慢性肾功能衰竭微炎症状态与中医证型关系研究

目的探讨慢性肾功能衰竭(CRF)微炎症状态及其与中医证型的关系。方法选择非透析的CRF患者69例,测定其C反应蛋白(CRP)、IL-6、TNF-α、Alb、Hb及SCr,并与健康对照组20例比较。结果①CRF组血CRP、IL-6及TNF-α均显著高于健康对照组(P均<0.01),微炎症状态发生率35%。②CRP增高组Alb低于CRP不增高组(P<0.05)。③CRF 2期、3期及4期CRP、IL-6及TNF-α均无显著性差异(P>0.05)。④各中医证型CRP、IL-6及TNF-α均高于健康对照组(P<0.01或0.05),脾肾阳虚型及阴阳两虚型CRP及IL-6低于肝肾阴虚型(P<0.01或0.05),而脾肾气虚及气阴两虚型CRP、IL-6与肝肾阴虚无显著性差异(P>0.05)。夹湿浊证及夹湿热证CRP及IL-6高于各型虚证(P<0.05)。结论①CRF普遍存在微炎症状态,微炎症状态是引起营养不良的重要原因。②各中医证型均存在微炎症状态,但不同证型微炎症状态程度有一定差异,其中夹湿浊或夹湿热证者微炎症状态程度最明显。微炎症状态程度可作为湿浊证及湿热证的辨证参考。

Relation study between micro-inflammatory state of chronic renal failure and traditional Chinese medical type of syndrome

Objective It is to study the micro-inflammatory state of chronic renal failure(CRF) and the relation between it and traditional Chinese medical type of syndrome.Methods 69 CRF patients that were lack of dialysis were chosen.Their C reactive protein(CRP),IL-6,TNF-α,Alb,Hb and SCr were determined and compared with that of 20 cases in health control group.Results ①CRP,IL-6 and TNF-α in CRF group were all significantly higher than that in health control group(P<0.01).The incidence rate of micro-inflammatory state was 35%.②Alb in CRP heighten group was lower than that in CRP non-heighten group(P<0.05).③There were no significant difference on CRP,IL-6 and TNF-α among stage 2,stage 3 and stage 4 of CRF(P>0.05).④CRP,IL-6 and TNF-α in each traditional Chinese medical type of syndrome were all higher than that in health control group(P<0.01 or 0.05).CRP and IL-6 in splenonephro-Yang deficiency type and both Yin and Yang deficiency type were all lower than that in hepatic and renal Yin deficiency type(P<0.01 or 0.05).CRP and IL-6 in spleen and renal vital energy deficiency type and both vital energy and Yin deficiency type had no significant difference compared with that in hepatic and renal yin deficiency type(P>0.05).CRP and IL-6 in humid turbid syndrome and humid heat syndrome were all higher than that in every type of deficient syndrome(P<0.05).Conclusion ①The micro-inflammatory state is universally reside in CRF.The micro-inflammatory state is important reason that causing malnutrition.②The micro-inflammatory state is reside in every traditional Chinese medical type of syndrome.But the degree of the micro-inflammatory state in different type of syndrome has definite difference,among the total,the degree of the micro-inflammatory state in humid turbid syndrome and humid heat syndrome are the most obvious.The degree of the micro-inflammatory state can be taken as differentiation of symptoms and signs reference of humid turbid syndrome and humid heat syndrome.