同型半胱氨酸及C反应蛋白与糖尿病肾病中医证候关系研究

Study on relation between different TCM syndrome types of diabetic nephropathy with plasma level of HCY and CRP

目的:探讨糖尿病肾病(DN)不同阶段、中医证型血清同型半胱氨酸(HCY)及C反应蛋白(CRP)水平的变化。方法:选择单纯糖尿病组60例、早期DN组58例、临床DN组62例及正常对照组60例,各组分别测定血清HCY、CRP水平。对早期DN及临床DN患者进行中医辨证分型。结果:①单纯糖尿病组、早期DN组和临床DN组血清HCY、CRP水平均较正常对照组明显升高(P<0.01),单纯糖尿病组、早期DN组和临床DN组血清HCY、CRP水平逐渐升高(P<0.01)。②糖尿病肾病阴虚燥热证、气阴两虚证、脾肾气虚证、阴阳两虚证血清HCY水平逐渐升高,而血清CRP水平则表现为脾肾气虚、阴阳两虚、气阴两虚、阴虚燥热依次升高。寒湿证、湿热证、痰瘀证、瘀证各组间血清HCY水平逐渐升高,血清CRP水平则表现为瘀证、痰瘀证、寒湿证、湿热证依次升高(P<0.01)。结论:①血清HCY和CRP水平与2型糖尿病及DN相关,且可能是2型糖尿病及DN发生发展的重要因素。②HCY、CRP与糖尿病肾病关系密切,在不同中医证型间有显著区别,可为DN中医辨证分型及治疗提供参考依据。

Objective： To investigate the relation among different periods of diabetic nephropathy and TCM syndrome types with plasma level of HCY and CRP. Methods： 60 cases with simple diabetic mellitus（SDM）, 58 cases incipient diabetic nephropathy（IDN）, 62 cases clinical diabetic nephropathy（CDN） and 60 cases healthy individuals were divided into four groups, plasma level of HCY and CRP were tested in each individual. The patients with incipient diabetic nephropathy and clinical diabetic nephropathy were divided into different TCM syndrome types according to TCM theory. Results： （1）The plasma level of HCY and CRP in SDM group, IDN group and CDN group were higher obviously than in control group（P〈0.01）, it became higher gradually from SDM, IDN to CDN group. There was significant difference among them（P〈0.01）. （2）The plasma level of HCY with diabetic nephropathy became high from the type of internal heat with yin deficiency, deficiency both qi and yin, deficiency of spleen and kidney qi to deficiency of yin and yang. However, the plasma level of CRP became higher gradually from the type of deficiency of spleen and kidney qi, deficiency both qi and yin, deficiency both qi and yin to the type of internal heat with yin deficiency. On the surface syndrome, the plasma level of HCY became high from cold wetness syndrome, hot wetness syndrome, sputum and blood stagnation syndrome to blood stagnation syndrome. The plasma level of CRP became high from blood stagnation syndrome, sputum and blood stagnation syndrome, cold wetness syndrome to heat wetness syndrome. There was significant difference among them（P〈0.01）. Conclusions： （1）The plasma level of HCY and CRP are not only associated with type 2 diabetic mellitus and diabetic nephropathy, but also are important factors which accelerated them. （2）The plasma level of HCY and CRP are associated closely with diabetic nephropathy. There is obviously difference in different TCM symptom types, so, they could be acted as the proof which distinguished TCM syndrome types and made treatment plan.