, while spleen and kidney elements gained dominance. Qi deficiency shifted toward the core during the mild proteinuria phase, ultimately converging with Yang deficiency and water retention. Clinical correlation analysis indicated that disease duration was positively correlated with kidney, water retention, and toxin (P<0.05). BMI positively correlated with spleen, phlegm, dampness, and water retention (P<0.05). Creatinine and urea levels positively correlated with kidney, spleen, water retention, Qi deficiency, Yang deficiency and toxin (P<0.05). Glomerular filtration rate (eGFR) exhibited significant negative correlations with these elements (P<0.05). Conclusion: The study identified phlegm, dampness, and Yin deficiency as foundational syndrome elements in elderly DKD. Deficiencies of spleen and kidney are pivotal in DKD pathogenesis, while the emergence of Qi deficiency and Yang deficiency triggers the accumulation of dampness-turbidity-toxin, marking critical progression drivers. The dynamic pathogenesis follows a "deficiency leading to excess" pattern, evolving sequentially from Qi-Yin deficiency of liver-kidney to spleen-kidney deficiency, culminating in dampness-turbidity-stasis-toxin.

Key words：diabetic nephropathy; elderly patients; proteinuria; syndrome element; visualization study

发布时间：2025-11-29

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