糖尿病肾病患者不同中医证型与肾功能及实验室指标的关系

Relationship between different TCM certificate types and renal function,serum ALB,blood lipids,TWEAK,CTGF,and CysC levels in patients with diabetic nephropathy

目的探究糖尿病肾病患者不同中医证型与肾功能、血清ALB、血脂、TWEAK、CTGF及CysC水平的关系。方法选取2019年1月至2020年5月期间武威市中医院收治的糖尿病肾病患者153例作为观察组,选取同期体检的健康人员30名作为健康组,对患者尿素氮(BUN),血肌酐(Scr),胱抑素C(CysC),总胆固醇(TC),三酰甘油(TG),血清清蛋白(ALB)、肿瘤坏死样凋亡微弱诱导因子(TWEAK)、结缔组织生长因子(CTGF)等指标进行检测比较。结果153例DN患者中阴虚燥热8例,占5.23%、气阴两虚20例,占13.07%、脾肾气虚56例,占36.6%、阴阳两虚69例,占54.1%;DN患者不同中医证型中脾肾气虚和阴阳两虚占比最高。BUN、Scr、CysC、TC、TG和CTGF指标在健康组、阴虚燥热、气阴两虚、脾肾气虚、阴阳两虚组间逐渐上升,差异有统计学意义(P<0.05)。ALB、TWEAK指标在阴虚燥热、气阴两虚、脾肾气虚、阴阳两虚组间逐渐下降,差异有统计学意义(P<0.05);logisitic回归分析显示,BUN、Scr、CysC、TC、TG、ALB、TWEAK和CTGF是糖尿病肾病患病的独立影响因素(P<0.05);Spearman秩相关分析显示,主证证型与BUN、Scr、CysC、TC、TG和CTG呈正相关关系,与ALB、TWEAK呈负相关关系(P<0.05)。结论DN随着疾病分期的进展,中医证型主要表现为阴虚燥热—气阴两虚—脾肾气虚—阴阳两虚。DN中医证型与BUN、Scr、CysC、TC、TG、ALB、TWEAK和CTGF有一定相关性,可为临床DN判断病情、治疗及预后提供依据。

Objective renal function,serum ALB,blood lipids,TWEAK,CTGF and CysC levels in patients with diabetic nephropathy.Methods From January 2019 to May 2020,153 patients with diabetic nephropathy admitted to Wuwei Hospital of Traditional Chinese Medicine were selected as the observation group,and 30 healthy persons who underwent physical examination during the same period were selected as the healthy group,cystatin C(CysC),total cholesterol(TC),triacylglycerol(TG),serum albumin(ALB),tumor necrosis weak inducer of apoptosis(TWEAK),connective tissue growth factor(CTGF),etc.indicators for comparison.Results Among the 153 DN patients,8 cases of yin deficiency and heat,accounting for 5.23%,20 cases of qi and yin deficiency,accounting for 13.07%,56 cases of spleen and kidney qi deficiency,accounting for 36.6%,and69 cases of yin and yang deficiency,accounting for 54.1%;Among the syndrome types,deficiency of spleen and kidney qi and deficiency of both yin and yang accounted for the highest proportion.The indexes of BUN,Scr,CysC,TC,TG and CTGF increased gradually among the healthy group,yin deficiency,dryness and heat,qi and yin deficiency,spleen and kidney qi deficiency,and yin and yang deficiency groups,and the difference was statistically significant(P<0.05).The indexes of ALB and TWEAK decreased gradually among the yin deficiency,dryness and heat,qi and yin deficiency,spleen and kidney qi deficiency,and yin and yang deficiency groups,and the difference was statistically significant(P<0.05).Logisitic regression analysis showed that BUN,Scr,CysC,TC,TG,ALB,TWEAK and CTGF were independent influencing factors of diabetic nephropathy(P<0.05);Spearman rank correlation analysis showed that the main syndrome type was positively correlated with BUN,Scr,CysC,TC,TG and CTG,and was positively correlated with ALB,TWEAK were negatively correlated(P<0.05).Conclusion DN With the progression of disease stages,TCM syndromes are mainly manifested as yin deficiency,dryness and heat-qi and yin deficiency-spleen and kidney qi deficiency-yin and yang deficiency.The TCM syndrome types of DN have a certain correlation with BUN,Scr,CysC,TC,TG,ALB,TWEAK and CTGF,which can provide a basis for the judgment,treatment and prognosis of clinical DN.