早期慢性肾脏病尿蛋白与中医证候相关性研究

作者	单位
万毅刚	南京大学医学院附属鼓楼医院中医科
孙伟	江苏省中医院肾内科
王婧	南京中医药大学研究生院
张慧兰	南京中医药大学研究生院
严巧婧	南京中医药大学研究生院
窦晨辉	南京中医药大学研究生院
陈萍	南京中医药大学研究生院

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中文摘要:

目的分析早期慢性肾脏病（chronic kidney discase,CKD）患者中医证候分布特点及其与尿蛋白的相关性,为阐明早期CKD患者中医证候辨证规律提供依据。方法采用回顾性调查方法,收集199例早期CKD患者中医证候和尿蛋白等资料,进行中医证候与尿蛋白的多因素的回归分析,其中,尿蛋白包括24 h尿蛋白定量（Upro）、尿白蛋白（UA（?）b）、尿β₂-微球蛋白（Uβ₂-MG）、尿N-乙酰-β-D-氨基葡萄糖苷酶（UNAG）、尿β-半乳糖苷酶（UGAL）等。结果在早期CKD患者中,作为尿蛋白独立相关因素的中医证候包括"腰酸、食少纳呆、小溲黄赤、泛酸、夜尿多、浮肿、泡沫尿、咳嗽、畏寒肢冷"等;UA（?）b升高与脾肾气虚证素"腰酸、食少纳呆"相关;UNAG升高与"浮肿、泡沫尿、夜尿多、咳嗽"相关;UGAL升高与脾肾阳虚证素"腰酸、畏寒肢冷"相关;Uβ₂-MG与"浮肿"相关;脾肾气虚证者UA（?）b、UNAG异常升高,与肝肾阴虚证、肺肾气虚证、脾肾阳虚证者比较,组间差异均有统计学意义（P<0.05）。结论对于早期CKD患者而言,出现尿蛋白的主要脏器与肾、脾有关,其基本病机是脾肾两虚;UA（?）b与脾肾气虚证相关,可以作为其微观证素之一;UNAG也与脾肾气虚证有一定关系;湿热证可能是独立证型。

英文摘要:

Objective To analyze the characteristics of TCM syndrome distribution and its correlation with u- rinary protein in patients with early chronic kidney diseases （CKD）,for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in CKD.Methods Adopting traditional epidemiological retrospective method,the TCM syndrome and urinary protein related indexes,including 24 h urinary protein （Upro）,urinary al- bumin （UAlb）,urinaryβ₂-microglobulin （Uβ₂-MG）,urinary N-acety（?）-β-D-glucosaminidase （UNAG）,urinaryβ-galactosidase （UGAL）,etc,were collected from 199 patients with early CKD,and a multiple factor regression analysis between them was conducted.Results In patients with early stage CKD,the TCM symptoms,as inde- pendent factors closely related to urinary protein,were aching loins,poor appetite and indigestion,yellow and brownish urine,regurgitation acid,profuse nocturnal urine,edema,foamy urine,cough,aversion to cold and cold limbs,etc;the elevation of UA（?）b with the factors of Pi-Shen qi-deficiency as aching loins,poor appetite and indi- gestion was correlated;elevation of UNAG with edema,foamy urine,profuse nocturnal urine,cough;UGAL with Pi-Shen yang-deficiency factors as aching loins,aversion to cold and cold limbs;and elevation of Uβ₂-MG with e- dema were correlated respectively as well.Levels of UAlb and UNAG in patients of Pi-Shen qi-deficiency type were significantly higher than those in patients of Gan-Shen yin-deficiency type,Fei-Shen qi-deficiency type,and Pi- Shen yang-deficiency type,respectively （all P<0.05）.Conclusion For early stage CKD patients,Shen and Pi are the major organs related to the appearance of urinary protein;Pi-Shen deficiency is the basic pathogene- sis.Level of UAlb,which is associated with Pi-Shen qi-deficiency type,could be taken as one of microcosmic syn- drome factors for the syndrome type;UNAG also be related with that syndrome to certain extent;and heat-damp syndrome might be an independent type.

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