糖尿病肾病辨证方案研究
|
摘要
中医药防治DN的作用和优势日益受到国内外的关注,有关DN的既往研究由于缺少严格的科研设计和统一的中医辨证标准,疗效评价方面又缺少既能突出中医优势又能与国际医学接轨的疗效评价方法,得出的结论科学性较差,严重制约了中医药科研成果的推广应用和走向世界。因此,总结DN中医诊治规律,开展DN诊疗标准化、规范化工作势在必行。辨证是诊疗的起点和关键,开展辨证方案研究是首要工作之一。
1目的
遵照循证医学精神,结合中医特点,开展DN文献调研、专家经验征集、地区性诊疗方案分析、多中心大样本中医证候流行病学调查、中医病机理论研究等方面研究,从中分析和把握DN中医证候类型和分布规律,为DN的辨证工作提供循证医学证据,以期建立较为合理DN的辨证方案。
2方法
文献调研采用定性、定量研究方法对近20年有关DN辨证分型文献进行评价;专家经验征集采用国外广泛应用德尔菲(Delphi)法;地区性诊疗方案分析采用定性研究方法;中医证候流行病学调查采用量表进行测量,运用统计描述、主成分分析等多元统计学方法对证候特点及分布规律进行分析;理论研究采用传统文献梳理与现代文献分析的方法对DN病机进行归纳和总结。
3结果
3.1文献调研
通过文献定性研究表明DN辨证方案多达60余种,临床辨证方法有分型辨证、分期辨证、分型分期辨证、分期分型辨证等不同;辨证模式有气血阴阳辨证、脏腑辨证、标本虚实辨证等不同;还有一些辨证方法和模式相互重叠、交叉的情况。这些皆来源于实践,具有一定合理性,各具特征,各有规律,各有侧重。
文献定量评价研究借鉴Meta分析原理,收集到DN病例2182例,涉及DN证型种类多达40余种。中医证型的构成比排在前5位的依次是:气阴两虚型(33.91%)、阴阳两虚型(20.90%)、阳虚型(12.56%)、阴虚型(11.32%)、阴虚热盛型(5.32%)。
3.2基于德尔菲(Delphi)法的DN辨证专家问卷调查分析
中医是经验医学,专家经验在大多数情况下被认为是金标准,Delph法可合理科学地征集专家意见。本研究就DN辨证模式、辨证方法、病变脏腑、常见证素等条目进行了两轮问卷咨询。
第一轮汇总结果,中医证候、病变脏腑部分专家意见高度集中,且变异系数较低,专家的协调程度较高,认为DN中医证候以复合证、虚实夹杂形式存在,病变脏腑以两脏或多脏多见;有些指标专家集中程度较低,变异系数在1.0以上,在第二轮问卷中对咨询条目进行了调整,删除了六经辨证及其他辨证模式等条目,增加了一项条目。
第二轮专家问卷评价结果来看,大多数指标变异系数在0.5左右,调查专家观点趋于一致,意见较为集中。专家在DN病性、病机、病位等认识取得一致意见,认为DN乃本虚标实之证,本虚有气虚、阴虚、阳虚、血虚之分,标实有血瘀、湿浊、痰湿、气滞之别,其中气(阴)两虚、血瘀、湿浊在DN发展中占了较大比率。DN病变具有以肾虚为中心,脾肾、肝肾乃至心、肺、脾胃等多脏腑阴阳气血复合虚损的特点。
3.3“十一五”重点专科建设项目DN辨证方案定性研究
国家中医药管理局“十一五”肾病重点专科13份DN诊疗方案代表了国内当今DN治疗水平,可作为循证医学证据来进行研究。通过定性分析得出结论:虽然DN辨证方案多样化,但对DN病性、病位、病机等认识基本一致,气阴两虚、气虚、阴阳两虚、血瘀、湿浊在DN方案中占了较大比率,病位以肾为中心,涉及脾肾、肝肾,以脾肾气(阳)虚、肝肾阴虚、肝肾气阴两虚型多见。DN作为一种复杂而不断变化的疾病,有着明确阶段性,早期DN多以气阴两虚、气虚为多,晚期肾病以阳虚、阴阳两虚、湿浊比率高,血瘀证则贯穿于病程始终。分期辨证已成趋势,分期辨证体现了DN动态变化,便于临床操作,又便于中西医沟通。
3.4糖尿病肾病中医证候学调查
经全国10个中心308例DN中医证候流行病学调查,发现DN证候分布及演变呈一定规律。
DNⅢ期证候因子发生率依次为:气虚＞血瘀＞阴虚＞阳虚＞痰湿＞湿浊＞血虚,提示本虚证以气虚、阴虚为主要表现,标实证中以血瘀、痰湿为主要表现;Ⅳ期为:气虚＞血瘀＞阴虚＞阳虚＞湿浊＞痰湿＞血虚,提示本虚证以气虚、阴虚、阳虚为主要表现,标实证中以血瘀、湿浊为主要表现;Ⅴ期为:气虚＞阳虚＞湿浊＞血虚＞血瘀＞痰湿＞阴虚,提示本虚证以气虚、阳虚、血虚为主要表现,标实证中以湿浊、血瘀为主要表现。
DN证候以虚实夹杂为主,Ⅲ期患者单纯虚证占9.43%,实证占3.77%,虚实夹杂占86.79%。Ⅳ期患者单纯虚证占4.52%,虚实夹杂占95.48%。Ⅴ期单纯虚证占2.12%,虚实夹杂占98.87%。可以看出随病程的发展,虚实夹杂呈上升趋势。
从证素组合结果来看,每期证素组合多达几十种。Ⅲ期单一证占总数的6.6%,两证组合占15.1%,三证组合占29.3%,四证组合占20.8%,五证组合占16.9%,六证组合占8.5%,七证组合占总数2.3%;Ⅳ期单一证占1.3%,两证组合占9.7%,三证组合占24.5%,四证组合占26.5%,五证组合占20.0%,六证组合占12.9%,七证组合占5.2%;Ⅴ期单一证、两证组合0例,三证组合占6.4%,四证组合占25.5%,五证组合占14.9%,六证组合占总数31.9%,七证组合数21.3%。
将DN七个证素经主成分分析法(PCA)法分析,根据贡献率和专业知识,选取了三个主成分,得到三个主成分表达式为:
Z_1=0.315X_1+0.267X_2-0.213X_3+0.431X_4+0.275X_5+0.435X_6+0.431X_7
Z_2=0.304X_1+0.172X_2+0.712X_3-0.418X_4+0.351X_5+0.248X_6-0.112X_7
Z_3=-0.424X_1+0.242X_2+0.442X_3+0.381X_4-0.629X_5+0.144X_6+0.342X_7
运用专业知识对三个主成分进行分析,第一主成分Z_1与气虚、阳虚、痰湿、湿浊关系密切;第二主成分Z_2与气虚、阴虚、阳虚、血瘀、痰湿关系密切;第三主成分Z_3与气虚、阴虚、阳虚、血瘀、湿浊关系密切。三个主成分集中了七个证素原始信息,组合相对稳定,且出现机率较高,三个主成分实际上将DN划分为三个类型(即中医证型),所以,运用主成分分析等降维统计学方法对DN辨证分型进行探索具有一定意义。
3.5理论研究
通过传统文献梳理与现代文献分析,DM“内热伤阴耗气”(简称热伤气阴)基本病机和DN“微型(?)瘕”病理假说可全面地反映了DN发生、发展、变化的机理,对DN临床辨证有指导意义。
DN是在“内热伤阴耗气”基本病机基础上发展而来,内热是“壮火”,“壮火食气”,不仅可伤阴,又可耗气,形成气阴两虚结热之局,进一步传变,阴损及阳,乃至阴阳俱虚;久病入络,热结、气滞、血瘀、痰湿互相影响,混处络脉,日久在肾之络脉形成“微型(?)瘕”,可致肾体受损,肾用失司,导致DN的发生。
4结论
(1) DN辨证方案具有多样化、复杂性特点。
(2)德尔菲(Delphi)法是科学合理地获得专家经验一种途径。
(3) DN分期辨证已成趋势。
(4) DN证候分布及演变具有一定规律。
(5)采用主成分分析等降维统计学方法可对DN证型进行探索。
(6)“热伤气阴”基本病机和“微型(?)瘕”病理假说理论对DN辨证具有指导意义。
Effect of traditional Chinese medicine (TCM) on diabetic nephropathy (DN) is getting more and more concerns in the world. But the previous studies on DN was always deficient in the rigorous experimental design and uniform standard of syndrome differentiation, so the conclusion of the study was always not authentic and it had become a major for the application of the TCM treatment to the world. It is necessary to sum up experience of treatment on DN and get the progress on the standardization and normalization of the DN treatment. At the first, different types of syndrome is one of the most important works to investigate.
Objective
The study follows the rule of evidence-based medicine and combined with the characteristics of TCM, and based on DN clinical date and TCM theoretical research, experiences was collected from experts, According the analysis of regional treating program of DN, and the research of multi-center epidemiological clinical syndrome types of DN with large sample, distribution rule and clinical syndrome types of DN was investigated. Then the program of syndrome types research in DN will be set up for clinical treatment.
Methods
The literature research in the past 20 years on the DN was used with qualitative and quantitative methods; Experiences from experts collected by Delphi method; Analysis of regional clinics program was used by qualitative research methods; The program of syndrome type research in DN used by multivariate statistical analysis, such as descriptive statistics, principal component analysis statistical methods and so on; Traditional and modern literature about DN was summarized for theoretical research.
Results
1 Literature research
Qualitative study of the literature showed that DN syndrome types up to more than 60 species. Syndrome types were classified by different stages or other ways. Patterns of differentiation syndrome were classified by qi blood yin yang, by organs, or by xu shi. They were derived from practice, and had some rationality. Each had its characteristics, different laws, and different emphases.
The study on quantitative evaluation of literature was made use of meta analysis of principle. 2182 cases of DN was collected, DN Syndromes were up to 40 kinds of types. The top five TCM syndromes were: qi-yin deficiency type (33.91%), yin-yang deficiency type (20.90%), Yang deficiency type (12.56%), yin deficiency type (11.32%), extreme heat with yin deficiency type (5.32%).
2 The experiences of DN syndromes from experts collected with Delphi method
TCM is a medicine based on experiences, the experiences from experts in most cases can be considered the gold standard. The opinions of experts may be reasonably collected by Delphi method.
From the summary of first round results, Experts achieved highly consensus in TCM syndromes and disease location. Many entries had lower coefficient of variation and a higher degree of coordination. Experts agree on that TCM syndromes appear with compound symptomes and multiple zang-fu diseases.
From the results of the second round questionnaire, we found that the variation coefficient of major entries were about 0.5. We got a conclusion: experts' opinions tended to be uniform. Experts agreed to opinions of the disease location, nature of disease, disease pathogenesis. DN was primary deficiency-secondary excess syndrome, the primary deficiency syndromes involved qi deficiency, blood deficiency, yin deficiency, yang deficiency; the secondary excess syndrome involved blood stasis, qi stagnation, phlegm turbid, turbid dampness. Qi-yin deficiency, blood stasis, turbid dampness accounted for a larger proportion of the DN syndromes.
3 DN regional clinics programs analysis with qualitative research method
13 DN clinic programs from kidney specialist of National Administration of Traditional Chinese Medicine, represent the domestic level of DN treatment. They can be used as evidences to evidence-based medicine research. By qualitative analysis we concluded that: although the DN syndrome programs diversification, opinions of the disease location, nature of disease, disease pathogenesis were the same. The DN syndromes were made up a larger proportion of qi-yin deficiency, qi deficiency, yin-yang deficiency, blood stasis, turbid dampness. Blood stasis existed in the whole development of DN syndromes. Different treatment by stage had become a trend, it could reflect the dynamic changes of DN, and easy to be accepted in the exchanges between Chinese and Western medicine.
4 Epidemiological investigation on DN TCM syndromes
308 cases were collected from 10 national centers for the epidemiological investigation on DN TCM syndromes. We discovered that the law of the distribution and evolution of DN syndromes showed some regularity.
The incidences of syndrome factors in DNⅢstage were as follows: qi deficiency＞blood stasis＞yin deficiency＞yang deficiency＞phlegm＞turbid dampness＞blood deficiency. The incidences of syndrome factor in DNⅣstage were as follows: qi deficiency＞blood stasis＞yin deficiency＞yang deficiency＞turbid dampness＞phlegm＞blood deficiency. The incidences of syndrome factor in DNⅤstage were as follows: qi deficiency＞yang deficiency＞turbid dampness＞blood deficiency＞blood stasis＞phlegm＞yin deficiency.
From the results combination of syndromes, each stage had many combinations. In DNⅢ, a single syndrome is the total 6.6%, combination of two syndromes is 15.1%, combination of three syndromea is the total 29.3%, combination of four syndromes is the total 20.8%, combination of five syndromes is the total 16.9%, combination of six syndromes is the total 8.5%, combination of seven syndromes is the total 2.3%. In DNⅣ, a single syndrome is the total 1.3%, combination of two syndromes is 9.7%, combination of three syndromes is the total 24.5%, combination of four syndromes is the total 26.5%, combination of five syndromes is the total 20.0 %, combination of six syndromes is the total 12.9%, combination of seven syndromes is the total 5.2%. In DN V, combination of three syndromes is the total 6.4%, combination of four syndromes is the total 25.5%, combination of five syndromes is the total 14.9%, combination of six syndromes is the total 31.9%, combination of seven syndromes is the total 21.3 %.
