腹膜透析患者血清klotho蛋白水平与中医证候的相关性研究

Relationship Between Serum Klotho Protein Level and TCM Syndromes in Peritoneal Dialysis Patients

目的:探讨腹膜透析患者血清klotho蛋白水平与中医证候的相关性。方法:选取180例规律腹膜透析患者作为研究对象,均进行中医辨证,分为主证和兼证两类;并根据患者肾小球滤过率(GFR)和血清分泌型klotho蛋白水平的四分位数,分为4组,统计各组中医主证、兼证分布情况。结果:180例腹膜透析患者主证占比,脾肾气虚证>气阴两虚证>肝肾阴虚证>脾肾阳虚证>阴阳两虚证;兼证占比,瘀血证>湿热证>湿浊证;不同主证的GFR和klotho蛋白水平存在显著性差异(P<0.05),GFR、klotho蛋白水平比较,肝肾阴虚证<阴阳两虚证<气阴两虚证<脾肾阳虚证<脾肾气虚证,且GFR与血清klotho蛋白水平呈正相关。不同兼证患者GFR和klotho蛋白水平比较无统计学意义(P>0.05)。按照血清分泌型klotho蛋白水平分布范围分组,发现在klotho蛋白水平较低的患者中,肝肾阴虚证和阴阳两虚证的占比较高;相反,在klotho蛋白水平较高的患者中,脾肾气虚证和脾肾阳虚证的占比较高,各组中医主证比率比较有统计学意义(P<0.05),而兼证比率比较无统计学意义(P>0.05)。结论:腹膜透析患者血清klotho蛋白水平与中医主证呈显著相关性,且肝肾阴虚证、阴阳两虚证者klotho蛋白降低尤其明显,主要与肾精不足或衰退相关。

Objective:To analyze the relationship between serum klotho protein levels and TCM syndromes in peritoneal dialysis(PD)patients.Methods:All cases were from ESRD patients who received regular PD follow-up from September 2015 to February 2018 in Wuhan Hospital of Integrated Chinese and Western Medicine,with a total of 180 cases,all of whom underwent TCM diagnosis and were divided into two categories:primary syndromes and concurrent syndromes.Glomerular filtration rate(GFR)and serum secretory klotho protein levels were measured,and the patients were divided into 4 groups according to the quartiles of the distribution range of klotho protein levels,and the distribution of TCM primary syndromes and concurrent syndromes in each group was counted.Results:In 180 PD patients,the proportion of primary symptoms were spleen-kidney qi deficiency>deficiency of qi-yin>yin deficiency of liver-kidney>yang deficiency of spleen-kidney>deficiency of yin-yang;the proportion of concurrent symptoms were stasis of blood>damp-heat>damp-deficiency.There was a significant difference in GFR and klotho protein levels between patients with different primary syndromes(P<0.05),while there was no statistical significance in the comparison of GFR and klotho protein levels between patients with different concurrent syndromes(P>0.05).The distribution range of serum-secreting klotho protein levels showed serum-secreting klotho protein with lower level in yin deficiency of liver-kidney syndrome,deficiency of yin-yang syndrome,klotho protein with higher level in qi deficiency of spleen and kidney syndrome and yang deficiency of spleen and kidney syndrome,there was statistically significance between each primary syndrome(P<0.05),but there was no statistically significance between each concurrent syndrome(P>0.05).Conclusion:The serum klotho protein levels of PD patients were significantly correlated with the primary syndromes,and the decrease of klotho protein was especially obvious in yin deficiency of liver-kidney and deficiency of yin-yang syndromes,which was mainly related to the deficiency or decline of kidney essence.