糖尿病肾脏病患者中医证型与颈动脉内膜中层厚度相关性

The Relationship Between Carotid Intima Media Thickness and Hcy,Blood Lipid and TCM Syndromes in Diabetic Nephropathy

目的:通过观察糖尿病肾脏病(DKD)患者不同中医证型与颈动脉内膜中层厚度的相关性,采用相应的中医辨证治疗方法,对预防及延缓DKD患者心血管事件的发生发展提供一定临床价值。方法:选取北京中医药大学东直门医院近5年的DKD患者326例和T2DM组患者36例,同时选取东直门医院国家部体检科健康者30例,测定所有入组患者的血脂、Hcy、CIMT、肾功能,并根据CIMT水平分为CIMT正常组和CIMT增厚组,比较分析DKD患者中医证型与血脂、Hcy、CIMT、肾功能的相关性。结果:DKD患者的TC、TR、HDL-C、LDL-C、Hcy高于T2DM组及正常组,差异有统计学意义(P<0.05)。痰瘀阻滞证与气阴两虚证比较,TC、HDL-C、LDL-C、HCY最高,差异有统计学意义(P<0.05);DKD组CIMT、CREA、UREA水平明显高于T2DM组及正常组,差异有统计学意义(P<0.05),痰瘀阻滞证的CIMT、CREA、UREA均高于阴虚燥热证,差异有统计学意义(P<0.05)。CIMT增厚组TC、LDL-C、Hcy、CREA均高于CIMT正常组,增厚组eGFR低于CIMT正常组,差异有统计学意义(P<0.05)。CIMT增厚的危险因素分析发现,BMI、吸烟史、SBP、Hcy、LDL-C、CREA是CIMT增厚的独立危险因素(P<0.05)。结论:DKD患者不同中医证型之间CIMT、血脂、Hcy、肾功能存在差异性,痰浊、瘀血在DKD患者病情进展及AS形成中至关重要,临床中需正确管理生活方式,及时采用化痰祛湿、活血化瘀疗法对症治疗,对延缓DKD病情进展,减少发生AS的风险,预防心血管病的发生发展提供重要的参考价值。

Objective:By observing the correlation between different TCM syndrom types and carotid intima media thickness in patients with diabetic nephropathy(DKD),and adopting corresponding TCM syndrom differentiation treatment methods,it provides certain clinical value for preventing and delaying the occurrence and development of cardiovascular events in patients with DKD.Methods:A total of 326 DKD patients and 36 T2DM patients were selected from Dongzhimen Hospital of Beijing University of Chinese Medicine in recent 5 years.Meanwhile,30 healthy subjects from the National Physical Examination Department of Dongzhimen Hospital were selected.Blood lipid,Hcy,CIMT and renal function of all enrolled patients were measured,and divided into normal group and thickened group according to CIMT level.The correlation between TCM syndrome type and blood lipid,Hcy,CIMT and renal function in DKD patients was compared and analyzed.Results:TC,TR,HDL-C,LDL-C and Hcy in DKD patients were higher than those in T2DM group and normal group,and the difference was statistically significant(P<0.05).TC,HDL-C,LDL-C and Hcy were the highest in phlegm and blood stasis syndrome compared with Qi and Yin deficiency syndrome,and the difference was statistically significant(P<0.05).The levels of CIMT,CREA and UREA in DKD group were significantly higher than those in T2DM group and normal group,and the differences were statistically significant(P<0.05).The CIMT,CREA and UREA of phlegm and blood stasis syndrome were higher than those of Yin deficiency and dry heat syndrome,with statistical significance(P<0.05).TC,LDL-C,Hcy and CREA in CIMT thickening group were higher than those in CIMT normal group,and EGFR in CIMT thickening group was lower than that in CIMT normal group,with statistical significance(P<0.05).Risk factor analysis of CIMT thickening showed that BMI,smoking history,SBP,Hcy,LDL-C and CREA were independent risk factors for CIMT thickening(P<0.05).Conclusion:There are differences in CIMT,blood lipid,Hcy and renal function among different TCM syndromes of DKD patients.Turbid sputum and blood stasis are of great importance in the progression of DKD patients and the formation of AS.In clinical practice,it is necessary to timely adopt sputum-reducing clearing damp and blood-promoting and stasis removing therapy for symptomatic treatment,which can provide important reference value for delaying the progression of DKD,reducing the risk of AS and preventing the occurrence and development of cardiovascular diseases.