The seven symptom factors were statistically analyzed by principal component analysis, we selected the three principal components according to the contribution rate and professional knowledge. The formula of the three principal components is:
Z_1=0.315X_1+0.267X_2-0.213X_3+0.431X_4+0.275X_5+0.435X_6 +0.431X_7
Z_2=0.304X_1+0.172X_2+0.712X_3-0.418X_4+0.351X_5+0.248X_6-0.112X_7
Z_3=-0.424X_1+0.242X_2+0.442X_3+0.381X_4-0.629X_5+0.144X_6+0.342X_7
We use our professional knowledge to analysis the three principal components. The first principal component was close relationship with qi deficiency, yang deficiency, phlegm, turbid dampness. The second principal component was close relationship with qi deficiency, yin deficiency, yang deficiency, blood stasis, phlegm. The third principal component was close relationship with qi deficiency, yin deficiency, yang deficiency, blood stasis, turbid dampness.
5 Theoretical research
According to the analysis of traditional and modern literatures, we got a conclusion: the happening, development, and changing of DN could be explained by DM basic pathological mechanism of "hot hurt qi and yin" and DN pathological hypothesis of "micro-Zhengjia". This theory could be directional for the differentiation of DN syndrome types.
The onset and development of DN is the delay and the improper treatment of DM, which leaded the injury of the yin and qi, even the yin and yang. The cementation of the sputum, qi stagnation, heat, and blood stasis in the kidney collaterals which called"micro-Zhengjia" was formed.
Conclusions:
①Syndrome types in DN showed diversification and complication.
②Experiences from experts can be reasonable collected by Delphi method.
③Syndromes differentiation for different stage of DN has become a trend.
④The distribution and evolution of DN syndromes had some regularity.
⑤The statistical methods such as principal component analysis can be used in the investigation of syndrome types of DN.
⑥DM basic pathological mechanism of "hot hurt qi and yin" and DN pathological hypothesis of "micro-Zhengjia" has showed significance for the differentiation of DN syndrome types.
1目的
遵照循证医学精神,结合中医特点,开展DN文献调研、专家经验征集、地区性诊疗方案分析、多中心大样本中医证候流行病学调查、中医病机理论研究等方面研究,从中分析和把握DN中医证候类型和分布规律,为DN的辨证工作提供循证医学证据,以期建立较为合理DN的辨证方案。
2方法
文献调研采用定性、定量研究方法对近20年有关DN辨证分型文献进行评价;专家经验征集采用国外广泛应用德尔菲(Delphi)法;地区性诊疗方案分析采用定性研究方法;中医证候流行病学调查采用量表进行测量,运用统计描述、主成分分析等多元统计学方法对证候特点及分布规律进行分析;理论研究采用传统文献梳理与现代文献分析的方法对DN病机进行归纳和总结。
3结果
3.1文献调研
通过文献定性研究表明DN辨证方案多达60余种,临床辨证方法有分型辨证、分期辨证、分型分期辨证、分期分型辨证等不同;辨证模式有气血阴阳辨证、脏腑辨证、标本虚实辨证等不同;还有一些辨证方法和模式相互重叠、交叉的情况。这些皆来源于实践,具有一定合理性,各具特征,各有规律,各有侧重。
文献定量评价研究借鉴Meta分析原理,收集到DN病例2182例,涉及DN证型种类多达40余种。中医证型的构成比排在前5位的依次是:气阴两虚型(33.91%)、阴阳两虚型(20.90%)、阳虚型(12.56%)、阴虚型(11.32%)、阴虚热盛型(5.32%)。
3.2基于德尔菲(Delphi)法的DN辨证专家问卷调查分析
中医是经验医学,专家经验在大多数情况下被认为是金标准,Delph法可合理科学地征集专家意见。本研究就DN辨证模式、辨证方法、病变脏腑、常见证素等条目进行了两轮问卷咨询。
第一轮汇总结果,中医证候、病变脏腑部分专家意见高度集中,且变异系数较低,专家的协调程度较高,认为DN中医证候以复合证、虚实夹杂形式存在,病变脏腑以两脏或多脏多见;有些指标专家集中程度较低,变异系数在1.0以上,在第二轮问卷中对咨询条目进行了调整,删除了六经辨证及其他辨证模式等条目,增加了一项条目。
第二轮专家问卷评价结果来看,大多数指标变异系数在0.5左右,调查专家观点趋于一致,意见较为集中。专家在DN病性、病机、病位等认识取得一致意见,认为DN乃本虚标实之证,本虚有气虚、阴虚、阳虚、血虚之分,标实有血瘀、湿浊、痰湿、气滞之别,其中气(阴)两虚、血瘀、湿浊在DN发展中占了较大比率。DN病变具有以肾虚为中心,脾肾、肝肾乃至心、肺、脾胃等多脏腑阴阳气血复合虚损的特点。
3.3“十一五”重点专科建设项目DN辨证方案定性研究
国家中医药管理局“十一五”肾病重点专科13份DN诊疗方案代表了国内当今DN治疗水平,可作为循证医学证据来进行研究。通过定性分析得出结论:虽然DN辨证方案多样化,但对DN病性、病位、病机等认识基本一致,气阴两虚、气虚、阴阳两虚、血瘀、湿浊在DN方案中占了较大比率,病位以肾为中心,涉及脾肾、肝肾,以脾肾气(阳)虚、肝肾阴虚、肝肾气阴两虚型多见。DN作为一种复杂而不断变化的疾病,有着明确阶段性,早期DN多以气阴两虚、气虚为多,晚期肾病以阳虚、阴阳两虚、湿浊比率高,血瘀证则贯穿于病程始终。分期辨证已成趋势,分期辨证体现了DN动态变化,便于临床操作,又便于中西医沟通。
3.4糖尿病肾病中医证候学调查
经全国10个中心308例DN中医证候流行病学调查,发现DN证候分布及演变呈一定规律。
DNⅢ期证候因子发生率依次为:气虚＞血瘀＞阴虚＞阳虚＞痰湿＞湿浊＞血虚,提示本虚证以气虚、阴虚为主要表现,标实证中以血瘀、痰湿为主要表现;Ⅳ期为:气虚＞血瘀＞阴虚＞阳虚＞湿浊＞痰湿＞血虚,提示本虚证以气虚、阴虚、阳虚为主要表现,标实证中以血瘀、湿浊为主要表现;Ⅴ期为:气虚＞阳虚＞湿浊＞血虚＞血瘀＞痰湿＞阴虚,提示本虚证以气虚、阳虚、血虚为主要表现,标实证中以湿浊、血瘀为主要表现。
DN证候以虚实夹杂为主,Ⅲ期患者单纯虚证占9.43%,实证占3.77%,虚实夹杂占86.79%。Ⅳ期患者单纯虚证占4.52%,虚实夹杂占95.48%。Ⅴ期单纯虚证占2.12%,虚实夹杂占98.87%。可以看出随病程的发展,虚实夹杂呈上升趋势。
从证素组合结果来看,每期证素组合多达几十种。Ⅲ期单一证占总数的6.6%,两证组合占15.1%,三证组合占29.3%,四证组合占20.8%,五证组合占16.9%,六证组合占8.5%,七证组合占总数2.3%;Ⅳ期单一证占1.3%,两证组合占9.7%,三证组合占24.5%,四证组合占26.5%,五证组合占20.0%,六证组合占12.9%,七证组合占5.2%;Ⅴ期单一证、两证组合0例,三证组合占6.4%,四证组合占25.5%,五证组合占14.9%,六证组合占总数31.9%,七证组合数21.3%。
将DN七个证素经主成分分析法(PCA)法分析,根据贡献率和专业知识,选取了三个主成分,得到三个主成分表达式为:
Z_1=0.315X_1+0.267X_2-0.213X_3+0.431X_4+0.275X_5+0.435X_6+0.431X_7
Z_2=0.304X_1+0.172X_2+0.712X_3-0.418X_4+0.351X_5+0.248X_6-0.112X_7
Z_3=-0.424X_1+0.242X_2+0.442X_3+0.381X_4-0.629X_5+0.144X_6+0.342X_7
运用专业知识对三个主成分进行分析,第一主成分Z_1与气虚、阳虚、痰湿、湿浊关系密切;第二主成分Z_2与气虚、阴虚、阳虚、血瘀、痰湿关系密切;第三主成分Z_3与气虚、阴虚、阳虚、血瘀、湿浊关系密切。三个主成分集中了七个证素原始信息,组合相对稳定,且出现机率较高,三个主成分实际上将DN划分为三个类型(即中医证型),所以,运用主成分分析等降维统计学方法对DN辨证分型进行探索具有一定意义。
3.5理论研究
通过传统文献梳理与现代文献分析,DM“内热伤阴耗气”(简称热伤气阴)基本病机和DN“微型(?)瘕”病理假说可全面地反映了DN发生、发展、变化的机理,对DN临床辨证有指导意义。
DN是在“内热伤阴耗气”基本病机基础上发展而来,内热是“壮火”,“壮火食气”,不仅可伤阴,又可耗气,形成气阴两虚结热之局,进一步传变,阴损及阳,乃至阴阳俱虚;久病入络,热结、气滞、血瘀、痰湿互相影响,混处络脉,日久在肾之络脉形成“微型(?)瘕”,可致肾体受损,肾用失司,导致DN的发生。
4结论
(1) DN辨证方案具有多样化、复杂性特点。
(2)德尔菲(Delphi)法是科学合理地获得专家经验一种途径。
(3) DN分期辨证已成趋势。
(4) DN证候分布及演变具有一定规律。
(5)采用主成分分析等降维统计学方法可对DN证型进行探索。
(6)“热伤气阴”基本病机和“微型(?)瘕”病理假说理论对DN辨证具有指导意义。
Effect of traditional Chinese medicine (TCM) on diabetic nephropathy (DN) is getting more and more concerns in the world. But the previous studies on DN was always deficient in the rigorous experimental design and uniform standard of syndrome differentiation, so the conclusion of the study was always not authentic and it had become a major for the application of the TCM treatment to the world. It is necessary to sum up experience of treatment on DN and get the progress on the standardization and normalization of the DN treatment. At the first, different types of syndrome is one of the most important works to investigate.
Objective
The study follows the rule of evidence-based medicine and combined with the characteristics of TCM, and based on DN clinical date and TCM theoretical research, experiences was collected from experts, According the analysis of regional treating program of DN, and the research of multi-center epidemiological clinical syndrome types of DN with large sample, distribution rule and clinical syndrome types of DN was investigated. Then the program of syndrome types research in DN will be set up for clinical treatment.
Methods
The literature research in the past 20 years on the DN was used with qualitative and quantitative methods; Experiences from experts collected by Delphi method; Analysis of regional clinics program was used by qualitative research methods; The program of syndrome type research in DN used by multivariate statistical analysis, such as descriptive statistics, principal component analysis statistical methods and so on; Traditional and modern literature about DN was summarized for theoretical research.
Results
1 Literature research
Qualitative study of the literature showed that DN syndrome types up to more than 60 species. Syndrome types were classified by different stages or other ways. Patterns of differentiation syndrome were classified by qi blood yin yang, by organs, or by xu shi. They were derived from practice, and had some rationality. Each had its characteristics, different laws, and different emphases.
The study on quantitative evaluation of literature was made use of meta analysis of principle. 2182 cases of DN was collected, DN Syndromes were up to 40 kinds of types. The top five TCM syndromes were: qi-yin deficiency type (33.91%), yin-yang deficiency type (20.90%), Yang deficiency type (12.56%), yin deficiency type (11.32%), extreme heat with yin deficiency type (5.32%).
2 The experiences of DN syndromes from experts collected with Delphi method
TCM is a medicine based on experiences, the experiences from experts in most cases can be considered the gold standard. The opinions of experts may be reasonably collected by Delphi method.
From the summary of first round results, Experts achieved highly consensus in TCM syndromes and disease location. Many entries had lower coefficient of variation and a higher degree of coordination. Experts agree on that TCM syndromes appear with compound symptomes and multiple zang-fu diseases.
From the results of the second round questionnaire, we found that the variation coefficient of major entries were about 0.5. We got a conclusion: experts' opinions tended to be uniform. Experts agreed to opinions of the disease location, nature of disease, disease pathogenesis. DN was primary deficiency-secondary excess syndrome, the primary deficiency syndromes involved qi deficiency, blood deficiency, yin deficiency, yang deficiency; the secondary excess syndrome involved blood stasis, qi stagnation, phlegm turbid, turbid dampness. Qi-yin deficiency, blood stasis, turbid dampness accounted for a larger proportion of the DN syndromes.
3 DN regional clinics programs analysis with qualitative research method
13 DN clinic programs from kidney specialist of National Administration of Traditional Chinese Medicine, represent the domestic level of DN treatment. They can be used as evidences to evidence-based medicine research. By qualitative analysis we concluded that: although the DN syndrome programs diversification, opinions of the disease location, nature of disease, disease pathogenesis were the same. The DN syndromes were made up a larger proportion of qi-yin deficiency, qi deficiency, yin-yang deficiency, blood stasis, turbid dampness. Blood stasis existed in the whole development of DN syndromes. Different treatment by stage had become a trend, it could reflect the dynamic changes of DN, and easy to be accepted in the exchanges between Chinese and Western medicine.
