腹膜透析患者证候及四时规律与营养容量的相关性和薏苡仁干预的临床研究
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摘要
背景
慢性肾功能衰竭是一种常见的临床综合征,已经成为威胁全球公共健康的主要疾病之一,发病率有不断上升的趋势。其后期可能发展为终末期肾病,患者将不得不依靠肾脏替代治疗维系生命。
腹膜透析(Peritoneal Dialysis, PD)是终末期肾病患者所采用的一种有效的肾脏替代治疗方法,然而治疗过程中仍存在一些问题,比如PD患者营养不良的发生率较高,体内容量超负荷明显增加、容易导致高血压及相应的并发症等。目前西医对于PD治疗中营养不良与容量超负荷的病因已有较深入的认识,但治疗方法上仍较为局限,对PD的营养与容量管理仍处于未真正成熟的阶段。中医在这方面也做了许多的研究,目前治疗手段主要为口服汤剂、静脉用药及PD液中加中药等,但汤剂与静脉用药都无形中增加了患者液体的摄入量,PD液加药也增加了腹膜炎的潜在危险,都不是理想的干预手段。
辨证论治是中医诊疗的前提,然而目前国内对于PD患者证候的研究却非常少,且不够深入。而且PD治疗是一个漫长的过程,患者一年四季营养及容量状况可能会有所不同,作为中医理论重要组成部分的“四时”理论,也许能应用于PD营养与容量的管理中来,提供新的治疗手段和思路。
目的
分析PD患者证候分布、四时阴阳转变规律与营养、容量指标变化的相关性,提出可能的干预方法。再用薏苡仁食疗做一探索性的研究,试图为运用中医中药防治PD患者营养不良及容量失衡,改善透析质量提供新的思路。
方法
研究一：参考中华中医药学会肾病分会2006年《慢性肾衰的诊断、辨证分析及疗效评定》标准对164例PD患者进行中医辨证分型及分析,并比较不同证型间透析方案(包括透析剂量、透析液渗透浓度、KT／V)、营养相关指标(包括主观综合性营养评估、平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、握力、血清白蛋白、血肌酐、血红蛋白)、容量相关指标(包括血压、体重、饮水量、尿液量及超滤量、Overhydration)的差异。
研究二：通过收集北京大学第三医院腹膜透析门诊定期随诊的150名腹膜透析患者2007年7月至2009年6月两年期间透析方案、营养、容量负荷的相关指标,包括透析剂量、透析液渗透浓度、KT／V(总)、KT／V(肾)、主观综合性营养评估、平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、握力、血尿素氮、血清白蛋白、细胞外液／细胞内液、血压、体重、饮水量、尿液量、超滤量、细胞外液、细胞内液、总体液量等。比较春夏秋冬四个季节间上述指标的变化情况,并结合中医四时阴阳转变规律进行分析。
研究三：选择5-8月夏季时分,将辨证为湿浊证、湿热证的PD患者,按纳入排除标准筛选后,将患者随机分为薏苡仁组及对照组做一尝试性研究,对照组维持原治疗方案及饮食方案,薏苡仁组在患者日常饮食中每天加食30g薏苡仁,维持3个月。干预前后比较患者的透析方案,营养、容量各项指标及中医证型、临床症状评分的变化情况。收集所有结果进行统计分析。
结果
研究一：各证型除了风动证外,在PD患者中均占一定比例,并且随着透析时间延长,本虚证方面,脾肾气虚证型逐渐减少；脾肾阳虚证型初期比例很小,中期明显增大,后期比例又明显减小；阴阳俱虚证型则随透析时间延长比例逐渐增加。标实证方面,湿浊证型在透析初期占了最大的比例,随着透析时间延长逐渐减少；无标证比例也随透析时间逐渐减少；而血瘀证比例随时间延长呈逐渐增多的趋势。
本虚证当中,脾肾阳虚证组与阴阳俱虚证组平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、右手握力、左手握力、血清白蛋白、血红蛋白等营养指标均较低,差异有统计学意义(P<0.01,P<0.05)。同时,脾肾阳虚证组与阴阳俱虚证组容量指标Overhydration(OH)较高,与其它组比较差异有统计学意义(P<0.01)。
标实证当中,湿浊证、湿热证组的营养摄入DEI、DPI较低,其中湿热证组最低,差异有统计学意义(P<0.01,P<0.05)；湿浊证组与湿热证组容量指标OH最高,差异有统计学意义(P<0.01,P<0.05)。并且湿浊证组与湿热证组的透析液葡萄糖含量最高,差异有统计学意义(P<0.01,P<0.05)。
研究二：各季节间透析方案,包括透析剂量和PD液的葡萄糖渗透浓度差异没有统计学意义(P>0.05)；KT／V(总)及KT／V(肾)各季节间差异也没有统计学意义(P>0.05)。
