终末期肾病维持性血液透析患者中医证型分布与钙磷代谢指标的相关性研究

Correlation Between the Distribution of TCM Syndromes and Calcium and Phosphorus Metabolism Indexes in End-stage Renal Disease Patients with Maintenance Hemodialysis

目的研究终末期肾病(End stage renal disease,ESRD)维持性血液透析(Maintenance hemodialysis,MHD)患者中医证型分布与磷钙代谢指标的相互关系。方法选取2020年1月—2021年12月期间在南京中医药大学附属张家港市中医医院实施MHD治疗的ESRD患者92例。收集患者的电解质分析结果及甲状旁腺激素(Parathyroid hormone,PTH)等生化指标。对患者进行辨证分型,分析中医中医证型分布与钙磷代谢指标的关系。结果各本虚证型的年龄及透析龄比较,差异有统计学意义(P<0.05),阴阳两虚证患者年龄大于其他证型,差异有统计学意义(P<0.05),脾肾阳虚、气阴两虚和阴阳两虚证患者的透析龄大于脾肾气虚证和肝肾阴虚证,差异有统计学意义(P<0.05)。本虚证中,脾肾气虚证占比高于其他证型,差异有统计学意义(P<0.05),标实证中,血瘀证占比高于其他证型,差异有统计学意义(P<0.05)。中医证型组合分布中,脾肾气虚证和脾肾阳虚证者兼并湿热、湿浊、血瘀证居多,气阴两虚、阴阳两虚和肝肾阴虚证兼并血瘀证居多。肝肾阴虚证的Ca^(2+)水平高于其他证型,差异有统计学意义(P<0.05),阴阳两虚证的P~(3-)和PTH水平高于其他证型,差异有统计学意义(P<0.05)。脾肾气虚、气阴两虚和肝肾阴虚证患者中高PTH发生率最高,脾肾阳虚证低钙血症发生率最高,阴阳两虚证高磷血证发生率最高。结论MHD治疗的ESRD患者年龄、透析龄与中医辨证分型有关,且常见本虚证以脾肾气虚为主,标实证以血瘀证为主,本虚证多兼并湿热、湿浊、血瘀证。本虚证型分布与磷钙代谢紊乱有关,脾肾气虚、气阴两虚和肝肾阴虚证者多发高PTH,脾肾阳虚证多发低钙血症,阴阳两虚证多发高磷血证。

Objective To investigate the correlation between the distribution of traditional Chinese medicine(TCM)syndromes and phosphorus-calcium metabolism indexes in end-stage renal disease(ESRD)patients with mainte-nance hemodialysis(MHD).Methods Ninety-two ESRD patients treated with MHD in Zhangjiagang Hospital of Tradi-tional Chinese Medicine,Nanjing University of Chinese Medicine from January 2020 to December 2021 were enrolled.Elec-trolyte analysis results and biochemical indicators such as parathyroid hormone(PTH)were collected.TCM syndrome differ-entiation was performed on the patients,and the correlation between TCM syndrome distribution and calcium-phosphorus metabolism indexes was analyzed.Results There were statistically significant differences in age and duration of dialysis a-mong different deficiency syndromes(P<0.05).Patients with yin-yang deficiency syndrome were older than those with other syndromes(P<0.05).Patients with spleen-kidney yang deficiency,qi-yin deficiency,and yin-yang deficiency syndromes had a longer duration of dialysis than those with spleen-kidney qi deficiency and liver-kidney yin deficiency syndromes(P<0.05).Among the deficiency syndromes,spleen-kidney qi deficiency syndrome accounted for a higher proportion than other syndromes(P<0.05),while blood stasis syndrome accounted for a higher proportion among excess syndromes(P<0.05).Among the combined TCM syndromes,spleen-kidney qi deficiency and spleen-kidney yang defi-ciency syndromes were most commonly accompanied by dampness-heat,dampness-turbidity,and blood stasis syn-dromes,while qi-yin deficiency,yin-yang deficiency,and liver-kidney yin deficiency syndromes were most commonly accompanied by blood stasis syndrome.Patients with liver-kidney yin deficiency syndrome had higher levels of Ca^(2+)than other syndromes(P<0.05),and patients with yin-yang deficiency syndrome had higher levels of phosphorus(P3-)and PTH than other syndromes(P<0.05).Patients with spleen-kidney qi deficiency,qi-yin deficiency,and liver-kidney yin deficiency syndromes had the highest occurrence rate of elevated PTH levels,while patients with spleen-kidney yang deficiency syndrome had the highest occurrence rate of hypocalcemia,and patients with yin-yang deficiency syndrome had the highest occurrence rate of hyperphosphatemia.Conclusion The age and duration of dialysis in ESRD patients treated with MHD are associated with TCM syndromes.The common deficiency syndrome is spleen-kidney qi deficiency often ac-companied by dampness-heat,dampness-turbidity,and blood stasis syndromes,while the common excess syndrome is blood stasis syndrome.The distribution of deficiency syndromes is related to phosphorus-calcium metabolism disorders.Patients with spleen-kidney qi deficiency,qi-yin deficiency,and liver-kidney yin deficiency syndromes are more likely to have elevated PTH levels.Patients with spleen-kidney yang deficiency syndrome are more likely to develop hypocalce-mia,and patients with yin-yang deficiency syndrome are more likely to develop hyperphosphatemia.