4 Epidemiological investigation on DN TCM syndromes
308 cases were collected from 10 national centers for the epidemiological investigation on DN TCM syndromes. We discovered that the law of the distribution and evolution of DN syndromes showed some regularity.
The incidences of syndrome factors in DNⅢstage were as follows: qi deficiency＞blood stasis＞yin deficiency＞yang deficiency＞phlegm＞turbid dampness＞blood deficiency. The incidences of syndrome factor in DNⅣstage were as follows: qi deficiency＞blood stasis＞yin deficiency＞yang deficiency＞turbid dampness＞phlegm＞blood deficiency. The incidences of syndrome factor in DNⅤstage were as follows: qi deficiency＞yang deficiency＞turbid dampness＞blood deficiency＞blood stasis＞phlegm＞yin deficiency.
From the results combination of syndromes, each stage had many combinations. In DNⅢ, a single syndrome is the total 6.6%, combination of two syndromes is 15.1%, combination of three syndromea is the total 29.3%, combination of four syndromes is the total 20.8%, combination of five syndromes is the total 16.9%, combination of six syndromes is the total 8.5%, combination of seven syndromes is the total 2.3%. In DNⅣ, a single syndrome is the total 1.3%, combination of two syndromes is 9.7%, combination of three syndromes is the total 24.5%, combination of four syndromes is the total 26.5%, combination of five syndromes is the total 20.0 %, combination of six syndromes is the total 12.9%, combination of seven syndromes is the total 5.2%. In DN V, combination of three syndromes is the total 6.4%, combination of four syndromes is the total 25.5%, combination of five syndromes is the total 14.9%, combination of six syndromes is the total 31.9%, combination of seven syndromes is the total 21.3 %.
The seven symptom factors were statistically analyzed by principal component analysis, we selected the three principal components according to the contribution rate and professional knowledge. The formula of the three principal components is:
Z_1=0.315X_1+0.267X_2-0.213X_3+0.431X_4+0.275X_5+0.435X_6 +0.431X_7
Z_2=0.304X_1+0.172X_2+0.712X_3-0.418X_4+0.351X_5+0.248X_6-0.112X_7
Z_3=-0.424X_1+0.242X_2+0.442X_3+0.381X_4-0.629X_5+0.144X_6+0.342X_7
We use our professional knowledge to analysis the three principal components. The first principal component was close relationship with qi deficiency, yang deficiency, phlegm, turbid dampness. The second principal component was close relationship with qi deficiency, yin deficiency, yang deficiency, blood stasis, phlegm. The third principal component was close relationship with qi deficiency, yin deficiency, yang deficiency, blood stasis, turbid dampness.
5 Theoretical research
According to the analysis of traditional and modern literatures, we got a conclusion: the happening, development, and changing of DN could be explained by DM basic pathological mechanism of "hot hurt qi and yin" and DN pathological hypothesis of "micro-Zhengjia". This theory could be directional for the differentiation of DN syndrome types.
The onset and development of DN is the delay and the improper treatment of DM, which leaded the injury of the yin and qi, even the yin and yang. The cementation of the sputum, qi stagnation, heat, and blood stasis in the kidney collaterals which called"micro-Zhengjia" was formed.
Conclusions:
①Syndrome types in DN showed diversification and complication.
②Experiences from experts can be reasonable collected by Delphi method.
③Syndromes differentiation for different stage of DN has become a trend.
④The distribution and evolution of DN syndromes had some regularity.
⑤The statistical methods such as principal component analysis can be used in the investigation of syndrome types of DN.
⑥DM basic pathological mechanism of "hot hurt qi and yin" and DN pathological hypothesis of "micro-Zhengjia" has showed significance for the differentiation of DN syndrome types.
引文
[1] 罗月中.叶任高教授治疗糖尿病肾病的经验.中国中西医结合肾病杂志,2001,2(8):438-440.
[2] 周恩庆.王西周老师治疗糖尿病肾病经验介绍.陕西中医,2001,22(4):225-226.
[3] 毛黎明,俞东容,涂晓.辨证与辨病相结合治疗糖尿病肾病32例.浙江中医学院学报,2001,25(6):17-18.
[4] 沈稚舟主编.糖尿病慢性并发症.上海:上海医科大学出版社,1999,175-176.
[5] 刘从明,何金霞.辨证治疗糖尿病肾病临床观察.内蒙古中医药,1996,3:4-6.
[6] 张珍先,宋小平.糖尿病肾病的辨证施治.光明中医,2006,21(1):16.
[7] 鲁盈,楼狄.糖尿病肾病的诊断与中医治疗.浙江中西医结合杂志.1997,7(4):201-203.
[8] 邓经林.48例糖尿病肾病的中医辨证论治.江西中医药,2001.32(5):29.
[9] 郑庆媛.糖尿病肾病辨证分型论治.实用中医内科杂志.2003,17,(2):72.
[10] 董兴刚.张庆怡治疗早期糖尿病肾病临床经验.浙江中西医结合杂志,2005,15(12):751.
[11] 王志伏.辨证分型治疗糖尿病肾病42例观察.实用中医内科杂志,2007,21(3):34
[12] 张先闻.陈以平辨治糖尿病肾病经验撷要.上海中医药杂志,2008,42(6):6-7.
[13] 赵宗江.叶传蕙教授治疗糖尿病肾病的思路与方法.中国中西医结合肾病杂志,2006,7(3):129-131.
[14] 吕贵德.辨证论治糖尿病肾病38例疗效观察.河北中医,2002,24(2):103-104.
[15] 孙炜.早期糖尿病肾病的中医辨证治疗.浙江中医学院学报,1999,2(4):14.
[16] 郭连川.辨证治疗糖尿病性肾病54例.辽宁中医杂志,1993,(3):19-20.
[17] 傅能,赵韧.中西医结合治疗早期糖尿病肾病临床观察.现代中西医结合杂志,2006,15(8):989.
[18] 张庚良.糖尿病肾病的辨证治疗.河北中医,2005,27(8):594.
[19] 唐礴,蔡美珠.糖尿病肾病的中医辨证治疗.泸州医学院学报.1995,18(2):114-115.
[20] 苏小惠,戴舜珍.中西医结合治疗糖尿病肾病40例临床观察.辽宁中医杂志,2006,33(1)92-93.
[21] 陈筱云,赵莉娟.从“瘀”论治糖尿病肾病.中国中医基础医学杂志,2002,8(7):53.
[22] 吴家瑜.辨证分型治疗糖尿病肾病58例.中医药学刊,2006,24(9):1716
[23] 赵东鹰,倪佳.辨证论治结合西药治疗糖尿病肾病56例.陕西中医,2007,28(4):415-416.
[24] 仝小林,张志远,李宁,等.糖尿病肾病的中医治疗.中国医药学 报,1998,13(4):50-53.
[25] 王亚敏.中西医结合治疗糖尿病肾病疗效观察.中国中西医结合肾病杂志,2002,3(4):232-234.
[26] 中华中医药学会肾病分会.上海中医药杂志,2007,41(7):7-8
[27] 吕仁和主编.糖尿病及其并发症中西医诊治学(第一版).北京:人民卫生出版社,1977:128-130.
[28] 徐云生,李莹.程益春治疗糖尿病肾病及视网膜病变经验.山东中医杂志,1998,17卷(1):32-33.
[29] 程益春,糖尿病肾病证治体会.江苏中医药,2002,23(12):1.
[30] 尹义辉,牟淑敏.程益春治疗糖尿病肾病经验.山东中医药大学学报,2002,26(4):283-284.
[31] 程益春,徐灿坤.中医辨证配合口服木糖醇治疗糖尿病肾病疗效观察.山东中医药大学学报,2003,27(1):48-49.
[32] 高阳,李琪.刘启庭辨治糖尿病肾病经验.河南中医,1997,17(1):31-32.
[33] 张玉璞,刘玉英.辨证治疗糖尿病肾病.河北中医,1999,21(5):292.
[34] 赵会贤,苏荣华,高新业.糖尿病肾病的病因病机及证治浅识.中医药学刊,2004,22(9):1760-1763.
[35] 徐延,徐京育.中西医结合治疗糖尿病肾病33例.四川中医,2002,21(6):38-39.
[36] 邹本良,张燕.魏子孝治疗糖尿病肾病的临床经验浅述.北京中医,2006,25(3):144-146.
[37] 孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会.江苏中医药,2002,23(5):18-19.
[38] 任爱华,阚方旭.糖尿病肾病三焦辨治,山东中医杂志.2000,19(6):328-329.
[39] 翁苓,张丽霞.周国英主任治疗糖尿病肾病的经验总结.福建中医药,2005,36(6):14.
[40] 王晓光,王亚丽,张琪.张琪教授辨治糖尿病肾病经验介绍.陕西中医,2004,25(12):1116-1118.
[41] 王晓光,王亚丽,张佩清.张琪教授辨治糖尿病肾病经验介绍.新中医,2005年37(3):20-21.
[42] 林兰.糖尿病中西医结合论治.北京:北京科学技术出版社,1997,404-407.
[43] 倪青.著名中医学家林兰教授学术经验系列之四病机以气阴两虚为主治疗当益气养阴为先——治疗糖尿病肾病的经验整理.辽宁中医杂志,2000,27(4):145-146.
[44] 王立新.杨霓芝主任医师治疗糖尿病肾病经验拾萃.中医药研究,2000,16(6):36.
[45] 杨霓芝,李芳,徐大基,等,糖尿病肾病分期辨证治疗的探讨,辽宁中医杂志,1999,26(1):16-17.
[46] 刘喜明,智文.糖尿病肾病的诊治与分型方法.中国中医基础医学杂志,1999,5(7):41-44.
[47] 刘铜华,郑鸿雁.糖尿病肾病的中医药诊治述要.国际中医中药杂志,2006, 28(3):187-190
[48] 张瑞彬,糖尿病肾病中医辨治体会.河南中医,2003年,23(9):66-67.
[49] 周保林,柏喜林,庞莉.贺永清主任医师治疗糖尿病肾病经验.陕西中医学院学报,27(3):14-15.
[50] 梁炜,李世华.糖尿病肾病的发病机理和辨治思路.四川中医,2003,21(7):7-8.
[51] 李大钧,范克.糖尿病肾病的中医辨证治疗.河北中医,2001,23(9):682.
[52] 詹锐文,李敬.糖尿病肾病的中医分型辨治浅析.实用中医内科杂志,2004,18(6):566-567.
[53] 王改勤,姚丽,张寒梅.辨证治疗糖尿病肾病体会.江西中医药,2004,35(8):49.
[54] 吕仁和主编,糖尿病及其并发症中西医诊治学.第1版.北京:人民卫生出版社,1997,330-334.
[55] 吕仁和,赵进喜.糖尿病肾病临床研究述评,北京中医药大学学报,1994,17,(2):2-6.
[56] 王越.吕仁和用“六对论治”诊治糖尿病及其并发症的经验.中国医药学报,1998,13(4):46-49.
[57] 吕仁和,王越.糖尿病肾病分期辨治与568例临床分析.中国医药学报,1994,9(4):5-8.
[58] 王永炎主编.名老中医学术思想源流——东直门医院建院五十周年专辑.北京:中医古籍出版社,2008,290-295.
[59] 肖相如.著名肾病学家时振声教授系列经验之八糖尿病肾病的证治经验.辽宁中医杂志,1998,25(8):346.
[60] 冯健春,倪青.时振声教授治疗糖尿病肾病经验述要.1996,23(12):534-535.
[61] 倪青,时振声.糖尿病肾病辨证论治体会.中医函授通讯,1997,16(1):11-12.
[62] 张彤.名医经验叶景华主任治疗糖尿病肾病的临床经验.中医药信息,2003,29-30.
[63] 戴京璋,吕仁和,赵进喜,等.糖尿病肾病中医证治.北京中医药大学学报,2002,25(5):65-66.
[64] 高彦彬,易京红.中医药辨治糖尿病肾病100例临床分析.中医杂志,1991(7):31-34.
[65] 牟新,宋美玲.赵进喜教授治疗糖尿病肾病经验介绍.新中医,2005,37(11):15-16.
[66] 吕仁和,赵进喜,王世东.糖尿病及其并发症的临床研究.新中医,2001,33(3):3-5.
[67] 赵进喜主编.内分泌代谢病中西医诊治.第1版.沈阳:辽宁科学技术出版社,2004,198-214.
[1] Wild S,Roglic G, Green A, et al.Global prevalence of diabetes estimates for the year 2000 and projections for 2030.Diabetes Care,2004,27(5):1047-1053.
[2] Center for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003, Reved. Atlanta:US Department of Health and Human service,Center for Disease Control and Prevention, 2004.
[3] Collins AJ, Kasiske B, Herzog C, et al. United States renal data system 2006 annual data report abstract. Am J Kidney Dis,2007,49(1 Suppl 1):A6-7.
[4] American Diabetes Association. Diabetic nephropathy. Diabetes Care,2003, 26(Suppll):S94-S98.
[5] 黎磊石,刘志红.糖尿病肾病的治疗.中华老年多器官疾病杂志,2002,1(3):171-173.
[6] 陆菊明,潘长玉.糖尿病肾病的流行病学和诊断标准.中华老年多器官疾病杂志,2002,1(3):163-165.
[7] Okada S, Shikata K, et al. Intercellular adhesion molecule-1-deficient mice are resistant agains trenal injury after induction of diabetes.Diabetes,2003,52(10):2586.
