维持性血液透析患者中医证候分布与微炎症相关性的临床探讨

Study of Clinical Correlation between Traditional Chinese Medicine Syndrome Distribution and Micro Inflammation of Patients with Maintenance Hemodialysis

目的:探讨维持性血液透析下微炎症状影响慢性肾衰竭患者中医证候分布特点,便于临床辨证施治。方法:根据诊断标准纳入90病例,以C-反应蛋白(CRP)作为微炎症的标记物,分为微炎症组(透前CRP≥8 mg/L)和正常组(透前CRP<8mg/L)各45例,进行临床对照试验。对微炎症组患者进行证候调查并记录中医证候分布;检测C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、脂蛋白[Lp(a)],总结中医证候分布规律及其与微炎症指标的联系。结果:MHD微炎症状态患者本虚证以气阴两虚最多,其次为脾肾气虚证、脾肾阳虚证、肝肾阴虚证、阴阳两虚证;标实证中湿热证最多,其次湿浊证、血瘀证、水气证、风动证。C-反应蛋白、肿瘤坏死因子-α、白细胞介素、脂蛋白高于正常组(P<0.05)。结论:维持性血液透析患者炎性因子水平增加,临床应给予足够重视及尽早积极纠正促炎因素,改善临床症状,提高生存质量。

Objective：To explore and discuss the characteristics of TCM syndromes distribution influenced by micro inflammation of patients with chronic renal failures under maintenance hemodialysis, so as to facilitate the clinical dialectical therapy. Methods：According to the diagnostic criteria, 90 cases were included in the study. With the c- reactive protein （CRP） as a marker of inflammation, the patients were divided into micro inflammation group （before dialysis CRP≥8 mg/L） and the normal group （ before dialysis CRP〈8 mg/L）. Each group had 45 cases. The syndromes were investigated and the TCM syndrome distributions were recorded in the micro inflammation group; The CRP ,TNF-α, IL -6 and Lp（a） were tested. The distribution rule of TCM Syndromes and its relationship with the micro inflammation index were summarized.. Results： Most syndromes of MHD micro inflammatory patients were qi and yin deficiency, followed by spleen and kidney deficiency, spleen kidney yang deficiency syndrome, liver and kidney Yin deficiency syndrome and both Yin and Yang deficiency syndrome. The most excess syndrome was hot and humid syndrome, followed by the wet and turbid syndrome, blood stasis,syndrome,water qi syndrome and wind syndrome. The level of CRP, TNF-α, ,IL -6 and Lp（a）of the micro inflammation group was higher than that of the normal group （P〈0.05）. Conclusion： Maintenance hemodialysis can increase the inflammatory factor levels. We should pay enough attention to it and correct the pro-inflammatory factors as soon as possible to improve the clinical symptoms and the quality of life.