尿酸性肾病中医分型与氧化应激指标的相关性研究

目的:探讨尿酸性肾病中医分型与氧化应激相关性。方法:采用回顾性分析方法对2017年12月至2019年9月北京中医药大学第三附属医院收治的尿酸性肾病患者105例进行研究,选择同时期正常健康者105例作为对照,参考《中药新药临床研究指导原则》将105例尿酸性肾病和临床常见证型相结合,分成脾肾气虚18例、气阴两虚证19例、肝肾阴虚16例、阴阳两虚12例、湿热蕴结19例、瘀血阻滞17例、痰浊内阻13例,均在入院次日清晨空腹抽取静脉血,检测氧化应激氧化应激、肾功能损害指标,比较不同组别在氧化应激指标含量水平变化情况,比较中医分型和氧化应激、肾功能损害指标水平变化。结果:1)尿酸性肾病组总抗氧化能力(T-ACO)、晚期蛋白氧化物(AOPP)、血清丙二醇(MDA)、超氧化物歧化酶(SOD)含量水平分别为(19.45±3.42)U/mL、(42.45±3.53)μmol/L、(4.52±1.23)nmol/L、(76.78±5.64)U/mL,正常对照组则分别为(10.76±1.31)U/mL、(20.84±1.28)μmol/L、(2.13±0.76)nmol/L、(130.85±16.75)U/mL,尿酸性肾病组T-ACO、AOPP、MDA较正常对照组显著偏高,SOD显著偏低(P<0.05)。2)虚证中阴阳两虚证SOD含量上较其他证型均偏低,而MDA、T-AOC、AOPP、胱抑素C(CysC)、β2微球蛋白、尿微量白蛋白(UMALB)、蛋白尿发生率则较其他证型均偏高,差异均有统计学意义(P<0.05),实证中瘀血阻滞证SOD含量较其他证型均偏低,而MDA、T-AOC、AOPP则较其他证型均偏高,差异均有统计学意义(P<0.05)。结论:尿酸性肾病中医分型的阴阳两虚证、瘀血阻滞证氧化应激水平、肾损害指标均显著升高,可结合该实验室检查进行临床干预。

Study on the Correlation Between Traditional Chinese Medicine Classification of Uric Acid Nephropathy and Oxidative Stress Index

Objective:To explore the correlation between TCM classification and oxidative stress of uremic acid nephropathy.Methods:A retrospective analysis was used to analyze 105 cases of uremic acid nephropathy from December 2017 to September 2019,and 105 cases healthy people at the same period of were selected as the control group.Referring to Guidelines for Clinical Research on New Drugs of Traditional Chinese Medicine and combining 105 cases of uric acid nephropathy with common clinical syndromes,105 cases of uremic acid nephropathy were divided into 18 cases of qi deficiency of spleen and kidney,19 cases of deficiency of both qi and yin,16 cases of yin deficiency of liver and kidney,12 cases of deficiency of both yin and yang,19 cases of accumulated dampness-heat,17 cases of blood obstruction and stagnation,and 13 cases of phlegm and turbid internal obstruction.Venous blood was drawn on an empty stomach in the early morning of the day after admission to the hospital to detect oxidative stress and renal function damage indicators.The changes of oxidative stress indicators in different groups were compared,and the changes of TCM classification,oxidative stress and renal function damage indicators were compared.Results:1)The total antioxidant capacity(T-ACO),advanced protein oxide(AOPP),serum propylene glycol(MDA),and superoxide dismutase(SOD)levels in the uric acid nephropathy group were(19.45±3.42)U/mL,(42.45±3.53)μmol/L,(4.52±1.23)nmol/L,(76.78±5.64)U/mL.The normal control group was(10.76±1.31)U/mL,(20.84±1.28)μmol/L,(2.13±0.76)nmol/L,(130.85±16.75)U/mL,T-ACO,AOPP,MDA in uric acid nephropathy group were significantly higher than normal control group,SOD was significantly lower(P<0.05).2)The SOD content of deficiency of both yin and yang in deficiency syndrome was lower than other syndromes,while MDA,T-AOC,AOPP,Cystatin C(CysC),β2 microglobulin,Urine Microalbumin(UMALB),protein incidence of urine was higher than other syndrome types,and the difference is statistically significant(P<0.05).The empirical evidence of blood stasis block SOD content was lower than other syndrome types,while MDA,T-AOC,AOPP were higher than other syndrome types,and the difference was statistically significant(P<0.05).Conclusion:The indexes of oxidative stress and of renal damage in the TCM syndrome classification of both deficiency of yin and yang and stasis syndrome of uric acid nephropathy are significantly increased,which can be combined with the laboratory examination for clinical intervention.