营养方面,四季间对比,平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入的变化趋势是一致的,差异有统计学意义(P<0.05),由多到少排列依次为秋季>夏季>春季>冬季；右手握力、左手握力从大到小依次为冬季>春季>秋季>夏季,差异有统计学意义(P<0.05)；E／I、BUN反映的营养状况变化依次为冬季>春季>夏季>秋季,差异有统计学意义(P<0.01,P<0.05)；SGA评分显示的营养状况从好到差排列依次为春季>秋季>夏季>冬季(P<0.05)。
容量方面,四季间对比,患者的24小时尿量、超滤量、体重差异没有统计学意义(P>0.05)。容量负荷各指标由多至少依次排列为春季>冬季>夏季>秋季,其中细胞内液及总体液量差异有统计学意义(P<0.01)；收缩压、舒张压变化趋势是一致的,由高到低依次为冬季>秋季>春季>夏季,差异有统计学意义(P<0.01)；摄水量大小依次排列为夏季>秋季>春季>冬季,差异有统计学意义(P<0.01)。
研究三：治疗前后,薏苡仁组与对照组KT／V(总)、KT／V(肾)变化差异没有统计学意义(P>0.05)。
营养方面,薏苡组干预前后差异有统计学意义的是血清白蛋白和瘦体重的变化(P<0.01,P<0.05),但与对照组疗效比较,差异没有统计学意义(P>0.05)。而对照组试验前后各项指标比较,差异均没有统计学意义(P>0.05)。
容量方面,薏苡组干预前后饮水量、尿液量、超滤量以及血压差异均没有统计学意义(P>0.05),而OH值前后对比差异有统计学意义(P<0.05),与对照组疗效比较,差异无统计学意义(P>0.05)。对照组试验前后各项指标比较,差异均没有统计学意义(P>0.05)。
中医方面,两组患者中医本虚证型前后比较没有统计学意义,标实证型薏苡组前后差异有统计学意义(P<0.05),主要体现在湿浊证明显减少,可能向无标证转化,湿热证明显减少,可能向热毒证转化。中医临床症状评分薏苡组干预前后对比差异有统计学意义(P<0.01),与对照组疗效比较,差异有统计学意义(P<0.05)。
结论
研究一：在PD患者中,除了风动证外,中医各证型均占有一定的比例,并且随着透析时间延长,各证型间会有一定的演变规律。主要体现在本虚证方面由气虚向阳虚,再向阴阳俱虚转化,而标实证方面无标证、湿浊证有向血瘀证转化的趋势。西医各项营养、容量指标与中医证型间有一定的相关性。脾肾阳虚、阴阳俱虚患者营养摄入最少,营养状况最差,容量超负荷状况也是最严重的。而湿浊证、湿热证患者中医证型的形成可能与使用了较多的高渗葡萄糖PD液有关,且容量负荷较大,营养状况也可能是最差的。因此,为防治营养及容量的失衡,应当尽量避免使用高浓度葡萄糖透析液,同时中医中药治疗可从脾胃入手,适当补气温阳,佐以祛湿泄浊、清热化痰,祛除体内湿浊痰热,通畅气机,防止病邪水饮潴留,可能有效改善营养不良,减少容量负荷。
研究二：PD患者一年四季营养、容量负荷的变化确实与四季阴阳变化相应,但也有其PD人群特有的病理属性,主要表现为春季阳气盛于外,而虚于内；夏季阳气过盛而伤阴；秋季阴气盛于外而虚于内；冬季阴气过盛而伤阳。因此对PD患者的日常生活饮食指导中,当正确运用“春夏养阳,秋冬养阴”的“治未病”理论,春季注重温补内阳；夏季适当“食寒,以养于阳”；秋季注重补养内阴；冬季适当“食热,以养于阴”。注重日常生活调理,也许能有效防治营养不良与容量超负荷,可以避免中药汤剂,PD液中加药等既往常规的干预方式。
研究三：结合四时变化规律,辨证施膳,使用薏苡仁食疗对湿浊证、湿热证患者进行日常调理,可能有效改善患者中医证型及临床症状,西医营养及容量指标也可能随之好转。将中医证候及四时理论运用于PD患者营养及容量失衡的防治当中,可能具有一定的可行性和效果。能为中医中药干预PD管理提供更开阔的思路。
Background
Peritoneal Dialysis (Peritoneal Dialysis, PD) was popular used in end-stage renal disease patients, but there were still some problems, such as malnutrition and overhydration in PD patients. Currently the treatment of these problem was still limited. Chinese medicine doctors also finished a lot of researches, but the general way to prevent the complications mainly included decoction, infusion, and drug injection into dialysate. In fact, all the general way may took more clinical problems such as overhydration and inflammation.
