CKD-MBD患者血清骨代谢标记物与中医证候特征的回归分析

Regression analysis of serum bone metabolic markers and traditional Chinese medicine syndromes in patients with CKD-MBD

分析3,4期慢性肾脏病伴矿物质和骨代谢紊乱(CKD-MBD)患者血清骨代谢标记物与中医证候特征的依存性,为探寻CKD-MBD患者中医辨证规律提供客观依据。采用回顾性调查方法,收集105例CKD(3,4期)-MBD患者,观察其一般临床指标、中医证候出现频率和证型分布特征,并检测其血清骨代谢标记物,包括钙(Ca^(2+))、磷(P^(3+))、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)、1型胶原氨基端前肽(P1NP)以及I型胶原羧基端肽β特殊序列(β-CTX),同时,测定其骨密度(BMD)。而后,进行血清骨代谢标记物与中医证候特征的多因素回归分析。结果表明,对于105例患者,高龄、高血压、骨折、骨量减少以及血清骨代谢标记物轻度异常可能是其一般临床特点;出现频率较高的中医证候多与脾肾阳虚证、脾肾气虚证以及血瘀证有关;证型分布特征是脾肾阳虚证和血瘀证最多;高龄、中医证候积分升高以及iPTH,P1NP异常可能是脾肾阳虚证患者的临床特征。此外,Ca^(2+)异常与发脱齿摇、性功能减退等证候之间,P^(3+)异常与腰膝酸痛等证候之间,iPTH异常与腰膝酸软、倦怠乏力、畏寒肢冷等证候之间,ALP异常与大便溏泄等证候之间,P1NP异常与畏寒喜暖、大便偏稀等证候之间,β-CTX异常与腰膝冷痛等证候之间,皆有依存关系。总之,对于105例CKD(3,4期)-MBD患者,其临床特点是血清骨代谢指标的轻度改变;其主要中医证候特征是脾肾两虚;轻度改变的血清骨代谢标记物与其主要中医证候特征有依存性,可以作为中医辨证的客观证素。

To analyze the interdependent relationship between serum bone metabolic markers and traditional Chinese medicine （TCM） syndromes in patients with chronic kidney disease （ stages 3 and 4） -related mineral and bone disorder （ CKD-MBD）, in order to provide the objective basis for exploring the rules of TCM syndrome differentiation in patients with CKD-MBD. The retrospective sur- vey was conducted to collect 105 cases with CKD （stages 3 and 4）-MBD. General clinical indexes, frequency of TCM syndromes and distribution of TCM syndrome type were investigated. Furthermore, serum bone metabolic markers, including calcium （ Ca^2＋ ） , phos- phonium （P^3＋） , intact parathyroid hormone （iPTH） , alkaline phosphatase （ALP） , procollagen type 1 amino-N-terminal propeptide （P1 NP） and β-crosslaps （β-CTX） were analyzed, respectively. Meanwhile, bone mineral density （BMD） was assessed. And then, the multivariate regression analysis was performed for serum bone metabolic markers and TCM syndromes. The results showed that the general clinical features of the 105 patients included old age, hypertension, fracture, loss of bone mass and mild abnormalities of serum bone metabolic markers. High-frequency TCM syndromes were related to Yang deficiency in Spleen and Kidney, Qi deficiency in Spleen and Kidney and blood stasis. Moreover, Yang deficiency in Spleen and Kidney and blood stasis were found as the most frequent characteristics of the distribution of TCM syndromes type. The clinical characteristics of patients with the syndrome type of Yang defi- ciency in Spleen and Kidney were probably old age, increase in TCM syndrome scores and abnormalities in iPTH and PINP. In addi- tion, the interdependent relationship between abnormality in Cd^2＋ and syndromes of hair loss, tooth shake and sexual dysfunction, ab- normality in p^3＋ and syndromes of aches in waist and knees, abnminality in iPTH and syndromes of soreness and weakness in waist and knees, lassitude, fatigue and extreme chilliness, abnormality in ALP and syndromes of loose stools, abnormality in P1NP and syn- dromes of fear of chills, tendency of warmth and loose stools, and abnormality in β-CTX and syndromes of chills and pain in waist and knees. In general, among the 105 cases with CKD （stages 3 and 4）-MBD were clinically characterized by mild changes in serum bone metabolic markers; And their main TCM syndrome was the deficiency in spleen and kidney. Serum bone metabolic markers with mild changes have an interdependent relationship with main TCM syndromes, and can be considered as an objective syndrome factor of TCM syndrome differentiation.