CKD-MBD患者血清骨代谢标记物与中医证候特征的回归分析

发布时间：2018-06-17 08:14

本文选题：慢性肾脏病 + 矿物质和骨代谢紊乱　；参考：《中国中药杂志》2017年20期

【摘要】：分析3,4期慢性肾脏病伴矿物质和骨代谢紊乱(CKD-MBD)患者血清骨代谢标记物与中医证候特征的依存性,为探寻CKD-MBD患者中医辨证规律提供客观依据。采用回顾性调查方法,收集105例CKD(3,4期)-MBD患者,观察其一般临床指标、中医证候出现频率和证型分布特征,并检测其血清骨代谢标记物,包括钙(Ca~(2+))、磷(P~(3+))、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)、1型胶原氨基端前肽(P1NP)以及I型胶原羧基端肽β特殊序列(β-CTX),同时,测定其骨密度(BMD)。而后,进行血清骨代谢标记物与中医证候特征的多因素回归分析。结果表明,对于105例患者,高龄、高血压、骨折、骨量减少以及血清骨代谢标记物轻度异常可能是其一般临床特点;出现频率较高的中医证候多与脾肾阳虚证、脾肾气虚证以及血瘀证有关;证型分布特征是脾肾阳虚证和血瘀证最多;高龄、中医证候积分升高以及iPTH,P1NP异常可能是脾肾阳虚证患者的临床特征。此外,Ca~(2+)异常与发脱齿摇、性功能减退等证候之间,P~(3+)异常与腰膝酸痛等证候之间,iPTH异常与腰膝酸软、倦怠乏力、畏寒肢冷等证候之间,ALP异常与大便溏泄等证候之间,P1NP异常与畏寒喜暖、大便偏稀等证候之间,β-CTX异常与腰膝冷痛等证候之间,皆有依存关系。总之,对于105例CKD(3,4期)-MBD患者,其临床特点是血清骨代谢指标的轻度改变;其主要中医证候特征是脾肾两虚;轻度改变的血清骨代谢标记物与其主要中医证候特征有依存性,可以作为中医辨证的客观证素。
[Abstract]:To analyze the dependence of serum bone metabolism markers on TCM syndromes in patients with chronic kidney disease with mineral and bone metabolism disorder in stage 3 and 4, and to provide an objective basis for exploring the law of TCM syndrome differentiation in CKD-MBD patients. A retrospective study was conducted in 105 patients with CKD3 / 3 stage 4 BMD. The clinical indexes, the frequency of TCM syndromes and the distribution of syndromes were observed, and the serum biomarkers of bone metabolism were detected. The results showed that the total parathyroid hormone (IPTHH), alkaline phosphatase (ALP) type 1 collagen amino terminal prepeptide P1NP) and type I collagen carboxyl terminal peptide 尾 (尾 -CTX) special sequence (尾 -CTXA) were included. The BMDs were measured at the same time. Then, multivariate regression analysis between serum bone metabolism markers and TCM syndromes was carried out. The results showed that the general clinical characteristics of 105 patients were old age, hypertension, fracture, decrease of bone mass and slight abnormality of serum bone metabolism markers, and more frequent TCM syndromes were associated with deficiency of spleen and kidney yang. Spleen and kidney qi deficiency syndrome and blood stasis syndrome related; the distribution characteristics of syndrome type is spleen and kidney yang deficiency syndrome and blood stasis syndrome the most; the elderly, the increase of TCM syndrome integral and the abnormal of iPTHN P1NP may be the clinical characteristics of spleen and kidney yang deficiency syndrome. In addition, there was no significant difference in iPTH between abnormal and other syndromes such as dysphoria and dysphoria, hypofunction of sex and other syndromes, such as pain of waist and knee, weakness of waist knee, fatigue, and so on. The relationship between abnormal ALP and loose stools, between abnormal P1NP and warm cold stool, between abnormal 尾 -CTX and cold pain of waist and knee, etc. In a word, for 105 patients with CKD3 / 4, their clinical characteristics were slight changes in serum bone metabolism indexes, the main TCM syndromes were deficiency of spleen and kidney, and the slightly changed markers of serum bone metabolism were dependent on the characteristics of their main TCM syndromes. It can be used as objective syndrome element of TCM syndrome differentiation.
【作者单位】：南京大学医学院附属鼓楼医院中医科;盐城市中医院肾内科;南京中医药大学中西医结合鼓楼临床医学院中医科;
【基金】：中央高校基本科研业务费专项资金项目(021414380219) 南京市医学科技发展资金项目
【分类号】：R277.5

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