慢性肾脏病-矿物质与骨异常中医证型分布特点及相关因素研究

Distribution characteristics of traditional Chinese medicine syndromes of chronic kidney disease-mineral and bone disorder and study of correlated factors

目的:探讨慢性肾脏病-矿物质与骨异常(CKD-MBD)中医证型分布特点与慢性肾脏病(CKD)分期、CKD-MBD分组等主要预后指标的相互关系,为CKD-MBD中医证型诊断的规范化和准确辨证用药提供依据。方法:采用现场调查方法,收集268例CKD3~5期透析(G3~G5D)患者CKD-MBD的中医证候学及实验室资料,分析CKD G3~G5D患者CKD-MBD的中医证型分布与CKD分期、CKD-MBD分组等的相关性。结果:268例CKD G3~G5D合并CKD-MBD,本虚证中,脾肾两虚97例(36.19%)最多见,主要分布在4~5期,肝肾阴虚35例(13.06%)次之,主要分布在3期;标实证中,以毒瘀证88例(32.83%)最多见,主要分布在5期。CKD-MBD虚实兼杂证共265例(98.88%),其中脾肾两虚兼毒瘀证78例(80.41%)最多见。CKD-MBD分组中,除肝肾阴虚外,其余证型均以混合型(钙、磷及甲状旁腺激素3项中有2项及以上指标异常)表现为最多见。结论:脾肾两虚是CKD G3~G5D患者CKD-MBD主要本虚证,毒瘀证是主要标实证。脾肾两虚兼毒瘀证是CKD-MBD最为常见虚实兼杂证。钙、磷及甲状旁腺激素3项中有2项及以上指标异常是CKD G3~G5D患者CKD-MBD各种证型的主要表现形式。

Objective: To examine the distribution characteristics of traditional Chinese medicine(TCM) syndromes of chronic kidney disease-mineral and bone disorder(CKD-MBD) and the relationship between CKD staging, CKD-MBD grouping,and other major prognostic markers, in order to provide a basis for the standardization of the diagnosis and differentiation and drug treatment for CKD-MBD TCM syndromes. Methods: On-site surveys were used to collect TCM syndrome and laboratory data from 268 patients under CKD stage 3–5 dialysis(G3~G5 D), and the correlation between CKD-MBD TCM syndrome distribution and CKD staging and CKD-MBD grouping among these patients was analyzed. Results: Among the 268 patients with CKD G3~G5 D with comorbid CKD-MBD, deficiency of the spleen and kidney was the most commonly seen pattern [97 patients(36.19%)], mainly distributed in stages 4 and 5, followed by liver-kidney yin deficiency [35 patients(13.06%)], and mainly distributed in stage 3. Among superficiality excess syndromes, toxin stasis syndrome was the most common [88 patients(32.83%)],mainly distributed in stage 5. There were 265 patients(98.88%) with concurrence of deficiency-excess complex pattern, among whom 78 patients(80.41%) had deficiency of the spleen and kidney and toxin stasis syndrome. In the CKD-MBD grouping,besides liver-kidney yin deficiency, the remaining syndromes were all of mixed types(abnormalities in at least 2 of the 3 markers,that was, calcium, phosphorous, and parathyroid hormone). Conclusion: Deficiency of the spleen and kidney is the main deficiency syndrome in CKD-MBD in patients with CKD G3~G5 D, and toxin stasis syndrome is the main syndrome in superficiality excess syndromes. Deficiency of the spleen and kidney with toxin stasis syndrome is the most common concurrence of the deficiencyexcess complex pattern seen in CKD-MBD. Abnormalities in the three markers, that is calcium, phosphorous, and parathyroid hormone, are the main presentations of various CKD-MBD syndromes in patients with CKD G3~G5 D.