血清TNF与2型糖尿病肾病及其中医证型关系的临床研究

目的：分析血清TNF水平与2型糖尿病肾病（DN）的关系，并探讨TNF与血瘀证、痰湿证的相关性。方法：检测入选170例DN Ⅲ、Ⅳ及Ⅴ期患者的尿微量白蛋白（UAlb）及血清肌酐等指标，并采用MDRD计算公式计算血瘀证、痰湿证、血瘀兼痰湿证、无血瘀痰湿证患者的肾小球滤过率（GFR），比较各组TNF值变化情况。结果：①血清TNF随DN病情的加重而逐渐升高，Ⅴ期TNF高于Ⅲ期、Ⅳ期（P＜0.01，P＜0.05），Ⅳ期高于Ⅲ期（P＜0.01）。②血清TNF与UAlb呈正相关（r=0.272，P=0.000），与GRF呈负相关（r=-0.455，P=0.000）。③随着血瘀证、痰湿证的发生，TNF逐渐升高，血瘀兼痰湿证组最高。结论：血清TNF可能参与了DN的发生发展，与其肾脏损害程度一致；中医的痰湿、血瘀与TNF有关。

Clinical Study on the Relationship between Serum TNF and Type 2 Diabetic Nephropathy

Objective： To analyze the relationship between the level of serum TNF and type 2 diabetic nephropathy（DN）, meanwhile, to explore the relativity between TNF and blood stasis pattern, phlegm-dampness pat-tern. Methods：The indexes of 170 patients atⅢ,ⅣandⅤstages including UAlb, serum creatinine and others were tested, glomerular filtration rates（GFR） of the patients with blood stasis pattern, phlegm-dampness pattern, blood sta-sis and phlegm-dampness pattern, without blood stasis and phlegm-dampness pattern were calculated with MDRD formula and the changes of TNF values in different groups were compared. Results：①Serum TNF increased as DN aggravated, the value atⅤstage was higher than those atⅢandⅣstages （P＆lt;0.01, P＆lt;0.05）;TNF atⅣstage was higher than that atⅢstage （P＆lt;0.01）.②Serum TNF was closely related to UAlb （r=0.272, P=0.000）;it was nega-tively related to GRF （r=-0.455, P=0.000）.③TNF increased gradually as blood stasis pattern and phlegm-dampness pattern occurred, and the index in the group of blood stasis and phlegm-dampness was the highest. Conclusion：Serum TNF might be relevant to the development of DN, identical with the degree of renal impairment;phlegm-dampness and blood stasis are associated with TNF.