[8] Abdel-Wahab N, WestonBS, et al.Connective tissue growthfactor and regulation of the mesangial cell cycle: role in cellular hypertrophy. J Am Soc Nephrol,2002, 13(10):2437.
[9] Forbes JM, Cooper ME, et al. Role of advanced glycation end products in diabetic nephropathy.J Am Soc Nephrol,2003,14(8Suppl 3):S254.
[10] Jin Y, Moriya T, Tanaka K, et al. Glumerular hyperfiltration in noprote in uric and non-hypertensive Janpanese type2 diabetic patients. Diabetes Rrs Clin Pract,2005:23.
[11] Banerjec S,Ghosh US,Saha SJ.Role of GFR estimation in assessment of the status of nephropathy in type2 diabetes mellitus. JAssoc Physicians India,2005,53:181-184.
[12] A podaca G. Modulation of membrane traffic by mechanical stimul. Am J Physiol Renal Physio,2002,282(2):179-190.
[13] Lane P.Diabetic kidney disease:impact of puberty.Am J Physiol Renal Physiol,2002,283:F589-F600.
[14] Wolf G, Ziyadeh FN. The role angiotensin II in diabetic nephropathy: emphasis on nonhemodynamic mechanisms. Am J Kid Dis,1997,29:153-163
[15] Anderson S. Role of local and systemic angiotensin in diabetic renal disease. Kidney Int.1997,52(Suppl 63):S107-110.
[16] Abboud H E.Growth factors and diabetic nephropathy over view.Kidney Int,1997,60:3-6.
[17] BDA Schaan, Lacchini S, Bertoluci MC, et al.Increased renal GLUT1 abundance and urinary TGF-betal in streptozotocin-induced diabetic rats: implications for the development of nephropathy complicating diabetes.Horm Metab Res,2001,33:664-669.
[18] Noh H,Ha H,Yu MR, et al.High glucose increases inducible NO production in cultured rat mesangial cells, possible role in fibronectin production. Nephron, 2002, 90:78-85.
[19] Bernadet-Monrozies P,Rostaining L, Kamar ,etal.Presse Med, 2002, 31(36): 1714-1720.
[20] Han DC,Hoffman BB,Hong SW,et al.Therapy with antisense TGF- β oligade oxynucleot-ides reduces kidney weight and matrix mRNAs in diabetic mice.Am J Physiop Renal Physiol,2000,278(4):28-34.
[21] Darren JK,Yuan Z,Claire H,et al. Protein kinase C- β inhibition attenuates the progression of experimental diabetic nephropathy in the presence of continued hypertension.Diab-etes,2003,52(2):51228.
[22] Thornalley PJ, Langborg A, Minhas HS.Formation of glyoxal, methylglyoxal and 3-deoxy glucosone in the glycation of proteins by glucose. Biochem J,1999, 15,344:109-16.
[23] JensenL J, Ostergard J, FlyvbjergA. AGE-RAGE and AGE Cross-link interaction: important players in the pathogenesis of diabetic kidney disease. Horm Metab Res,2005,37suppll:26-34.
[24] WautierJL, Schmidt AM.Prote in glycation:affirm link to endo the lialcell dysfunction.CircRes,2004,95(3):233-8.
[25] Ruan XZ,Varghese Z, Powis SH,etal.Human mesangia cells expressin ducible macrophages cavenger receptor.Kidney Int,1999,56:440-451.
[26] 刘志红,黎磊石.糖尿病肾病发病机理[J].中华肾脏病杂志,1999,15(2):122-123
[27] Schena FP, Gesualdo L.Pathogenetic mechanisms of diabetic nephropathy. JAM Soc Nephrol.2005;16Suppll:S30-S33.
[28] Strutz F, Zeisberg M, Renziehausen A, et al. TGF- β _1 induces proliferation in human rental fibroblasts via induction of basic fibroblast growth factor (FGF2). Kidney Int, 2001,59(2):579-592.
[29] McKnight AJ, Savage DA, Patterson CC,et al. Resequencing of genes for transforming growth factor betal (TGF- β _1) type 1 and 2 receptors (TGF- β R1, TGF- β R2), and association analysis of variants with diabetic nephropathy.BMC Med Genet.2007,8:1471-2350.
[30]Schena FP,Gesualdo L.Pathogenetic mechanisms of diabetic nephropathy.J AM Soc Nephrol.2005,16 Suppl 1:S30-3.
[31]Wolf G,Chen S,Ziyadeh FN.From the periphery of glumerular capillary wall toward the center of disease:podocyte injury comes of age in diabetic nephropathy.Diabetes,2005,54(6):1626-34.
[32]Flyvbjerg A,Khatir DS,Jensen LJ,et al.The involvement of growth hormone(GH),insulin-like growth factor(IGFs)and vascular endothelial growth factor(VEGF)in diabetic kindney disease.Curr Pharm Des,2004,10(27):3385-3394.
[33]Darren J,Jackie H,Sauro V,et al.Insulin-like growth factors inhibit podocyte apoptosis through the PI3 kinase pathway.Kidney Int,2005;67:1308-1314.
[34]李玉凤,王雪,戴皓洁,等．2型糖尿病肾病患者血清IGF-1、IGFBP-3的研究．北京医学,2005,27(6)：360．
[35]Cooper M E,Vranes D,Yonseef S,et al.Increased renal expression of vascular rendothelial growthfactor(VEGF)and its receptor VEGFR-2 in experimental diabetes.Diabetes,1999,48:2229-2239.
[36]Cha D R,Kim N H,Yoon J W,et al.Role of vascular rendothelial growth factor in diabetic nephropathy.Kidney Int,2000,58(Suppl775):104-112.
[37]Ostendorf T,Kunter V,Eitner F,et al.VEGF mediates glomerula rendothelial repair.J Clin Invest,1999,104:913-923.
[38]Leehey DJ,Singgh A K,Alavi N,et al.Role of angiotensin Ⅱ in diabetic ephropathy.Kidney Int,2000,58(Suppl77):93-98.
[39]Langham RG,Kelly DJ,Maguire J,et al.Over expression of platelet-derived growth factor in human diabetic nephropathy.Nephrology Dialysis Transplantation,2003,18(7):1392-1396.
[40]Uehara G,Suzuki G,Toyoda M,et al.Glomerular expression of platelet-derived growth factor PDGF-A,B chain and PDGF receptor-α,β in diabeticnephropathy.Clin Exp Nephrol,2004,8:36-42.
[41]Hida M,Fujita H,Ishikura K,et al.Eicosapentaenoic acid inhibits PDGF-induced mitogenesis and cyclin Dl expression via TGF-beta in mesangial cells.Journal of Cellular Physiology,2003,196(2):293-300.
[42]Caroline Sassy_Prigent,Didier Heudes,Chantal Mandet,etal.Early glomerular macrophage recruitment in streptozotocininduced diabetic rats.Diabetes.2000,49(3):466-475.
[43]Nishoka H,Kanauchi M,Dohi K.Role of monocyte chemotactic peptide Ⅰ in diabetic nephropathy.Nephron.2001,88(2):189-190.
[44] Roestenberg P, van Nieuwenhoven FA, Joles JA,et al. Temporal expression profile and distribution pattern indicate a role of connective tissue growthfactor (CTGF/CCN-2) in diabetic nephropathy in mice. Am J Physiol RenalPhysiol. 2006,290(6):F1344-F1354.
[45] 陈薇,叶山东,范爱红,等.糖尿病肾病患者尿中结缔组织生长因子的检测及意义.临床输血与检验,2006,8(4):265-267.
[46] Nordfeld S, Johansson C, Carlsson E, et al. Prevention of severe hypoglycaemia in type 1 diabetes: a randomized controlled population study. Arch Dis Child, 2003, 88:240-245.
[47] Goyal A, Crook ED. Thiazolidinediones and progression of renal disease in patients with diabetes. J Investig Med,2006,54:56-61.
[48] Bakris G, Viberti G, Weston WM, et al. Rosiglitazone reduces urinary album in excretion in type 2 diabetes. J Hum Hypertens, 2003,17:7-12.
[49] GoyalA, Crook ED. Thiazolidinediones and progression of renal disease in patients with diabetes. J investig Med,2006 Mar;54(2):56-61.
[50] Sarafidis PA, Bakris GL. Protection of the kidney by thiazolidinediones: An assessment from bench to bedside. Kidney Int,2006,70(7):1223-1233.
[51] Ruilope LM, Luno J. Angiotensin blockade in type2 diabetic renal diseases. Kidney Int Suppl,2002,82:61-63.
[52] Choe HM, Townsend KA, Blount G,et al. Treatment and control of blood pressure in patients with diabetes mellitus. Am J Health SystPharm, 2007,64(1):97-103.
[53] Araki S, Haneda M, Koya D,et al.Reduction in microalbum inuria as an integrated indicator for renal and cardiovascular risk reductionin patients with type 2 diabetes. Diabetes,2007,56(6):1727-1730.
[54] Pahor M,Psaty BM, Alderman MH, etal. Therapeutic benefits of ACE inhibitors and other antihypertensive drugs inpatients with type2 diabetes. Diabetes Care, 2000,23:888 892.
[55] Forbes JM,Thorpe SR,Thallas-Bonke V,etal. Modulation of soluble receptor for advanced glycation end products by angiotensin-converting enzyme-1 inhibition in diabetic nephropathy. Jam.Soc Nephrol,2005,16(8):2363-72.
[56] Remuzzi G, Macia M, Ruggenenti P. Prevention and Treatment of Di -abetic Renal Disease in Type 2 Diabetes: The BENEDICT Study .J Am Soc Nephrol.2006Apr;17:S90-97.
[57] YamagishiS,TakeuchiM,InoueH.Olmesartanmedoxomil,a newly developed angiotensin Ⅱ type 1 receptor antagonist, protects against renal damage in advanced glycation end product(age)-injected rats. Drugs Exp Clin Res, 2005,31(2):45-51.
[58]Parving HH,Lehnert H,Brochner-Mortensen J,etal.The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.N Engl J Med.2001 Sep 20;345(12):870-878.
[59]Remiuzzi G,Ruggenenti P,Perna A,etal.Continuum of renopro-tection with losartan at all stages of type 2 diabetic nephropathy:a post hoc analysis of the RENAAL trial results.J Am Soc Nephrol.2004 Dec;15(12):3117-25.
[60]Lewis EJ,Hunsicker LG,Clarke WR,etal.Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes.N Engl J Med,2001,345(12):851-860.
[61]Jennings DL,Kalus JS,Coleman CI,et al.Combination therapy with an ACE inhibitor and anangiotens in receptor blocker fo diabetic nephropathy:a meta-analysis.Diabet Med,2007,24(5):486-493.
[62]Saklayen MG,Gyebi LK,Tasosa J,et al.Effects of Additive Therapy With Spironolactone on Proteinuria in Diabetic Patients Already on ACE Inhibitor or ARB Therapy:Results of a Randomized,Placebo-Controlled,Double-Blind,Crossover Trial.J Investig Med,2008,56(4):714-719.
[63]Cha DR,Kang YS,Han SY,etal.Role of aldosterone in diabetic nephropathy.Nephrology(Carlton),2005,10(s2):S37-S39.
[64]Rachmani R,Slavachevsky IAmit M,et al.The effect of spironolactone,cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction:a randomized controlled study.Diabetic Med,2004,21(5):471-475
[65]Endo K,Miyashita Y,SasakiH,et al.Probucol delays progression of diabetic nephropathy.Diabetes Res Clin Pract.2005:8.
[66]Wanner C,Krane V,Marti W,et al.A torvastatin in patients with type2 diabetes mellitus undergoing hemodialysis.N Engl J Med,2005,353(3):238-248
[67]Ota T,Takamura T,Ando H,et al.Preventive effect of cerivastatin on diabetic nephropathy through suppression of glomerular macrophage recruitment in a rat model.Diabetologia,2003;46(6):843～851.
[68]Yang T,Chen JW,Liu CP.Combination of simvastation and cilazapril have preventive effect on diabetic nephropathy in diabetic rat and cultured mesangial cells.Diabetologia,2001,44(suppl):A265.
[69]Bohlender JM,Franke S,Stein G,et al.Advanced glycation end product and the kidney.Am J Physiol Renal Physiol,2005,289(4):F645-F659.
[70]Bolton WK,Cattran DC,Williams ME,et al.Wuerth JP:Randomized trial of an inhibitor of formation of advanced glycation end products in diabetic nephropathy.Am J Nephrol,2002,24:32-40.
[71]Williams M E,Bolton W K,K halifah RG,et al.Effects of pyridoxamine in combined phase 2 studies of patients with type 1 and type 2 diabetes and overt nephropathy.Am J Nephrol,2007,27(6):605-614.
[72]Kelly DJ,Chanty A,Gow RM,et al.Prote in kinase Cbetain hibition attenuates osteopontin expression,macrophage recruitment,and tubulointerstitial injury in advanced experimental diabetic nephropathy.J Am SocNephrol,2005,16(6):1654-60.
[73]Tuttle KR,Bakris GL,Toto RD,et al.The effect of ruboxistaurin on nephropathy in type2 diabetes.Diabetes Care,2005,28(l l):2686-2690.
