腹膜透析患者不同hs-CRP水平的中医证型与营养状况的特点

Correlation between TCM syndrome types of CRP and nutritional status in peritoneal dialysis patients

目的通过分析维持性腹膜透析(PD)患者不同超敏C反应蛋白(hs-CRP)水平的中医证型特点与蛋白能量消耗(Protein-energy wasting,PEW)的相关性,为PD患者处于PEW状态时提供中医诊疗参考。方法收集112例PD患者资料,检查血清中hs-CRP的表达水平,hs-CRP>3 mg/L和hs-CRP≤3 mg/L的患者分为A、B两组,进行中医辨证分型,观察不同hs-CRP的PD患者中医证型特点;采集两组患者人体学指标、生化指标,改良主观营养评估法(MQASG)评分,分析血清hs-CRP水平与营养指标的关系。结果hs-CRP>3 mg/L的患者本证以气阴两虚、阴阳两虚为主,标证以湿热多见;hs-CRP≤3 mg/L的PD患者本证以脾肾阳虚、阴阳两虚为主,标证以湿浊内阻多见。A组患者机体MQSGA评分显著高于B组,三角肌皮褶厚度(TSF)、中臂围(MAC)、白蛋白(ALB)、前白蛋白(PA)水平显著低于B组,差异具有统计学意义(P<0.05)。结论PD患者血清hs-CRP水平与PEW程度显示不同中医证型特点,CRP可能是中医证型湿热证的物质基础之一。

Objective To analyze the correlation between TCM syndrome characteristics and protein energy wasting(PEW)in maintenance peritoneal dialysis(PD)patients with different C-reactive protein(CRP),to provide TCM diagnosis and treatment reference for PD patients in Pew state.Methods 112 PD patients of PD were collected.The expression level of hs-CRP in serum was detected.According to hs-CRP>3 mg/L and hs-CRP≤3 mg/L,PD patients were divided into group A and group B.The TCM syndrome types of PD patients with different hs-CRP were observed;The relationship between serum hs-CRP level and nutritional evaluation index was analyzed.Results In patients with hs-CRP>3 mg/L,deficiency of both Qi and Yin,deficiency of both Yin and Yang are the main symptoms,and damp heat are the main symptoms;In PD patients with Hs-CRP≤3 mg/L,the syndrome was mainly characterized by deficiency of spleen and kidney Yang and Yin and Yang,and the standard syndrome was mainly characterized by dampness and turbidity internal obstruction.MQSGA score of group A was significantly higher than group B,deltoid skin fold thickness(TSF),midarm circumference(MAC),albumin(ALB)and prealbumin(PA)levels were significantly lower than group B(P<0.05),and the differences were statistically significant(P<0.05).Conclusion The serum hs-CRP level and PEW degree of PD patients show different characteristics of TCM syndrome type,CRP may be one of the material basis of TCM syndrome type damp-heat syndrome.