TCM syndrome differentiation is the prerequisite for treatment, but currently the study about PD patients'syndrome was very lack. And PD treatment was a long process, the nutritional and capacity of patients throughout the whole years may be different, Four Seasons Theory, as an important part of TCM theory, may be suitable to be use in the management of nutrition and the capacity complication, And which may provide a new way to improve the dialysis treatment with TCM.
Objectives
To analysis the relationship between changes of syndromes and four seasons'yin-yang and the indicators of nutrition and capacity. Then made a clinical research of adlay diet to prove the possible interventions. Try to provide a new thinking with TCM for the treatment of malnutrition and overhydration even all the complication of PD.
Methods
Study One:According to the criterion made by the Nephropathy Branch of China association of Chinese Medicine in 2006, the syndrome type of 164 patients were differentiated, and the parameters about nutrition and capacity were measured.
Study Two:To collect 150 CAPD patients'data about nutrition and volumes overload for 2 years. It included dialysis dose, dialysate osmotic, KT/V(ALL), KT/V(RRF), subjective general nutrition Appraisal(SGA), daily energy intake (DEI), daily protein intake (DPI), grip strength, blood urea nitrogen (BUN), albumin (ALB), the extracellular water (ECW), the intracellular water (ICW), the total body water (TBW), E/I, blood pressure, body weight, total drinking water, the urinary volume and the ultra filtration water (UF) for 24 hours. And then analyze the data with SPSS 13.0.
Study Three:PD patients referred to'damp-heat'or'turbid-damp'TCM syndromes were brought into our study. They were randomly divided into two groups including 16 patients in adlay group and 13 patients in control group. We let adlay group patients add 30g adlay in their daily diet, which should be kept every day for 3 months. Then we evaluated all the patients'parameters about nutrition and capacity pre and post the treatment.
Result
Study One:Syndrome type presented in patients was different. Along with the progress of dialysis, it changed in the origin syndromes from Spleen-Kidney-Qi-deficiency to Spleen-Kidney-Yang-deficiency and further to both Yin-Yang deficiency, while in the excess syndromes it turned from none-excess-syndrome and turbid-damp to blood-stasis. The intake of nutrition may be lowest in Spleen-Kidney-Yang-deficiency and Yin-Yang deficiency patients and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). And for the excess syndromes, the turbid-damp and damp-heat patients may intake least and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). furthermore, the dialysate osmotic may highest in the patients with the two syndromes (P＜0.01, P＜0.05)
Study Two:There were significantly differences between four seasons of the DEI and DPI (P＜0.05), with the order was autumn＞summer＞spring＞winter. And SGA were significantly difference (P＜0.05), with the order was spring ＞autumn＞summer＞winter. BUN, E/I were significantly difference (P<0.05), with the order was winter＞spring＞summer＞autumn. But there were no significantly differences between four seasons of the urinary volume and the UF. And the ICW and TBW were significantly differences between four seasons time (P＜0.01), with the order was spring＞winter＞summer＞autumn. And the total drinking water were significantly difference (P＜0.01), with the order was summer＞autumn＞spring＞winter.
Study Three:After 3 months, the patients'parameters about nutrition and capacity in adlay group were significantly lower than those at the beginning (P＜0.01, P＜0.05), and their clinical syndromes and symptoms were changed, too (P＜0.01, P＜0.05). while there were no significant differences in those of the control group (P＞0.05)
Conelusion
Study One:Some rules of syndrome type distribution could be seen in patients undergoing peritoneal dialysis, which is related with some laboratory parameters about nutrition and capacity, so may provide a few references for clinical treatment based on syndrome type.
Study Two:PD patients nutrition and overload capacity does change with the seasons corresponding of Chinese yin and yang, but there is some special changes for PD patients. And this regular pattern may help us to prevent the complication of nutrition and overload capacity of PD patients.
Study Three:adlay diet in daily life may be a simple and efficient treatment to prevent the malnutrition and overhydration for PD patients.