[74]Wu Y,Wu G,Qi X,et al.Protein kinase C beta inhibitor LY333531 attenuates intercellular adhesion molecule-1 and monocyte chemotactic protein-1 expression in the kidney in diabetic rats.J Pharmacol Sci,2006,101(4):335-343.
[75]Sugaru E,Nakagawa T,Ono-Kishino M,et al.SMP-534 amelio rates progression of glomerular fibrosis and urinary albumin in diabetic db/db mice.Am J Physiol Renal Physiol,2005:8.
[76]Schrijvers BF,Flyvbjerg A,Tilton RG,et al.Aneutralizing VEGF antibody prevents glomerular hypertrophy in amodel of obese type 2 diabetes,the Zucker diabetic fatty rat.Nephrol Dial Transplant,2005:25.
[77]Burns W C,T wigg SM,Forbes JM,et al.Connective tissue growth factor plays an important role in advanced glycation end product induced tubular epithelial-to-mesen chymal transition:implications for diabetic renal disease.J Am Soc Nephrol,2006,17(9):2484-2494.
[78]Guha M,Xu ZG,Tung D,et al.Specific down regulation of connective tissue growth factor attenuates progression of nephropathy in mouse models of type 1 and type 2 diabetes.FASEB J,2007,21(12):3355-3368.
[79]Cruzado JM,Lloberas N,Torras J,et al.Regression of Advanced Diabetic Nephropathy by Hepatocyte Growth Factor Gene Therapy in Rats.Diabetes,2004,53(4):1119-1127
[80]Cheng ZJ,Gronholm T,Louhelainen M,et al.Vascular and renal effects of vasopeptidase inhibition and angiotensin-converting enzyme blockade in spontaneously diabetic Goto-Kakizaki rats.J Hy pertens,2005,23(9):1757-70.
[81]Neuhofer W,Pittrow D.Role of endothelin and endothelin receptor antagonists in renal disease.Eur J Clin Invest,2006,36(3):78-88.
[82]Kolavennu V,Zeng L,Peng H,et al.Targeting of RhoA/ROCK signaling ameliorates progression of diabetic nephropathy independent of glucose control.Diabetes,2008,57(3):714-723.
[1] 熊玮.2型糖尿病肾病证候分布调查及早期主证治疗.浙江中医杂志,2006(41)8:437-439.
[2] 张恩丽,柏晋梅.中西医结合治疗糖尿病肾病30例临床观察.中医药研究,1994(6):46-47.
[3] 宋美铃,张丽芬,牟新,等.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究.中国中医基础医学杂志,2005(11)3:215-216.
[4] 邓经林.48例糖尿病肾病的中医辨证论治.江西中医药,2001,32(5):29.
[5] 杨霓芝,王立新,廖平平.248例糖尿病肾病患者分期辨证分析.广州中医药大学学报,1998(15)4:260-262.
[6] 曲晓璐,陈大舜,姚欣艳,等.1718例2型糖尿病患者糖尿病肾病发病率及其中医证型分布特点.中国中西医结合肾病杂志,2003(4)12:713-715.
[7] 张呈祥.祝建新.辨证分型配合胰岛素治疗糖尿病性肾病26例.陕西中医,1997(18)4:155.
[8] 刘从明,李理.辨证与辨病结合治疗糠尿病肾病52例疗效分析.中国实验方剂学杂志,1999(5)1:53-55.
[9] 谢秋芳,钱胜.从瘀论治糖尿病肾病水肿32例.北京中医药大学学报,1999(22)1:43.
[10] 曹勇,刘骁.尿毒清颗粒治疗糖尿病肾病致肾功能衰竭临床观察.中国中医急症,2005(14)4:313-314.
[11] 张奕民,陈岱.肾动脉血流灌注与糖尿病肾病中医辨证分型的相关性研究.中国中西医结合肾病杂志,2003(4)9:550-551.
[12] 吕仁和,王越,张子业.糖尿病肾病分期辨治568例临床分析.中国医药学报,1994(9)4:5-9.
[13] 高阳,李琪.糖肾康治疗糖尿病肾病48例.辽宁中医杂志,1997(24)1:26.
[14] 唐红,徐蓉娟,李红,等.血小板及纤溶活性与糖尿病肾病中医辨证分型关系研究.上海中医药杂志,2003(37)7:18-20.
[15] 李军.中西医结合治疗对早期糖尿病肾病尿微量白蛋白影响的临床观察.中华中医药学刊,2007(25)6:1302-1304.
[16] 江映红,李芹,陈晓燕,等.中西医结合治疗糖尿病肾病30例分析.中国医药学报,2005(15)1:78-79.
[17] 徐延,徐京育.中西医结合治疗糖尿病肾病33例.四川中医,2002(20)6:38-39.
[18] 赵章华,曹鸿云,华琼.中西医结合治疗糖尿病肾病42例.中医研究,1997(10)5:28-29.
[19] 李红,范世平.中西医结合治疗糖尿病肾病42例临床观察.福建中医药,2000(31)4:17-18.
[20] 伍新林,李俊彪,张伟君,等.中西医结合治疗糖尿病肾病的临床研究.中国中西医结合肾病杂志,2008(9)1:51-53.
[21] 李桂芝,郑万发.中医辨证治疗糖尿病肾病100例疗效观察.云南中医中药杂志,2007(28)1:17.
[22] 张史昭,王永钧.中医药为主综合治疗糖尿病肾病33例临床分析.浙江中医杂志,1994(9):399-400.
[23] 刘弘.痛经中医证型临床文献研究.中国中医药信息杂志,2007(14)11:102-104.
[24] 许方沥.慢性乙型肝炎中医证候分型的文献评价.实用肝脏病杂志,2008(11)2:109-111.
[25] 邱华,毛德文,胡振斌,等.重型肝炎中医证型相关文献统计分析.辽宁中医药大学学报,2008(10)4:9-11.
[26] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[1] Wallace L M. Psychological preparation as method of reducing the stress of surgery. J Human stress,1984,10(2):62-64.
[2] 曾兆,争辉.现代流行病学方法与应用.北京:北京医科大学、中国协和医科大学联合出版社,1994:250-70.
[3] Ohara L, Desouza LH, Ide L. A Delphi study of self-care in a community population of people with multiple-sclerosis. Clinical Rehabilitation, 2000,14(1):62-71.
[4] MacDonald EB, Ritchie KA, Murray KJ, et al. Requirements for occupational medicine training in Europe: a Delphi study, Occupational and environal medicine training in Europe: a Delphi study Occupational and Environmental medicine, 2000,57 (2):98 - 1051.
[5] 赵霞,汪受传,李德.基于德尔菲(Delphi)法的中医药治疗小儿病毒性肺炎疗效评价方法专家问卷调查分析.中华中医药杂志,2007(22)5:281-284.
[6] 李俊勇,刘民,周丽.医学科研项目全程评价指标体系的建立.中华医学科研管理杂志,2005(18)1:33-36.
[7] 陈青山,王声湧,荆春霞,等.应用Delphi法评价亚健康的诊断标准.中国公共卫生2003(19)12:1467-1468.
[8] 马烨,赵德才,臧春鹏,等.应用特尔菲法确定我国艾滋病抗病毒药物治疗监管评价指标.中华全科医师杂志,2006(5)11:664-668.
[9] Van Zolingen SJ, Klaassen CA. Selection processes in a Delphi study about key qualifications in Senior Secondary Vocational Education.Technological Forecasting and Social Change, 2003,70:317-340.
[10] 贾振华,吴以岭,高怀林,等.基于熵的复杂系统分化方法与冠心病心绞痛证候量化诊断研究.中医杂志,2008(49)5:459-461.
[11] 金其林,王颖丽,封岩,等.城市社区卫生服务工作考核体系及其应用研究.中国全科医学,2008(11)6:1014-1016.
[12] 刘学毅.德尔菲法在交叉学科研究评价中的运用.西南交通大学学报(社会科学版),2007,(8)2:21-25.
[13] Ohara L, Desouza LH, Ide L. A Delphi study of self-care in a community population of people with multiple-sclerosis. Clinical Rehabilitation, 2000,14(1):62-71.
[14] Millar G. The development of indicators for sustainable tourism: results of a Delphi survey of tourism researchers. Tourism Management, 2002, 22:351-362.
[15] Schuster MA, Asch SM, McGlynn EA, et al. Development of a quality of care measurement system for children and adolescents.Methodological considerations and comparisons with a system for adult women. Arch Pediatr Adolesc Med,l 997,151:1085-1092.
[16] Snyder-Halpern R, Thomp son CB, Schaffer J. Comparison of mailed vs Internet app lications of the Delphi technique in clinical informatics research. Proc AM IA Symp, 2000:809-813.
[1] 高绍强.教育科研资料的分析与研究.读与写杂志,2008(5)5:110.
[2] Catherine Pope, Sue Ziebland, Nicholas Mays. Qualitative research in health care: Analysing qualitative data. BMJ.2000,320:114-116.
[3] Beck CT. Benefits of participants in Internet Interviews: women helping women. Qualitative Health Research, 2005,15(3):411- 422.
[4] Global Tuberculosis Control Surveillance, Planning, Financin.WHO REPORT 2004 Geneva.
[5] Beck CT. The anniversary of birth trauma: Failure to rescue. Nursing Research, 2006, 55(6):381-390.
[6] Villafuerte BE, Gomez LL, Betancourt AM, etal. Cervical cancer: a qualitative study on subjectivity, family, gender and health services. Reprod Health 2007;4:2.
[7] Paterson C. Patients' experiences of Western-style acupunc-ture: the influence of acupuncture 'dose', self-carestrategies and integration. Health Serv Res Policy, 2007; 12(Suppll):S1-39-45.
[8] 马瞧勤,丛黎明,余非颖,等.浙江省大学生性健康教育需求定性研究.浙江预防医学,2005(17)5:6-8.
[9] 陈静,汪洋,Lekha Gurung.定性研究方法在肺结核病人发现研究中的应用.现代预防医学,2006(33)1:9-11.
[10] 王俊芳.定性研究方法在控烟需求评估中的应用.中国自然医学杂志,2007(9)1:56-58.
[11] 曾迎春,李定梅.运用定性研究探讨护士职业压力.护理实践与研究,2008(5)5:88-89.
[12] 刘丽红,郝元涛,黎明,等.使用核心讨论组方法研究肺结核病人生存质量的构成领域和方面.现代预防医学2008(35)11:2088-2091.
[13] 龙翔,陶芳标,黄锟,等.农村孕产期保健服务需求的定性分析.中国妇幼保健,2008(23)14:1974-1977.
[14] 刘建平.定性研究与循证医学.中国中西医结合杂志,2008(28)2:165-167.
[15] 戴斌荣.定量与定性结合——心理学研究方法的发展趋势.盐城师范学院学报,2005(25)1:119-124.
[16] 张宏伟.定性研究的基本属性和常用研究方法.中国中西医结合杂志,2008(28)2:167-169.
[17] 刘晓云,严非,詹绍康.卫生服务研究中的定性研究方法.上海预防医学杂志,2003(15)11:535-536.
[18] 谢雁鸣,廖星.定性研究现状分析.北京中医药大学学报,2008(31)4:232-235.
[1] 陈平雁主编.SPSS13.0统计软件应用教程.北京:人民卫生出版社.2008:245.
[2] 李志更,王天芳,任婕,等.中医科研中几种常用数据挖掘方法浅析.中医药学报,2008(36)2:29-31.
[3] 孙振球主编.医学统计学.北京:人民卫生出版社.2004:328-329.
[4] 张文霖.主成分分析在SPSS中的操作应用.市场研究,2005,12:31-34.
[5] 孙振球主编.医学统计学.北京:人民卫生出版社.2004:325.
[6] 林海明,张文霖.主成分分析与因子分析详细的异同和SPSS软件.统计研究,2005(3)1:1-6.
[7] 朱文峰主编.中医诊断学.北京:中国中医药出版社,2002:2.
[8] 朱文锋,何军锋,姜峻峰,等.确定证素辨证权值的“双层频权剪叉”算法.中西医结合学报,2007(11)6:607-609.
[9] 郭蕾,王永炎.关于证候概念的诠释.中华中医药学会内科分会学术年会资料汇编,2007:3-6.
[10] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[11] 丁英钧,肖永华,赵进喜,等.糖尿病肾病“微型(?)瘕”病理假说解析.中华中医药杂志,2009;24(1):27-30.
[1] 赵进喜,王世东,张丽芬.糖尿病相关中医病名考辨.辽宁中医杂志,2005,32(9):889-890.
[2] 赵进喜,邓德强,李靖.糖尿病肾病相关中医病名考辨.南京中医药大学学报,2005,21(5):288-289.
[3] 吕仁和,赵进喜主编.糖尿病及其并发症中西医诊治学(第二版).北京.人民卫生出版社,2009:835-837.
[4] 孟庆云.中国中医药发展50年(1949-1999).郑州:河南医科大学出版社.1999:237-248.
[5] 郭磊.关于证候概念的诠释.北京中医药大学学报,2003,26(2):5-8.
[6] 徐木林,黄修涛,王秋琴,等.“证”是病机与证候的统一体——从《伤寒杂病论》谈起.国医论坛,2002,17(5):1-3.
[7] 张伯臾主编.中医内科学.上海:上海科技出版社,1985:250.
[8] 周仲瑛主编.中医内科学.北京:中国中医药出版社,2003:428.
[9] 孙广仁主编.中医基础理论.北京:中国中医药出版社,2002:255-256.
