糖尿病肾病患者的中医证型及其与实验室指标的相关性研究

背景　糖尿病肾病（DN）的中医证型与实验室指标的相关性研究已经取得了一定成果，中医证型与相关实验室指标确实存在一定的相关性，这为规范化、标准化DN的中医药临床诊疗体系提供了一定的理论基础。但目前DN的中医证候诊断标准尚未统一化、标准化。目的　研究糖尿病肾病患者的中医证型及其与实验室指标的相关性。方法　收集2017年1月-2018年3月广州中医药大学第一附属医院、增城市中医医院肾病科与内分泌科收治的门诊及住院患者125例为研究对象，其中T2DM 31例，DNⅢ期31例，DNⅣ期32例，DNⅤ期31例；另募集同期性别、年龄相当的健康体检人员30例为健康组。统计各组本证、标证数量与比例，并检测各证型组尿素氮（BUN）、血肌酐（Scr）、胱抑素C（CysC）、估算肾小球滤过率（eGFR）、总胆固醇（TC）、三酰甘油（TG）、血清清蛋白（ALB）、尿蛋白定量、血液流变学指标。结果　T2DM患者主证主要表现为阴虚燥热证〔32.2%（10/31）〕与气阴两虚证〔58.1%（18/31）〕，DNⅢ期主要表现为脾肾气虚证〔48.4%（15/31）〕，DNⅣ期主要表现为阴阳两虚证〔46.9%（15/32）〕与脾肾气虚证〔31.2%（10/32）〕，DNⅤ期主要表现为阴阳两虚证〔64.5%（20/31）〕。T2DM和DNⅢ~Ⅴ期患者标证均主要表现为湿证和瘀证。DNⅢ~Ⅴ期各组患者肾功能指标、ALB、尿蛋白定量比较，差异均具有统计学意义（P<0.05），其中BUN、Scr、CysC、尿蛋白定量排序为阴虚燥热证<气阴两虚证<脾肾气虚证<阴阳两虚证，eGFR、ALB排序为阴阳两虚证<脾肾气虚证<气阴两虚证<阴虚燥热证。湿证、痰证、瘀证三组之间各实验室指标比较，差异均无统计学意义（P>0.05）。Spearman秩相关分析显示，主证证型与BUN、Scr、CysC、尿蛋白定量呈正相关关系，与eGFR、ALB呈负相关关系（P<0.05）。结论　DN随着疾病分期的进展，中医证型主要表现为阴虚燥热-气阴两虚-脾肾气虚-阴阳两虚；DN患者的BUN、Scr、CysC、eGFR、ALB、尿蛋白指标与中医证型存在一定的相关性。

TCM Syndrome Types of Diabetic Nephropathy and Their Correlation with Laboratory Indices

Background Studies about the TCM syndrome type and the laboratory index in diabetic nephropathy(DN)have obtained some results,showing that the two have a certain correlation,which provides a theoretical basis for normalizing and standardizing the TCM diagnosis and treatment system of DN.However,the diagnostic criteria for TCM syndrome of DN still have not been unified and standardized.Objective To study TCM syndrome types of diabetic nephropathy and their correlation with laboratory indices.Methods During January 2017 to March 2018,from Department of Nephrology,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,and Department of Endocrinology,Zengcheng TCM Hospital,125 outpatients and inpatients(including 31 with T2DM,31 with stageⅢDN,32 with stageⅣDN,and 31 with stageⅤDN),and other sex-and age-matched 30 healthy physical examinees were enrolled.Number and percentages of incidental and fundamental syndromes in each group were obtained.And urea nitrogen(BUN),serum creatine(Scr),cystatin C(CysC),estimated glomerular filtration rate(eGFR),total cholesterol(TC),triacylglycerol(TG),serum protein(ALB),24-hour urine protein quantity and hemorheological indices were measured in groups with different syndrome types.Results In terms of primary syndromes,T2DM patients showed yin deficiency and dryness heat syndromes〔32.2%(10/31)〕and qi-yin deficiency syndrome〔58.1%(18/31)〕,those with stageⅢDN showed spleen and kidney qi deficiency syndromes〔48.4%(15/31)〕,those with stageⅣDN demonstrated yin-yang deficiency syndrome〔46.9%(15/32)〕and spleen and kidney qi deficiency syndromes〔31.2%(10/32)〕,and those with stageⅤDN presented yin-yang deficiency syndrome〔64.5%(20/31)〕.The incidental syndromes in all T2DM and DN patients mainly were dampness syndrome and blood stasis syndrome.Renal function indices,ALB and 24-hour urine protein quantity differed by stage of DN in DN patients(P<0.05).DN patients with yin deficiency and dryness heat syndrome had the highest mean levels of BUN,Scr,CysC and 24-hour urine protein quantity,followed by those with qi-yin deficiency syndrome,those with spleen and kidney qi deficiency syndromes,and those with yin-yang deficiency syndrome.DN patients with yin-yang deficiency syndrome demonstrated the highest mean levels of eGFR and ALB,followed by those with spleen and kidney qi deficiency syndromes,those with qi-yin deficiency syndrome,and those with yin deficiency and dryness heat syndromes.Laboratory indices did not vary significantly across those with dampness syndrome,those with phlegm syndrome and those with blood stasis syndrome(P>0.05).Spearman correlation analysis showed that there was a positive correlation between primary syndrome type and BUN,Scr,CysC,24-hour urine protein quantity,and had a negative correlation with eGFR and serum ALB(P<0.05).Conclusion In DN patients,with the progression of the disease,the main manifestations of TCM syndrome type are yin deficiency and dryness heat,qi-yin deficiency,spleen and kidney qi deficiency,yin-yang deficiency.And the levels of BUN,Scr,CysC,eGFR,ALB,and urine protein results may be correlated with TCM syndromes.