慢性肾功能衰竭是一种常见的临床综合征,已经成为威胁全球公共健康的主要疾病之一,发病率有不断上升的趋势。其后期可能发展为终末期肾病,患者将不得不依靠肾脏替代治疗维系生命。
腹膜透析(Peritoneal Dialysis, PD)是终末期肾病患者所采用的一种有效的肾脏替代治疗方法,然而治疗过程中仍存在一些问题,比如PD患者营养不良的发生率较高,体内容量超负荷明显增加、容易导致高血压及相应的并发症等。目前西医对于PD治疗中营养不良与容量超负荷的病因已有较深入的认识,但治疗方法上仍较为局限,对PD的营养与容量管理仍处于未真正成熟的阶段。中医在这方面也做了许多的研究,目前治疗手段主要为口服汤剂、静脉用药及PD液中加中药等,但汤剂与静脉用药都无形中增加了患者液体的摄入量,PD液加药也增加了腹膜炎的潜在危险,都不是理想的干预手段。
辨证论治是中医诊疗的前提,然而目前国内对于PD患者证候的研究却非常少,且不够深入。而且PD治疗是一个漫长的过程,患者一年四季营养及容量状况可能会有所不同,作为中医理论重要组成部分的“四时”理论,也许能应用于PD营养与容量的管理中来,提供新的治疗手段和思路。
目的
分析PD患者证候分布、四时阴阳转变规律与营养、容量指标变化的相关性,提出可能的干预方法。再用薏苡仁食疗做一探索性的研究,试图为运用中医中药防治PD患者营养不良及容量失衡,改善透析质量提供新的思路。
方法
研究一：参考中华中医药学会肾病分会2006年《慢性肾衰的诊断、辨证分析及疗效评定》标准对164例PD患者进行中医辨证分型及分析,并比较不同证型间透析方案(包括透析剂量、透析液渗透浓度、KT／V)、营养相关指标(包括主观综合性营养评估、平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、握力、血清白蛋白、血肌酐、血红蛋白)、容量相关指标(包括血压、体重、饮水量、尿液量及超滤量、Overhydration)的差异。
研究二：通过收集北京大学第三医院腹膜透析门诊定期随诊的150名腹膜透析患者2007年7月至2009年6月两年期间透析方案、营养、容量负荷的相关指标,包括透析剂量、透析液渗透浓度、KT／V(总)、KT／V(肾)、主观综合性营养评估、平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、握力、血尿素氮、血清白蛋白、细胞外液／细胞内液、血压、体重、饮水量、尿液量、超滤量、细胞外液、细胞内液、总体液量等。比较春夏秋冬四个季节间上述指标的变化情况,并结合中医四时阴阳转变规律进行分析。
研究三：选择5-8月夏季时分,将辨证为湿浊证、湿热证的PD患者,按纳入排除标准筛选后,将患者随机分为薏苡仁组及对照组做一尝试性研究,对照组维持原治疗方案及饮食方案,薏苡仁组在患者日常饮食中每天加食30g薏苡仁,维持3个月。干预前后比较患者的透析方案,营养、容量各项指标及中医证型、临床症状评分的变化情况。收集所有结果进行统计分析。
结果
研究一：各证型除了风动证外,在PD患者中均占一定比例,并且随着透析时间延长,本虚证方面,脾肾气虚证型逐渐减少；脾肾阳虚证型初期比例很小,中期明显增大,后期比例又明显减小；阴阳俱虚证型则随透析时间延长比例逐渐增加。标实证方面,湿浊证型在透析初期占了最大的比例,随着透析时间延长逐渐减少；无标证比例也随透析时间逐渐减少；而血瘀证比例随时间延长呈逐渐增多的趋势。
本虚证当中,脾肾阳虚证组与阴阳俱虚证组平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入、右手握力、左手握力、血清白蛋白、血红蛋白等营养指标均较低,差异有统计学意义(P<0.01,P<0.05)。同时,脾肾阳虚证组与阴阳俱虚证组容量指标Overhydration(OH)较高,与其它组比较差异有统计学意义(P<0.01)。
标实证当中,湿浊证、湿热证组的营养摄入DEI、DPI较低,其中湿热证组最低,差异有统计学意义(P<0.01,P<0.05)；湿浊证组与湿热证组容量指标OH最高,差异有统计学意义(P<0.01,P<0.05)。并且湿浊证组与湿热证组的透析液葡萄糖含量最高,差异有统计学意义(P<0.01,P<0.05)。
研究二：各季节间透析方案,包括透析剂量和PD液的葡萄糖渗透浓度差异没有统计学意义(P>0.05)；KT／V(总)及KT／V(肾)各季节间差异也没有统计学意义(P>0.05)。
营养方面,四季间对比,平均每日每公斤体重热量摄入、平均每日每公斤体重蛋白质摄入的变化趋势是一致的,差异有统计学意义(P<0.05),由多到少排列依次为秋季>夏季>春季>冬季；右手握力、左手握力从大到小依次为冬季>春季>秋季>夏季,差异有统计学意义(P<0.05)；E／I、BUN反映的营养状况变化依次为冬季>春季>夏季>秋季,差异有统计学意义(P<0.01,P<0.05)；SGA评分显示的营养状况从好到差排列依次为春季>秋季>夏季>冬季(P<0.05)。