[10] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[11] 中国中西医结合学会糖尿病专业委员会.中西医结合糖尿病诊疗标准(草案).中国中西医结合杂志,2005,25(1):94-95.
[12] 仝小林,胡洁,李洪皎,等.糖尿病中医新论.中华中医药杂志,2006,21(6):349-352.
[13] 中国中医药学会消渴病专业委员会.糖尿病中医诊治荟萃.北京:中国医药科技出版社,1999:363-364.
[14] 邹万忠主编.肾活检病理学.北京:北京大学医学出版社,2006:122-125.
[15] 赵进喜主编.内分泌代谢疾病中西医诊治.沈阳:辽宁科学技术出版社,2004:202.
[16] 王耀献,王立,司银楚,等.止消通脉宁对实验性糖尿病大鼠尿白蛋白排泄率的影响.中国实验方剂学杂志,2005,11(1):57-59.
[17] 高彦彬,唐代屹,刘铜华,等.止消通脉宁对糖尿病大鼠肾组织晚期糖化终产物的影响.北京中医药大学学报,2002,25(1):19-21.
[18] 高彦彬,唐代屹,吕仁和,等.止消通脉宁对糖尿病大鼠肾组织糖化终产物受体mRNA表达的调节.北京中医药大学学报,2001,24(4):16-19.
[19] 张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10):755-758.
[20] 张丽芬,赵进喜,王世东,等.中医辨证论治糖尿病肾病肾功能不全证候疗效评价研究.中华现代医学与临床,2007,6(1):42-45.
[21] 张丽芬,吕仁和,赵进喜,等.中医辨证治疗方案对糖尿病肾病肾功能不全患者生存质量的影响.中医杂志,2008,49(2):119-122.
[2] 周恩庆.王西周老师治疗糖尿病肾病经验介绍.陕西中医,2001,22(4):225-226.
[3] 毛黎明,俞东容,涂晓.辨证与辨病相结合治疗糖尿病肾病32例.浙江中医学院学报,2001,25(6):17-18.
[4] 沈稚舟主编.糖尿病慢性并发症.上海:上海医科大学出版社,1999,175-176.
[5] 刘从明,何金霞.辨证治疗糖尿病肾病临床观察.内蒙古中医药,1996,3:4-6.
[6] 张珍先,宋小平.糖尿病肾病的辨证施治.光明中医,2006,21(1):16.
[7] 鲁盈,楼狄.糖尿病肾病的诊断与中医治疗.浙江中西医结合杂志.1997,7(4):201-203.
[8] 邓经林.48例糖尿病肾病的中医辨证论治.江西中医药,2001.32(5):29.
[9] 郑庆媛.糖尿病肾病辨证分型论治.实用中医内科杂志.2003,17,(2):72.
[10] 董兴刚.张庆怡治疗早期糖尿病肾病临床经验.浙江中西医结合杂志,2005,15(12):751.
[11] 王志伏.辨证分型治疗糖尿病肾病42例观察.实用中医内科杂志,2007,21(3):34
[12] 张先闻.陈以平辨治糖尿病肾病经验撷要.上海中医药杂志,2008,42(6):6-7.
[13] 赵宗江.叶传蕙教授治疗糖尿病肾病的思路与方法.中国中西医结合肾病杂志,2006,7(3):129-131.
[14] 吕贵德.辨证论治糖尿病肾病38例疗效观察.河北中医,2002,24(2):103-104.
[15] 孙炜.早期糖尿病肾病的中医辨证治疗.浙江中医学院学报,1999,2(4):14.
[16] 郭连川.辨证治疗糖尿病性肾病54例.辽宁中医杂志,1993,(3):19-20.
[17] 傅能,赵韧.中西医结合治疗早期糖尿病肾病临床观察.现代中西医结合杂志,2006,15(8):989.
[18] 张庚良.糖尿病肾病的辨证治疗.河北中医,2005,27(8):594.
[19] 唐礴,蔡美珠.糖尿病肾病的中医辨证治疗.泸州医学院学报.1995,18(2):114-115.
[20] 苏小惠,戴舜珍.中西医结合治疗糖尿病肾病40例临床观察.辽宁中医杂志,2006,33(1)92-93.
[21] 陈筱云,赵莉娟.从“瘀”论治糖尿病肾病.中国中医基础医学杂志,2002,8(7):53.
[22] 吴家瑜.辨证分型治疗糖尿病肾病58例.中医药学刊,2006,24(9):1716
[23] 赵东鹰,倪佳.辨证论治结合西药治疗糖尿病肾病56例.陕西中医,2007,28(4):415-416.
[24] 仝小林,张志远,李宁,等.糖尿病肾病的中医治疗.中国医药学 报,1998,13(4):50-53.
[25] 王亚敏.中西医结合治疗糖尿病肾病疗效观察.中国中西医结合肾病杂志,2002,3(4):232-234.
[26] 中华中医药学会肾病分会.上海中医药杂志,2007,41(7):7-8
[27] 吕仁和主编.糖尿病及其并发症中西医诊治学(第一版).北京:人民卫生出版社,1977:128-130.
[28] 徐云生,李莹.程益春治疗糖尿病肾病及视网膜病变经验.山东中医杂志,1998,17卷(1):32-33.
[29] 程益春,糖尿病肾病证治体会.江苏中医药,2002,23(12):1.
[30] 尹义辉,牟淑敏.程益春治疗糖尿病肾病经验.山东中医药大学学报,2002,26(4):283-284.
[31] 程益春,徐灿坤.中医辨证配合口服木糖醇治疗糖尿病肾病疗效观察.山东中医药大学学报,2003,27(1):48-49.
[32] 高阳,李琪.刘启庭辨治糖尿病肾病经验.河南中医,1997,17(1):31-32.
[33] 张玉璞,刘玉英.辨证治疗糖尿病肾病.河北中医,1999,21(5):292.
[34] 赵会贤,苏荣华,高新业.糖尿病肾病的病因病机及证治浅识.中医药学刊,2004,22(9):1760-1763.
[35] 徐延,徐京育.中西医结合治疗糖尿病肾病33例.四川中医,2002,21(6):38-39.
[36] 邹本良,张燕.魏子孝治疗糖尿病肾病的临床经验浅述.北京中医,2006,25(3):144-146.
[37] 孙伟,何伟明.糖尿病肾病蛋白尿的中医药治疗体会.江苏中医药,2002,23(5):18-19.
[38] 任爱华,阚方旭.糖尿病肾病三焦辨治,山东中医杂志.2000,19(6):328-329.
[39] 翁苓,张丽霞.周国英主任治疗糖尿病肾病的经验总结.福建中医药,2005,36(6):14.
[40] 王晓光,王亚丽,张琪.张琪教授辨治糖尿病肾病经验介绍.陕西中医,2004,25(12):1116-1118.
[41] 王晓光,王亚丽,张佩清.张琪教授辨治糖尿病肾病经验介绍.新中医,2005年37(3):20-21.
[42] 林兰.糖尿病中西医结合论治.北京:北京科学技术出版社,1997,404-407.
[43] 倪青.著名中医学家林兰教授学术经验系列之四病机以气阴两虚为主治疗当益气养阴为先——治疗糖尿病肾病的经验整理.辽宁中医杂志,2000,27(4):145-146.
[44] 王立新.杨霓芝主任医师治疗糖尿病肾病经验拾萃.中医药研究,2000,16(6):36.
[45] 杨霓芝,李芳,徐大基,等,糖尿病肾病分期辨证治疗的探讨,辽宁中医杂志,1999,26(1):16-17.
[46] 刘喜明,智文.糖尿病肾病的诊治与分型方法.中国中医基础医学杂志,1999,5(7):41-44.
[47] 刘铜华,郑鸿雁.糖尿病肾病的中医药诊治述要.国际中医中药杂志,2006, 28(3):187-190
[48] 张瑞彬,糖尿病肾病中医辨治体会.河南中医,2003年,23(9):66-67.
[49] 周保林,柏喜林,庞莉.贺永清主任医师治疗糖尿病肾病经验.陕西中医学院学报,27(3):14-15.
[50] 梁炜,李世华.糖尿病肾病的发病机理和辨治思路.四川中医,2003,21(7):7-8.
[51] 李大钧,范克.糖尿病肾病的中医辨证治疗.河北中医,2001,23(9):682.
[52] 詹锐文,李敬.糖尿病肾病的中医分型辨治浅析.实用中医内科杂志,2004,18(6):566-567.
[53] 王改勤,姚丽,张寒梅.辨证治疗糖尿病肾病体会.江西中医药,2004,35(8):49.
[54] 吕仁和主编,糖尿病及其并发症中西医诊治学.第1版.北京:人民卫生出版社,1997,330-334.
[55] 吕仁和,赵进喜.糖尿病肾病临床研究述评,北京中医药大学学报,1994,17,(2):2-6.
[56] 王越.吕仁和用“六对论治”诊治糖尿病及其并发症的经验.中国医药学报,1998,13(4):46-49.
[57] 吕仁和,王越.糖尿病肾病分期辨治与568例临床分析.中国医药学报,1994,9(4):5-8.
[58] 王永炎主编.名老中医学术思想源流——东直门医院建院五十周年专辑.北京:中医古籍出版社,2008,290-295.
[59] 肖相如.著名肾病学家时振声教授系列经验之八糖尿病肾病的证治经验.辽宁中医杂志,1998,25(8):346.
[60] 冯健春,倪青.时振声教授治疗糖尿病肾病经验述要.1996,23(12):534-535.
[61] 倪青,时振声.糖尿病肾病辨证论治体会.中医函授通讯,1997,16(1):11-12.
[62] 张彤.名医经验叶景华主任治疗糖尿病肾病的临床经验.中医药信息,2003,29-30.
[63] 戴京璋,吕仁和,赵进喜,等.糖尿病肾病中医证治.北京中医药大学学报,2002,25(5):65-66.
[64] 高彦彬,易京红.中医药辨治糖尿病肾病100例临床分析.中医杂志,1991(7):31-34.
[65] 牟新,宋美玲.赵进喜教授治疗糖尿病肾病经验介绍.新中医,2005,37(11):15-16.
[66] 吕仁和,赵进喜,王世东.糖尿病及其并发症的临床研究.新中医,2001,33(3):3-5.
[67] 赵进喜主编.内分泌代谢病中西医诊治.第1版.沈阳:辽宁科学技术出版社,2004,198-214.
[1] Wild S,Roglic G, Green A, et al.Global prevalence of diabetes estimates for the year 2000 and projections for 2030.Diabetes Care,2004,27(5):1047-1053.
[2] Center for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003, Reved. Atlanta:US Department of Health and Human service,Center for Disease Control and Prevention, 2004.
[3] Collins AJ, Kasiske B, Herzog C, et al. United States renal data system 2006 annual data report abstract. Am J Kidney Dis,2007,49(1 Suppl 1):A6-7.
[4] American Diabetes Association. Diabetic nephropathy. Diabetes Care,2003, 26(Suppll):S94-S98.
[5] 黎磊石,刘志红.糖尿病肾病的治疗.中华老年多器官疾病杂志,2002,1(3):171-173.
[6] 陆菊明,潘长玉.糖尿病肾病的流行病学和诊断标准.中华老年多器官疾病杂志,2002,1(3):163-165.
[7] Okada S, Shikata K, et al. Intercellular adhesion molecule-1-deficient mice are resistant agains trenal injury after induction of diabetes.Diabetes,2003,52(10):2586.
[8] Abdel-Wahab N, WestonBS, et al.Connective tissue growthfactor and regulation of the mesangial cell cycle: role in cellular hypertrophy. J Am Soc Nephrol,2002, 13(10):2437.
[9] Forbes JM, Cooper ME, et al. Role of advanced glycation end products in diabetic nephropathy.J Am Soc Nephrol,2003,14(8Suppl 3):S254.
[10] Jin Y, Moriya T, Tanaka K, et al. Glumerular hyperfiltration in noprote in uric and non-hypertensive Janpanese type2 diabetic patients. Diabetes Rrs Clin Pract,2005:23.
[11] Banerjec S,Ghosh US,Saha SJ.Role of GFR estimation in assessment of the status of nephropathy in type2 diabetes mellitus. JAssoc Physicians India,2005,53:181-184.
[12] A podaca G. Modulation of membrane traffic by mechanical stimul. Am J Physiol Renal Physio,2002,282(2):179-190.
[13] Lane P.Diabetic kidney disease:impact of puberty.Am J Physiol Renal Physiol,2002,283:F589-F600.
[14] Wolf G, Ziyadeh FN. The role angiotensin II in diabetic nephropathy: emphasis on nonhemodynamic mechanisms. Am J Kid Dis,1997,29:153-163
[15] Anderson S. Role of local and systemic angiotensin in diabetic renal disease. Kidney Int.1997,52(Suppl 63):S107-110.
[16] Abboud H E.Growth factors and diabetic nephropathy over view.Kidney Int,1997,60:3-6.
[17] BDA Schaan, Lacchini S, Bertoluci MC, et al.Increased renal GLUT1 abundance and urinary TGF-betal in streptozotocin-induced diabetic rats: implications for the development of nephropathy complicating diabetes.Horm Metab Res,2001,33:664-669.
[18] Noh H,Ha H,Yu MR, et al.High glucose increases inducible NO production in cultured rat mesangial cells, possible role in fibronectin production. Nephron, 2002, 90:78-85.
