糖尿病肾病生化指标与中医辨证分型的相关性研究

Relationship Between Biological Indexes and TCM Syndrome Types in Diabetic Nephropathy Patients

目的:观察糖尿病肾病(DN)的生化指标与中医证型的相关性,为制定中西医结合诊治方案提供科学依据。方法:选择DN患者489例,正常对照组50例,检测其生化指标(空腹血糖;24 h尿蛋白定量,计算尿蛋白排泄率;尿、血β2-微球蛋白;血肌酐,计算内生肌酐清除率;血尿素氮)。结果:①随着病情的发展,中医证候出现阴虚燥热-气阴两虚-阴阳两虚-阳衰瘀阻的演变规律;②随证型的变化,患者空腹血糖逐渐升高,各证型组与正常组,及各证型组间比较,差异非常显著(P<0.01);③随证型的变化,尿蛋白、尿白蛋白排泄率、尿β2-微球蛋白逐渐升高,但阳衰瘀阻证较阴阳两虚证逆向降低;血β2-微球蛋白及血肌酐、尿素氮值逐渐增高,肌酐排泄率逐渐降低;24 h尿蛋白及尿白蛋白排泄率、尿β2-微球蛋白,血肌酐、尿素氮、血β2-微球蛋白、肌酐清除率,气阴两虚证、阴阳两虚证、阳衰瘀阻证分别与正常对照组比较,差异非常显著(P<0.01);阴虚燥热证与正常对照组比较,差异不显著(P>0.05),但各证型组间比较,差异非常显著(P<0.01)。结论:DN的生化指标与中医辨证分型有一定的相关性,可作为其分型参考的客观指标。

Objective：By analyzing the relationship between biological indexes and TCM syndrome types in diabetic nephropa- thy patients, it is to provide a scientific basis for the development of diagnosis and treatment of integrative medicine. Methods ：489 cases of DN patients were selected, and normal control group had 50 patients. Tthe biochemical indexes （fasting plasma glucose,24 - hour urine protein, urine protein excretion rate calculation, urine 82 - microglobulin, blood 82 - microglobulin, serum creati- nine, calculated creatinine clearance rate, blood urea nitrogen） were tested. Results：①As the disease progressed, the syndromes e- volution was yin deficiency and hot syndrome-qi and yin deficiency syndrome-both yin and yang deficiency syndrome-yang defi- ciency and blood stasis syndrome. ②With the TCM syndrome types changing, fasting glucose increased gradually, the difference between syndrome group with noimal group, or the syndrome group compared with each other was significant （P 〈 0. 01 ）. ③With the TCM syndrome types changing, urinary protein, urinary albumin excretion rate, urine 132 - microglobulin gradually increased, except yang deficiency and blood stasis syndrome, which was lower than that of both yin and yang deficiency syndrome ： serum 132 - microglobulin and serum creatinine, blood urea nitrogen value was gradually increased, creatinine excretion decreased gradual- ly ：24 - hour urinary protein and urinary albumin excretion rate, urinary 132 - microglobulin, serum creatinine, urea nitrogen, serum 82 -microglobulin, creatinine clearance rate, qi and yin deficiency syndrome, both yin and yang deficiency syndrome, yang defi- ciency and blood stasis syndrome compared with the control group ,the difference was significant （P 〈 0. 01 ） ：yin deficiency and hot syndrome compared with the normal control group, the difference was not significant （ P 〉 0.05 ）, but syndrome group com- pared with each other,the difference was quite significant（ P 〈 0. 01 ）. Conclusion：There is some relevance between biological in- dexes and TCM syndrome types in diabetic nephropathy patients,and they can be objective indicators for diagnosing syndromes.