容量方面,四季间对比,患者的24小时尿量、超滤量、体重差异没有统计学意义(P>0.05)。容量负荷各指标由多至少依次排列为春季>冬季>夏季>秋季,其中细胞内液及总体液量差异有统计学意义(P<0.01)；收缩压、舒张压变化趋势是一致的,由高到低依次为冬季>秋季>春季>夏季,差异有统计学意义(P<0.01)；摄水量大小依次排列为夏季>秋季>春季>冬季,差异有统计学意义(P<0.01)。
研究三：治疗前后,薏苡仁组与对照组KT／V(总)、KT／V(肾)变化差异没有统计学意义(P>0.05)。
营养方面,薏苡组干预前后差异有统计学意义的是血清白蛋白和瘦体重的变化(P<0.01,P<0.05),但与对照组疗效比较,差异没有统计学意义(P>0.05)。而对照组试验前后各项指标比较,差异均没有统计学意义(P>0.05)。
容量方面,薏苡组干预前后饮水量、尿液量、超滤量以及血压差异均没有统计学意义(P>0.05),而OH值前后对比差异有统计学意义(P<0.05),与对照组疗效比较,差异无统计学意义(P>0.05)。对照组试验前后各项指标比较,差异均没有统计学意义(P>0.05)。
中医方面,两组患者中医本虚证型前后比较没有统计学意义,标实证型薏苡组前后差异有统计学意义(P<0.05),主要体现在湿浊证明显减少,可能向无标证转化,湿热证明显减少,可能向热毒证转化。中医临床症状评分薏苡组干预前后对比差异有统计学意义(P<0.01),与对照组疗效比较,差异有统计学意义(P<0.05)。
结论
研究一：在PD患者中,除了风动证外,中医各证型均占有一定的比例,并且随着透析时间延长,各证型间会有一定的演变规律。主要体现在本虚证方面由气虚向阳虚,再向阴阳俱虚转化,而标实证方面无标证、湿浊证有向血瘀证转化的趋势。西医各项营养、容量指标与中医证型间有一定的相关性。脾肾阳虚、阴阳俱虚患者营养摄入最少,营养状况最差,容量超负荷状况也是最严重的。而湿浊证、湿热证患者中医证型的形成可能与使用了较多的高渗葡萄糖PD液有关,且容量负荷较大,营养状况也可能是最差的。因此,为防治营养及容量的失衡,应当尽量避免使用高浓度葡萄糖透析液,同时中医中药治疗可从脾胃入手,适当补气温阳,佐以祛湿泄浊、清热化痰,祛除体内湿浊痰热,通畅气机,防止病邪水饮潴留,可能有效改善营养不良,减少容量负荷。
研究二：PD患者一年四季营养、容量负荷的变化确实与四季阴阳变化相应,但也有其PD人群特有的病理属性,主要表现为春季阳气盛于外,而虚于内；夏季阳气过盛而伤阴；秋季阴气盛于外而虚于内；冬季阴气过盛而伤阳。因此对PD患者的日常生活饮食指导中,当正确运用“春夏养阳,秋冬养阴”的“治未病”理论,春季注重温补内阳；夏季适当“食寒,以养于阳”；秋季注重补养内阴；冬季适当“食热,以养于阴”。注重日常生活调理,也许能有效防治营养不良与容量超负荷,可以避免中药汤剂,PD液中加药等既往常规的干预方式。
研究三：结合四时变化规律,辨证施膳,使用薏苡仁食疗对湿浊证、湿热证患者进行日常调理,可能有效改善患者中医证型及临床症状,西医营养及容量指标也可能随之好转。将中医证候及四时理论运用于PD患者营养及容量失衡的防治当中,可能具有一定的可行性和效果。能为中医中药干预PD管理提供更开阔的思路。
Background
Peritoneal Dialysis (Peritoneal Dialysis, PD) was popular used in end-stage renal disease patients, but there were still some problems, such as malnutrition and overhydration in PD patients. Currently the treatment of these problem was still limited. Chinese medicine doctors also finished a lot of researches, but the general way to prevent the complications mainly included decoction, infusion, and drug injection into dialysate. In fact, all the general way may took more clinical problems such as overhydration and inflammation.