[19] Bernadet-Monrozies P,Rostaining L, Kamar ,etal.Presse Med, 2002, 31(36): 1714-1720.
[20] Han DC,Hoffman BB,Hong SW,et al.Therapy with antisense TGF- β oligade oxynucleot-ides reduces kidney weight and matrix mRNAs in diabetic mice.Am J Physiop Renal Physiol,2000,278(4):28-34.
[21] Darren JK,Yuan Z,Claire H,et al. Protein kinase C- β inhibition attenuates the progression of experimental diabetic nephropathy in the presence of continued hypertension.Diab-etes,2003,52(2):51228.
[22] Thornalley PJ, Langborg A, Minhas HS.Formation of glyoxal, methylglyoxal and 3-deoxy glucosone in the glycation of proteins by glucose. Biochem J,1999, 15,344:109-16.
[23] JensenL J, Ostergard J, FlyvbjergA. AGE-RAGE and AGE Cross-link interaction: important players in the pathogenesis of diabetic kidney disease. Horm Metab Res,2005,37suppll:26-34.
[24] WautierJL, Schmidt AM.Prote in glycation:affirm link to endo the lialcell dysfunction.CircRes,2004,95(3):233-8.
[25] Ruan XZ,Varghese Z, Powis SH,etal.Human mesangia cells expressin ducible macrophages cavenger receptor.Kidney Int,1999,56:440-451.
[26] 刘志红,黎磊石.糖尿病肾病发病机理[J].中华肾脏病杂志,1999,15(2):122-123
[27] Schena FP, Gesualdo L.Pathogenetic mechanisms of diabetic nephropathy. JAM Soc Nephrol.2005;16Suppll:S30-S33.
[28] Strutz F, Zeisberg M, Renziehausen A, et al. TGF- β _1 induces proliferation in human rental fibroblasts via induction of basic fibroblast growth factor (FGF2). Kidney Int, 2001,59(2):579-592.
[29] McKnight AJ, Savage DA, Patterson CC,et al. Resequencing of genes for transforming growth factor betal (TGF- β _1) type 1 and 2 receptors (TGF- β R1, TGF- β R2), and association analysis of variants with diabetic nephropathy.BMC Med Genet.2007,8:1471-2350.
[30]Schena FP,Gesualdo L.Pathogenetic mechanisms of diabetic nephropathy.J AM Soc Nephrol.2005,16 Suppl 1:S30-3.
[31]Wolf G,Chen S,Ziyadeh FN.From the periphery of glumerular capillary wall toward the center of disease:podocyte injury comes of age in diabetic nephropathy.Diabetes,2005,54(6):1626-34.
[32]Flyvbjerg A,Khatir DS,Jensen LJ,et al.The involvement of growth hormone(GH),insulin-like growth factor(IGFs)and vascular endothelial growth factor(VEGF)in diabetic kindney disease.Curr Pharm Des,2004,10(27):3385-3394.
[33]Darren J,Jackie H,Sauro V,et al.Insulin-like growth factors inhibit podocyte apoptosis through the PI3 kinase pathway.Kidney Int,2005;67:1308-1314.
[34]李玉凤,王雪,戴皓洁,等．2型糖尿病肾病患者血清IGF-1、IGFBP-3的研究．北京医学,2005,27(6)：360．
[35]Cooper M E,Vranes D,Yonseef S,et al.Increased renal expression of vascular rendothelial growthfactor(VEGF)and its receptor VEGFR-2 in experimental diabetes.Diabetes,1999,48:2229-2239.
[36]Cha D R,Kim N H,Yoon J W,et al.Role of vascular rendothelial growth factor in diabetic nephropathy.Kidney Int,2000,58(Suppl775):104-112.
[37]Ostendorf T,Kunter V,Eitner F,et al.VEGF mediates glomerula rendothelial repair.J Clin Invest,1999,104:913-923.
[38]Leehey DJ,Singgh A K,Alavi N,et al.Role of angiotensin Ⅱ in diabetic ephropathy.Kidney Int,2000,58(Suppl77):93-98.
[39]Langham RG,Kelly DJ,Maguire J,et al.Over expression of platelet-derived growth factor in human diabetic nephropathy.Nephrology Dialysis Transplantation,2003,18(7):1392-1396.
[40]Uehara G,Suzuki G,Toyoda M,et al.Glomerular expression of platelet-derived growth factor PDGF-A,B chain and PDGF receptor-α,β in diabeticnephropathy.Clin Exp Nephrol,2004,8:36-42.
[41]Hida M,Fujita H,Ishikura K,et al.Eicosapentaenoic acid inhibits PDGF-induced mitogenesis and cyclin Dl expression via TGF-beta in mesangial cells.Journal of Cellular Physiology,2003,196(2):293-300.
[42]Caroline Sassy_Prigent,Didier Heudes,Chantal Mandet,etal.Early glomerular macrophage recruitment in streptozotocininduced diabetic rats.Diabetes.2000,49(3):466-475.
[43]Nishoka H,Kanauchi M,Dohi K.Role of monocyte chemotactic peptide Ⅰ in diabetic nephropathy.Nephron.2001,88(2):189-190.
[44] Roestenberg P, van Nieuwenhoven FA, Joles JA,et al. Temporal expression profile and distribution pattern indicate a role of connective tissue growthfactor (CTGF/CCN-2) in diabetic nephropathy in mice. Am J Physiol RenalPhysiol. 2006,290(6):F1344-F1354.
[45] 陈薇,叶山东,范爱红,等.糖尿病肾病患者尿中结缔组织生长因子的检测及意义.临床输血与检验,2006,8(4):265-267.
[46] Nordfeld S, Johansson C, Carlsson E, et al. Prevention of severe hypoglycaemia in type 1 diabetes: a randomized controlled population study. Arch Dis Child, 2003, 88:240-245.
[47] Goyal A, Crook ED. Thiazolidinediones and progression of renal disease in patients with diabetes. J Investig Med,2006,54:56-61.
[48] Bakris G, Viberti G, Weston WM, et al. Rosiglitazone reduces urinary album in excretion in type 2 diabetes. J Hum Hypertens, 2003,17:7-12.
[49] GoyalA, Crook ED. Thiazolidinediones and progression of renal disease in patients with diabetes. J investig Med,2006 Mar;54(2):56-61.
[50] Sarafidis PA, Bakris GL. Protection of the kidney by thiazolidinediones: An assessment from bench to bedside. Kidney Int,2006,70(7):1223-1233.
[51] Ruilope LM, Luno J. Angiotensin blockade in type2 diabetic renal diseases. Kidney Int Suppl,2002,82:61-63.
[52] Choe HM, Townsend KA, Blount G,et al. Treatment and control of blood pressure in patients with diabetes mellitus. Am J Health SystPharm, 2007,64(1):97-103.
[53] Araki S, Haneda M, Koya D,et al.Reduction in microalbum inuria as an integrated indicator for renal and cardiovascular risk reductionin patients with type 2 diabetes. Diabetes,2007,56(6):1727-1730.
[54] Pahor M,Psaty BM, Alderman MH, etal. Therapeutic benefits of ACE inhibitors and other antihypertensive drugs inpatients with type2 diabetes. Diabetes Care, 2000,23:888 892.
[55] Forbes JM,Thorpe SR,Thallas-Bonke V,etal. Modulation of soluble receptor for advanced glycation end products by angiotensin-converting enzyme-1 inhibition in diabetic nephropathy. Jam.Soc Nephrol,2005,16(8):2363-72.
[56] Remuzzi G, Macia M, Ruggenenti P. Prevention and Treatment of Di -abetic Renal Disease in Type 2 Diabetes: The BENEDICT Study .J Am Soc Nephrol.2006Apr;17:S90-97.
[57] YamagishiS,TakeuchiM,InoueH.Olmesartanmedoxomil,a newly developed angiotensin Ⅱ type 1 receptor antagonist, protects against renal damage in advanced glycation end product(age)-injected rats. Drugs Exp Clin Res, 2005,31(2):45-51.
[58]Parving HH,Lehnert H,Brochner-Mortensen J,etal.The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes.N Engl J Med.2001 Sep 20;345(12):870-878.
[59]Remiuzzi G,Ruggenenti P,Perna A,etal.Continuum of renopro-tection with losartan at all stages of type 2 diabetic nephropathy:a post hoc analysis of the RENAAL trial results.J Am Soc Nephrol.2004 Dec;15(12):3117-25.
[60]Lewis EJ,Hunsicker LG,Clarke WR,etal.Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes.N Engl J Med,2001,345(12):851-860.
[61]Jennings DL,Kalus JS,Coleman CI,et al.Combination therapy with an ACE inhibitor and anangiotens in receptor blocker fo diabetic nephropathy:a meta-analysis.Diabet Med,2007,24(5):486-493.
[62]Saklayen MG,Gyebi LK,Tasosa J,et al.Effects of Additive Therapy With Spironolactone on Proteinuria in Diabetic Patients Already on ACE Inhibitor or ARB Therapy:Results of a Randomized,Placebo-Controlled,Double-Blind,Crossover Trial.J Investig Med,2008,56(4):714-719.
[63]Cha DR,Kang YS,Han SY,etal.Role of aldosterone in diabetic nephropathy.Nephrology(Carlton),2005,10(s2):S37-S39.
[64]Rachmani R,Slavachevsky IAmit M,et al.The effect of spironolactone,cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction:a randomized controlled study.Diabetic Med,2004,21(5):471-475
[65]Endo K,Miyashita Y,SasakiH,et al.Probucol delays progression of diabetic nephropathy.Diabetes Res Clin Pract.2005:8.
[66]Wanner C,Krane V,Marti W,et al.A torvastatin in patients with type2 diabetes mellitus undergoing hemodialysis.N Engl J Med,2005,353(3):238-248
[67]Ota T,Takamura T,Ando H,et al.Preventive effect of cerivastatin on diabetic nephropathy through suppression of glomerular macrophage recruitment in a rat model.Diabetologia,2003;46(6):843～851.
[68]Yang T,Chen JW,Liu CP.Combination of simvastation and cilazapril have preventive effect on diabetic nephropathy in diabetic rat and cultured mesangial cells.Diabetologia,2001,44(suppl):A265.
[69]Bohlender JM,Franke S,Stein G,et al.Advanced glycation end product and the kidney.Am J Physiol Renal Physiol,2005,289(4):F645-F659.
[70]Bolton WK,Cattran DC,Williams ME,et al.Wuerth JP:Randomized trial of an inhibitor of formation of advanced glycation end products in diabetic nephropathy.Am J Nephrol,2002,24:32-40.
[71]Williams M E,Bolton W K,K halifah RG,et al.Effects of pyridoxamine in combined phase 2 studies of patients with type 1 and type 2 diabetes and overt nephropathy.Am J Nephrol,2007,27(6):605-614.
[72]Kelly DJ,Chanty A,Gow RM,et al.Prote in kinase Cbetain hibition attenuates osteopontin expression,macrophage recruitment,and tubulointerstitial injury in advanced experimental diabetic nephropathy.J Am SocNephrol,2005,16(6):1654-60.
[73]Tuttle KR,Bakris GL,Toto RD,et al.The effect of ruboxistaurin on nephropathy in type2 diabetes.Diabetes Care,2005,28(l l):2686-2690.
[74]Wu Y,Wu G,Qi X,et al.Protein kinase C beta inhibitor LY333531 attenuates intercellular adhesion molecule-1 and monocyte chemotactic protein-1 expression in the kidney in diabetic rats.J Pharmacol Sci,2006,101(4):335-343.
[75]Sugaru E,Nakagawa T,Ono-Kishino M,et al.SMP-534 amelio rates progression of glomerular fibrosis and urinary albumin in diabetic db/db mice.Am J Physiol Renal Physiol,2005:8.
[76]Schrijvers BF,Flyvbjerg A,Tilton RG,et al.Aneutralizing VEGF antibody prevents glomerular hypertrophy in amodel of obese type 2 diabetes,the Zucker diabetic fatty rat.Nephrol Dial Transplant,2005:25.
[77]Burns W C,T wigg SM,Forbes JM,et al.Connective tissue growth factor plays an important role in advanced glycation end product induced tubular epithelial-to-mesen chymal transition:implications for diabetic renal disease.J Am Soc Nephrol,2006,17(9):2484-2494.
[78]Guha M,Xu ZG,Tung D,et al.Specific down regulation of connective tissue growth factor attenuates progression of nephropathy in mouse models of type 1 and type 2 diabetes.FASEB J,2007,21(12):3355-3368.
[79]Cruzado JM,Lloberas N,Torras J,et al.Regression of Advanced Diabetic Nephropathy by Hepatocyte Growth Factor Gene Therapy in Rats.Diabetes,2004,53(4):1119-1127
[80]Cheng ZJ,Gronholm T,Louhelainen M,et al.Vascular and renal effects of vasopeptidase inhibition and angiotensin-converting enzyme blockade in spontaneously diabetic Goto-Kakizaki rats.J Hy pertens,2005,23(9):1757-70.
[81]Neuhofer W,Pittrow D.Role of endothelin and endothelin receptor antagonists in renal disease.Eur J Clin Invest,2006,36(3):78-88.
[82]Kolavennu V,Zeng L,Peng H,et al.Targeting of RhoA/ROCK signaling ameliorates progression of diabetic nephropathy independent of glucose control.Diabetes,2008,57(3):714-723.
