[1]呼延晓婷,刘宏峰,张自青,等.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,(1):34-39.[doi:DOI:10.3969/j.issn.1000-7369.2026.01.006]
　HUYAN Xiaoting,LIU Hongfeng,ZHANG Ziqing,et al.Clinical presentation and treatment characteristics of spleen-kidney yang deficiency syndrome in type 2 diabetic kidney disease across mogensen stages Ⅲ-Ⅴ[J].,2026,(1):34-39.[doi:DOI:10.3969/j.issn.1000-7369.2026.01.006]
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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

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2026年1期
页码:
34-39
栏目:
临床研究
出版日期:
2026-01-05

文章信息/Info

Title:
Clinical presentation and treatment characteristics of spleen-kidney yang deficiency syndrome in type 2 diabetic kidney disease across mogensen stages Ⅲ-Ⅴ
作者:
呼延晓婷1; 刘宏峰1; 张自青1; 沈霞1; 张楠2; 赵亚峰2; 李现成2; 于丽丽3; 王俊文4; 屈凯2
（1.陕西中医药大学，陕西 咸阳 712046；2.陕西省中医医院，陕西 西安 710003；3.澳门科技大学，澳门 999078；4.中国中医科学院中医基础理论研究所，北京 100007）
Author(s):
HUYAN Xiaoting1; LIU Hongfeng1; ZHANG Ziqing1; SHEN Xia1; ZHANG Nan2; ZHAO Yafeng2; LI Xiancheng2; YU Lili3; WANG Junwen4; QU Kai2
（1.Shaanxi University of Chinese Medicine,Xianyang 712046,China;2.Shaanxi Province Hospital of Traditional Chinese Medicine,Xi’an 710003,China；3.Macau University of Science and Technology,Macau 999078,China;4.Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100007,China）
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
Keywords:
Type 2 diabetic kidney disease; Spleen-kidney yang deficiency syndrome; Clinical staging; Tonifying spleen-kidney; Promoting blood circulation and diuresis; Herb frequency analysis
分类号:
R 692
DOI:
DOI:10.3969/j.issn.1000-7369.2026.01.006
文献标志码:
A
摘要:
目的：分析2型糖尿病肾病脾肾阳虚证患者不同Mogensen分期的临床特征、理化检查指标演变规律及中药用药特点。方法：选取73例2型糖尿病肾病脾肾阳虚证患者。根据Mogensen分期分为Ⅲ期组13例、Ⅳ期组55例、Ⅴ期组5例。分别收集基线资料、中医症状、理化检查指标及中药处方，比较组间中医症状、理化检查指标的特征变化及用药规律。结果：73例2型糖尿病肾病脾肾阳虚证患者根据Mogensen分期分为Ⅲ期组13例、Ⅳ期组55例、Ⅴ期组5例。患者男性占比72.60%，平均年龄分布在67.0（55.0，72.0）岁，糖尿病病程10.0（8.5，21.0）年，高血压病程10.0（5.0，20.0）年,组间比较差异均无统计学意义(均P>0.05)。对其症状分布进行Ⅲ-Ⅴ期对比结果示：畏寒（Ⅲ期38.5%至Ⅴ期80.0%）、水肿（Ⅲ期7.7%至Ⅴ期40.0%）、胸闷（Ⅲ期0.0%至Ⅴ期40.0%）、气短（Ⅲ期0%至Ⅴ期60.0%）、纳差（Ⅲ期7.7%至Ⅴ期40.0%）随分期进展明显上升，泡沫尿、乏力、夜尿频数始终高频存在于Ⅲ-Ⅴ期。2型糖尿病肾病脾肾阳虚证患者胱抑素、肾小球滤过率、24 h尿蛋白定量、总胆红素、总胆固醇在Ⅲ期、Ⅳ期、Ⅴ期至少两组间存在显著差异（P<0.05）。胱抑素、总胆红素、白蛋白Ⅲ期与Ⅳ期之间差异有统计学意义（P<0.05），24 h尿蛋白定量、总胆固醇Ⅲ期与Ⅳ期、Ⅴ期相比，差异有统计学意义（P<0.05）；肾小球滤过率Ⅴ期与Ⅲ期、Ⅳ期相比差异有统计学意义（P<0.05）。本研究共收集63份中药处方（Ⅲ期11份、Ⅳ期47份、Ⅴ期5份），涉及66种中药。频次前20次的共14味中药，Ⅲ期以茯苓（90.91%）、丹参（81.82%）、黄芪（63.64%）为主；Ⅳ期以黄芪（82.98%）、酒萸肉（70.21%）、茯苓（65.96%）为主；Ⅴ期以党参（80%）、黄芪（60%）、白术（60%）为主，黄芪在各分期高频使用。结论：2型糖尿病肾病脾肾阳虚证集中于Ⅲ-Ⅴ期（Ⅳ期占75.3%），症状、理化检查指标与中药治法均随分期动态演变。临床治法应以“温补脾肾、益气助阳”为核心，“活血化瘀、利水渗湿”为辅，为优化分期精准诊疗提供依据。
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-kidney 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 characteristics ( 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 Chinese herbal prescriptions were included (11 from Stage Ⅲ,47 from Stage Ⅳ,and 5 from Stage Ⅴ),involving 66 distinct 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 prescribed were Astragalus root (82.98%),Cornus officinalis (70.21%),and Poria (65.96%).In Stage Ⅴ,the dominant 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.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目（81603454）；陕西省科技厅重点产业链项目（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)
更新日期/Last Update: 2026-01-08