TCM syndrome differentiation is the prerequisite for treatment, but currently the study about PD patients'syndrome was very lack. And PD treatment was a long process, the nutritional and capacity of patients throughout the whole years may be different, Four Seasons Theory, as an important part of TCM theory, may be suitable to be use in the management of nutrition and the capacity complication, And which may provide a new way to improve the dialysis treatment with TCM.
Objectives
To analysis the relationship between changes of syndromes and four seasons'yin-yang and the indicators of nutrition and capacity. Then made a clinical research of adlay diet to prove the possible interventions. Try to provide a new thinking with TCM for the treatment of malnutrition and overhydration even all the complication of PD.
Methods
Study One:According to the criterion made by the Nephropathy Branch of China association of Chinese Medicine in 2006, the syndrome type of 164 patients were differentiated, and the parameters about nutrition and capacity were measured.
Study Two:To collect 150 CAPD patients'data about nutrition and volumes overload for 2 years. It included dialysis dose, dialysate osmotic, KT/V(ALL), KT/V(RRF), subjective general nutrition Appraisal(SGA), daily energy intake (DEI), daily protein intake (DPI), grip strength, blood urea nitrogen (BUN), albumin (ALB), the extracellular water (ECW), the intracellular water (ICW), the total body water (TBW), E/I, blood pressure, body weight, total drinking water, the urinary volume and the ultra filtration water (UF) for 24 hours. And then analyze the data with SPSS 13.0.
Study Three:PD patients referred to'damp-heat'or'turbid-damp'TCM syndromes were brought into our study. They were randomly divided into two groups including 16 patients in adlay group and 13 patients in control group. We let adlay group patients add 30g adlay in their daily diet, which should be kept every day for 3 months. Then we evaluated all the patients'parameters about nutrition and capacity pre and post the treatment.
Result
Study One:Syndrome type presented in patients was different. Along with the progress of dialysis, it changed in the origin syndromes from Spleen-Kidney-Qi-deficiency to Spleen-Kidney-Yang-deficiency and further to both Yin-Yang deficiency, while in the excess syndromes it turned from none-excess-syndrome and turbid-damp to blood-stasis. The intake of nutrition may be lowest in Spleen-Kidney-Yang-deficiency and Yin-Yang deficiency patients and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). And for the excess syndromes, the turbid-damp and damp-heat patients may intake least and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). furthermore, the dialysate osmotic may highest in the patients with the two syndromes (P＜0.01, P＜0.05)
Study Two:There were significantly differences between four seasons of the DEI and DPI (P＜0.05), with the order was autumn＞summer＞spring＞winter. And SGA were significantly difference (P＜0.05), with the order was spring ＞autumn＞summer＞winter. BUN, E/I were significantly difference (P<0.05), with the order was winter＞spring＞summer＞autumn. But there were no significantly differences between four seasons of the urinary volume and the UF. And the ICW and TBW were significantly differences between four seasons time (P＜0.01), with the order was spring＞winter＞summer＞autumn. And the total drinking water were significantly difference (P＜0.01), with the order was summer＞autumn＞spring＞winter.
Study Three:After 3 months, the patients'parameters about nutrition and capacity in adlay group were significantly lower than those at the beginning (P＜0.01, P＜0.05), and their clinical syndromes and symptoms were changed, too (P＜0.01, P＜0.05). while there were no significant differences in those of the control group (P＞0.05)
Conelusion
Study One:Some rules of syndrome type distribution could be seen in patients undergoing peritoneal dialysis, which is related with some laboratory parameters about nutrition and capacity, so may provide a few references for clinical treatment based on syndrome type.
Study Two:PD patients nutrition and overload capacity does change with the seasons corresponding of Chinese yin and yang, but there is some special changes for PD patients. And this regular pattern may help us to prevent the complication of nutrition and overload capacity of PD patients.
Study Three:adlay diet in daily life may be a simple and efficient treatment to prevent the malnutrition and overhydration for PD patients.
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