[1] 熊玮.2型糖尿病肾病证候分布调查及早期主证治疗.浙江中医杂志,2006(41)8:437-439.
[2] 张恩丽,柏晋梅.中西医结合治疗糖尿病肾病30例临床观察.中医药研究,1994(6):46-47.
[3] 宋美铃,张丽芬,牟新,等.糖尿病肾病辨证分型与肾功能及血清Ⅳ胶原相关性研究.中国中医基础医学杂志,2005(11)3:215-216.
[4] 邓经林.48例糖尿病肾病的中医辨证论治.江西中医药,2001,32(5):29.
[5] 杨霓芝,王立新,廖平平.248例糖尿病肾病患者分期辨证分析.广州中医药大学学报,1998(15)4:260-262.
[6] 曲晓璐,陈大舜,姚欣艳,等.1718例2型糖尿病患者糖尿病肾病发病率及其中医证型分布特点.中国中西医结合肾病杂志,2003(4)12:713-715.
[7] 张呈祥.祝建新.辨证分型配合胰岛素治疗糖尿病性肾病26例.陕西中医,1997(18)4:155.
[8] 刘从明,李理.辨证与辨病结合治疗糠尿病肾病52例疗效分析.中国实验方剂学杂志,1999(5)1:53-55.
[9] 谢秋芳,钱胜.从瘀论治糖尿病肾病水肿32例.北京中医药大学学报,1999(22)1:43.
[10] 曹勇,刘骁.尿毒清颗粒治疗糖尿病肾病致肾功能衰竭临床观察.中国中医急症,2005(14)4:313-314.
[11] 张奕民,陈岱.肾动脉血流灌注与糖尿病肾病中医辨证分型的相关性研究.中国中西医结合肾病杂志,2003(4)9:550-551.
[12] 吕仁和,王越,张子业.糖尿病肾病分期辨治568例临床分析.中国医药学报,1994(9)4:5-9.
[13] 高阳,李琪.糖肾康治疗糖尿病肾病48例.辽宁中医杂志,1997(24)1:26.
[14] 唐红,徐蓉娟,李红,等.血小板及纤溶活性与糖尿病肾病中医辨证分型关系研究.上海中医药杂志,2003(37)7:18-20.
[15] 李军.中西医结合治疗对早期糖尿病肾病尿微量白蛋白影响的临床观察.中华中医药学刊,2007(25)6:1302-1304.
[16] 江映红,李芹,陈晓燕,等.中西医结合治疗糖尿病肾病30例分析.中国医药学报,2005(15)1:78-79.
[17] 徐延,徐京育.中西医结合治疗糖尿病肾病33例.四川中医,2002(20)6:38-39.
[18] 赵章华,曹鸿云,华琼.中西医结合治疗糖尿病肾病42例.中医研究,1997(10)5:28-29.
[19] 李红,范世平.中西医结合治疗糖尿病肾病42例临床观察.福建中医药,2000(31)4:17-18.
[20] 伍新林,李俊彪,张伟君,等.中西医结合治疗糖尿病肾病的临床研究.中国中西医结合肾病杂志,2008(9)1:51-53.
[21] 李桂芝,郑万发.中医辨证治疗糖尿病肾病100例疗效观察.云南中医中药杂志,2007(28)1:17.
[22] 张史昭,王永钧.中医药为主综合治疗糖尿病肾病33例临床分析.浙江中医杂志,1994(9):399-400.
[23] 刘弘.痛经中医证型临床文献研究.中国中医药信息杂志,2007(14)11:102-104.
[24] 许方沥.慢性乙型肝炎中医证候分型的文献评价.实用肝脏病杂志,2008(11)2:109-111.
[25] 邱华,毛德文,胡振斌,等.重型肝炎中医证型相关文献统计分析.辽宁中医药大学学报,2008(10)4:9-11.
[26] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[1] Wallace L M. Psychological preparation as method of reducing the stress of surgery. J Human stress,1984,10(2):62-64.
[2] 曾兆,争辉.现代流行病学方法与应用.北京:北京医科大学、中国协和医科大学联合出版社,1994:250-70.
[3] Ohara L, Desouza LH, Ide L. A Delphi study of self-care in a community population of people with multiple-sclerosis. Clinical Rehabilitation, 2000,14(1):62-71.
[4] MacDonald EB, Ritchie KA, Murray KJ, et al. Requirements for occupational medicine training in Europe: a Delphi study, Occupational and environal medicine training in Europe: a Delphi study Occupational and Environmental medicine, 2000,57 (2):98 - 1051.
[5] 赵霞,汪受传,李德.基于德尔菲(Delphi)法的中医药治疗小儿病毒性肺炎疗效评价方法专家问卷调查分析.中华中医药杂志,2007(22)5:281-284.
[6] 李俊勇,刘民,周丽.医学科研项目全程评价指标体系的建立.中华医学科研管理杂志,2005(18)1:33-36.
[7] 陈青山,王声湧,荆春霞,等.应用Delphi法评价亚健康的诊断标准.中国公共卫生2003(19)12:1467-1468.
[8] 马烨,赵德才,臧春鹏,等.应用特尔菲法确定我国艾滋病抗病毒药物治疗监管评价指标.中华全科医师杂志,2006(5)11:664-668.
[9] Van Zolingen SJ, Klaassen CA. Selection processes in a Delphi study about key qualifications in Senior Secondary Vocational Education.Technological Forecasting and Social Change, 2003,70:317-340.
[10] 贾振华,吴以岭,高怀林,等.基于熵的复杂系统分化方法与冠心病心绞痛证候量化诊断研究.中医杂志,2008(49)5:459-461.
[11] 金其林,王颖丽,封岩,等.城市社区卫生服务工作考核体系及其应用研究.中国全科医学,2008(11)6:1014-1016.
[12] 刘学毅.德尔菲法在交叉学科研究评价中的运用.西南交通大学学报(社会科学版),2007,(8)2:21-25.
[13] Ohara L, Desouza LH, Ide L. A Delphi study of self-care in a community population of people with multiple-sclerosis. Clinical Rehabilitation, 2000,14(1):62-71.
[14] Millar G. The development of indicators for sustainable tourism: results of a Delphi survey of tourism researchers. Tourism Management, 2002, 22:351-362.
[15] Schuster MA, Asch SM, McGlynn EA, et al. Development of a quality of care measurement system for children and adolescents.Methodological considerations and comparisons with a system for adult women. Arch Pediatr Adolesc Med,l 997,151:1085-1092.
[16] Snyder-Halpern R, Thomp son CB, Schaffer J. Comparison of mailed vs Internet app lications of the Delphi technique in clinical informatics research. Proc AM IA Symp, 2000:809-813.
[1] 高绍强.教育科研资料的分析与研究.读与写杂志,2008(5)5:110.
[2] Catherine Pope, Sue Ziebland, Nicholas Mays. Qualitative research in health care: Analysing qualitative data. BMJ.2000,320:114-116.
[3] Beck CT. Benefits of participants in Internet Interviews: women helping women. Qualitative Health Research, 2005,15(3):411- 422.
[4] Global Tuberculosis Control Surveillance, Planning, Financin.WHO REPORT 2004 Geneva.
[5] Beck CT. The anniversary of birth trauma: Failure to rescue. Nursing Research, 2006, 55(6):381-390.
[6] Villafuerte BE, Gomez LL, Betancourt AM, etal. Cervical cancer: a qualitative study on subjectivity, family, gender and health services. Reprod Health 2007;4:2.
[7] Paterson C. Patients' experiences of Western-style acupunc-ture: the influence of acupuncture 'dose', self-carestrategies and integration. Health Serv Res Policy, 2007; 12(Suppll):S1-39-45.
[8] 马瞧勤,丛黎明,余非颖,等.浙江省大学生性健康教育需求定性研究.浙江预防医学,2005(17)5:6-8.
[9] 陈静,汪洋,Lekha Gurung.定性研究方法在肺结核病人发现研究中的应用.现代预防医学,2006(33)1:9-11.
[10] 王俊芳.定性研究方法在控烟需求评估中的应用.中国自然医学杂志,2007(9)1:56-58.
[11] 曾迎春,李定梅.运用定性研究探讨护士职业压力.护理实践与研究,2008(5)5:88-89.
[12] 刘丽红,郝元涛,黎明,等.使用核心讨论组方法研究肺结核病人生存质量的构成领域和方面.现代预防医学2008(35)11:2088-2091.
[13] 龙翔,陶芳标,黄锟,等.农村孕产期保健服务需求的定性分析.中国妇幼保健,2008(23)14:1974-1977.
[14] 刘建平.定性研究与循证医学.中国中西医结合杂志,2008(28)2:165-167.
[15] 戴斌荣.定量与定性结合——心理学研究方法的发展趋势.盐城师范学院学报,2005(25)1:119-124.
[16] 张宏伟.定性研究的基本属性和常用研究方法.中国中西医结合杂志,2008(28)2:167-169.
[17] 刘晓云,严非,詹绍康.卫生服务研究中的定性研究方法.上海预防医学杂志,2003(15)11:535-536.
[18] 谢雁鸣,廖星.定性研究现状分析.北京中医药大学学报,2008(31)4:232-235.
[1] 陈平雁主编.SPSS13.0统计软件应用教程.北京:人民卫生出版社.2008:245.
[2] 李志更,王天芳,任婕,等.中医科研中几种常用数据挖掘方法浅析.中医药学报,2008(36)2:29-31.
[3] 孙振球主编.医学统计学.北京:人民卫生出版社.2004:328-329.
[4] 张文霖.主成分分析在SPSS中的操作应用.市场研究,2005,12:31-34.
[5] 孙振球主编.医学统计学.北京:人民卫生出版社.2004:325.
[6] 林海明,张文霖.主成分分析与因子分析详细的异同和SPSS软件.统计研究,2005(3)1:1-6.
[7] 朱文峰主编.中医诊断学.北京:中国中医药出版社,2002:2.
[8] 朱文锋,何军锋,姜峻峰,等.确定证素辨证权值的“双层频权剪叉”算法.中西医结合学报,2007(11)6:607-609.
[9] 郭蕾,王永炎.关于证候概念的诠释.中华中医药学会内科分会学术年会资料汇编,2007:3-6.
[10] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[11] 丁英钧,肖永华,赵进喜,等.糖尿病肾病“微型(?)瘕”病理假说解析.中华中医药杂志,2009;24(1):27-30.
[1] 赵进喜,王世东,张丽芬.糖尿病相关中医病名考辨.辽宁中医杂志,2005,32(9):889-890.
[2] 赵进喜,邓德强,李靖.糖尿病肾病相关中医病名考辨.南京中医药大学学报,2005,21(5):288-289.
[3] 吕仁和,赵进喜主编.糖尿病及其并发症中西医诊治学(第二版).北京.人民卫生出版社,2009:835-837.
[4] 孟庆云.中国中医药发展50年(1949-1999).郑州:河南医科大学出版社.1999:237-248.
[5] 郭磊.关于证候概念的诠释.北京中医药大学学报,2003,26(2):5-8.
[6] 徐木林,黄修涛,王秋琴,等.“证”是病机与证候的统一体——从《伤寒杂病论》谈起.国医论坛,2002,17(5):1-3.
[7] 张伯臾主编.中医内科学.上海:上海科技出版社,1985:250.
[8] 周仲瑛主编.中医内科学.北京:中国中医药出版社,2003:428.
[9] 孙广仁主编.中医基础理论.北京:中国中医药出版社,2002:255-256.
[10] 丁英钧,王世东,王颖辉.糖尿病“内热伤阴耗气”基本病机探讨.中医杂志,2008,49(5):389-391.
[11] 中国中西医结合学会糖尿病专业委员会.中西医结合糖尿病诊疗标准(草案).中国中西医结合杂志,2005,25(1):94-95.
[12] 仝小林,胡洁,李洪皎,等.糖尿病中医新论.中华中医药杂志,2006,21(6):349-352.
[13] 中国中医药学会消渴病专业委员会.糖尿病中医诊治荟萃.北京:中国医药科技出版社,1999:363-364.
[14] 邹万忠主编.肾活检病理学.北京:北京大学医学出版社,2006:122-125.
[15] 赵进喜主编.内分泌代谢疾病中西医诊治.沈阳:辽宁科学技术出版社,2004:202.
[16] 王耀献,王立,司银楚,等.止消通脉宁对实验性糖尿病大鼠尿白蛋白排泄率的影响.中国实验方剂学杂志,2005,11(1):57-59.
[17] 高彦彬,唐代屹,刘铜华,等.止消通脉宁对糖尿病大鼠肾组织晚期糖化终产物的影响.北京中医药大学学报,2002,25(1):19-21.
[18] 高彦彬,唐代屹,吕仁和,等.止消通脉宁对糖尿病大鼠肾组织糖化终产物受体mRNA表达的调节.北京中医药大学学报,2001,24(4):16-19.
[19] 张丽芬,赵进喜,吕仁和,等.糖尿病肾病肾功能不全防治优化方案的有效性和安全性研究.中医杂志,2006,47(10):755-758.
[20] 张丽芬,赵进喜,王世东,等.中医辨证论治糖尿病肾病肾功能不全证候疗效评价研究.中华现代医学与临床,2007,6(1):42-45.
[21] 张丽芬,吕仁和,赵进喜,等.中医辨证治疗方案对糖尿病肾病肾功能不全患者生存质量的影响.中医杂志,2008,49(2):119-122.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |