慢性原发性肾小球疾病中风邪证候的分布规律及与炎症因子的相关性分析
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摘要
在我国,慢性原发性肾小球疾病(以下简称慢性肾病)是导致终末期肾病(ESRD)最常见的原因。中医药在治疗和延缓慢性肾脏病的发展方面具有很大优势。从风论治肾脏病的思路已有多家论述。风邪在肾脏病中的地位尚存在分歧。既往研究多为临床理论与个人经验,缺乏对肾脏病中风邪的客观证候、指标、致病机制等的具体研究。
目的：观察慢性肾病患者,研究合并风邪和非合并风邪组在具体症状、证候类型、病理类型之间有无差异,总结存在风邪表现的肾脏病患者证候、症状及病理学特点。观察慢性肾病患者血、尿IL-6、TNF-a水平,以及和其它临床资料的相关性。并观察在风邪组病人中,IL-6、TNF-a水平与非风邪组有无差异,从而探讨风邪在慢性肾病中的特点。
方法：共收集128例患者的临床资料进行观察,探讨风邪证和其他中医证型的关系,以及风邪的分布特点。其中有106例患者留取了血清、尿液样本,用EL ISA方法检测血清、尿液的IL-6TNF-a水平,并结合中医证型、生化指标,肾脏病理等,分析之间的相关性,使用SPSS18.0统计软件包进行临床资料和IL-6、TNF-a的数据分析。
结果：
1慢性肾病患者中,风邪证是最多见的标实证候,占60.16%(77/128)。风邪证常见症状为尿中泡沫明显(56.25%),颜面浮肿(53.13%)及反复遇外感而发作(50.78%)。合并风邪证的患者在肾病综合征中的比例高于慢性肾炎,二者相比较有统计学意义,P<0.05。
2在实邪证型中,风邪证最常和湿热证合并出现。在虚证中,合并风邪者以气阴两虚型为主,肝肾阴虚型最少。各种病理类型均有风邪证合并,其中微小病变合并风邪证比例最高。慢性肾脏病(CKD)的1-4期,均有风邪合并存在。
3风邪组较非风邪组24小时尿蛋白定量明显升高,血清白蛋白水平降低,P<0.05。IgE水平在风邪证组高于非风邪证,但统计学检验无显著差异,P>0.05。随着蛋白尿量的增加,合并风邪患者明显增加,蛋白尿>1g者与蛋白尿≤1g者比较差异显著,P<0.01。蛋白尿≥3.5g者较lg<24hUTP<3.5g者合并风邪患者也有增加,但之间没有显著差异。
4在患者的血、尿标本中,IL-6、TNF-α浓度均高于健康对照组,有统计学意义。血IL-6在CKD1-4期均与正常组有差异,P<0.05；尿IL-6在CKD2、3、4期与正常组有差异,P<0.05；血TNF-α在CKD2、3、4期与正常组有差异,P<0.05；尿TNF-a在CKD1、2、3、4期均与正常组有差异,P<0.05；组间比较尿TNF-α在CKD4期与CKD2期有差异,P<0.05。
5在风邪组中,血、尿的IL-6浓度均高于非风邪组。其中血IL-6浓度在两组之间有统计学意义。血、尿的TNF-a浓度均高于非风邪组。其中尿TNF-a浓度在两组之间有统计学意义。在标实证型中,合并风邪证患者血、尿IL-6、TNF-a含量最高。均高于其他标实证型。
结论：(1)慢性肾病患者中存在中医证型的差异,标实证中以风邪证最常见,且最常合并湿热证一起出现。明显的泡沫尿、颜面浮肿及反复遇外感而发作是风邪证的常见表现。(2)风邪组较非风邪组24小时尿蛋白定量明显升高,血清白蛋白水平降低。提示蛋白尿水平可作为患者存在风邪的重要微观辨证依据。(3)在风邪组中,血、尿的IL-6、TNF-α浓度均高于非风邪组,并高于其他标实证型。提示风邪证的发病机制与细胞因子存在相关性。
Chronic primary glomerular disease is a kind of prevalent kidney disease, and is the main cause of the end stage renal disease (ESRD) in China. Chinese medicine treatment has a great advantage in delaying the development of chronic kidney disease. Many researchers have discussed the treatment of chronic primary glomerular disease based on the theory of wind. However, differences exist in the status of wind in kidney disease. Previous studies have focused on clinical theory and personal experience, which lacks specific study on objective syndrome, indicators and pathogenic mechanisms.
Objective:To observe the differences of clinical symptoms, syndromic types and pathological types between the windpathogen group and non-windpathogen group. To determine whether chronic kidney disease is associated with windpathogen by analyzing the difference of many factors including symptoms、physical signs、 blood pressure、blood biochemical indexes、blood and urine routine、24hupro、 CRP、renal pathology、TNF-α and IL-6in both blood and urine.
Methods:Test1included128patients. Clinical data was collected to explore the relationship between pathogenic wind syndrome and other TCM syndromes, and the characteristics of pathogenic wind in chronic primary glomerular disease.106patients were brought into the investigation in test2. Col lected serum and urine samples of40patients, used ELISA method to measure the levels of serum and urine IL-6, TNF-alpha, and SPSS18.0to analyze the data.
Results:
1Pathogenic wind syndrome is the most common syndrome (60.7%) in patients with chronic kidney disease. The most common symptoms in windpathogen patients include foamy urine (56.25%), puff iness of face (53.13%) and repeated at tack by exopathy (50.78%)
2Pathogenic wind syndrome was often mixed with dampness-heat syndrome (27.34%) in excess pathogenic factors. Windpathogen exists extensively in various pathological types and in CKD1-4.
3The quantitative of proteinuria in24hour was significantly increased in windpathogen group, and serum albumin was decreased significantly. The amount of patients who have wind syndrome increased as24hour urinary protein increased.
4The level of IL-6、TNF-α in serum and urine of patients with chronic primary glomerular disease were significantly higher than the healthy control group (P<0.05); urine TNF-α levels in patients of CKD4were significantly higher than CKD2period.
5The level of IL-6in serum of patients with pathogenic wind syndrome was significant ly higher than the non-windpathogen group (P<0.05). The level of TNF-α in urine of patients with pathogenic wind syndrome was significantly higher than the non-windpathogen group (P<0.05). No difference exist both in serum TNF-α and in urine IL-6between the patients with pathogenic wind syndrome and non-windpathogen group (P>0.05)
Conclusion:
(1) TCM syndrome type differences exist in patients with chronic kidney disease. Pathogenic wind syndrome is the most common syndrome in patients with chronic kidney disease. The most common symptoms in windpathogen patients include foamy urine, puffiness of face and repeated attack by exopathy. Pathogenic wind syndrome was often mixed with dampness-heat syndrome.(2) The quantitative of proteinuria in24hour was significantly increased in windpathogen group, and serum albumin was decreased significantly. The amount of patients increased as24hour urinary protein increased.(3) The level of IL-6、TNF-α in serum and urine of patients with chronic primary glomerular disease were significantly higher than the healthy control group (P<0.05); The level of IL-6in serum of patients with pathogenic wind syndrome was significant ly higher than the non-windpathogen group (P<0.05). The level of TNF-α in urine of patients with pathogenic wind syndrome was significantly higher than the non-windpathogen group (P<0.05).
目的：观察慢性肾病患者,研究合并风邪和非合并风邪组在具体症状、证候类型、病理类型之间有无差异,总结存在风邪表现的肾脏病患者证候、症状及病理学特点。观察慢性肾病患者血、尿IL-6、TNF-a水平,以及和其它临床资料的相关性。并观察在风邪组病人中,IL-6、TNF-a水平与非风邪组有无差异,从而探讨风邪在慢性肾病中的特点。
方法：共收集128例患者的临床资料进行观察,探讨风邪证和其他中医证型的关系,以及风邪的分布特点。其中有106例患者留取了血清、尿液样本,用EL ISA方法检测血清、尿液的IL-6TNF-a水平,并结合中医证型、生化指标,肾脏病理等,分析之间的相关性,使用SPSS18.0统计软件包进行临床资料和IL-6、TNF-a的数据分析。
结果：
1慢性肾病患者中,风邪证是最多见的标实证候,占60.16%(77/128)。风邪证常见症状为尿中泡沫明显(56.25%),颜面浮肿(53.13%)及反复遇外感而发作(50.78%)。合并风邪证的患者在肾病综合征中的比例高于慢性肾炎,二者相比较有统计学意义,P<0.05。
2在实邪证型中,风邪证最常和湿热证合并出现。在虚证中,合并风邪者以气阴两虚型为主,肝肾阴虚型最少。各种病理类型均有风邪证合并,其中微小病变合并风邪证比例最高。慢性肾脏病(CKD)的1-4期,均有风邪合并存在。
3风邪组较非风邪组24小时尿蛋白定量明显升高,血清白蛋白水平降低,P<0.05。IgE水平在风邪证组高于非风邪证,但统计学检验无显著差异,P>0.05。随着蛋白尿量的增加,合并风邪患者明显增加,蛋白尿>1g者与蛋白尿≤1g者比较差异显著,P<0.01。蛋白尿≥3.5g者较lg<24hUTP<3.5g者合并风邪患者也有增加,但之间没有显著差异。
4在患者的血、尿标本中,IL-6、TNF-α浓度均高于健康对照组,有统计学意义。血IL-6在CKD1-4期均与正常组有差异,P<0.05；尿IL-6在CKD2、3、4期与正常组有差异,P<0.05；血TNF-α在CKD2、3、4期与正常组有差异,P<0.05；尿TNF-a在CKD1、2、3、4期均与正常组有差异,P<0.05；组间比较尿TNF-α在CKD4期与CKD2期有差异,P<0.05。
5在风邪组中,血、尿的IL-6浓度均高于非风邪组。其中血IL-6浓度在两组之间有统计学意义。血、尿的TNF-a浓度均高于非风邪组。其中尿TNF-a浓度在两组之间有统计学意义。在标实证型中,合并风邪证患者血、尿IL-6、TNF-a含量最高。均高于其他标实证型。
结论：(1)慢性肾病患者中存在中医证型的差异,标实证中以风邪证最常见,且最常合并湿热证一起出现。明显的泡沫尿、颜面浮肿及反复遇外感而发作是风邪证的常见表现。(2)风邪组较非风邪组24小时尿蛋白定量明显升高,血清白蛋白水平降低。提示蛋白尿水平可作为患者存在风邪的重要微观辨证依据。(3)在风邪组中,血、尿的IL-6、TNF-α浓度均高于非风邪组,并高于其他标实证型。提示风邪证的发病机制与细胞因子存在相关性。
Chronic primary glomerular disease is a kind of prevalent kidney disease, and is the main cause of the end stage renal disease (ESRD) in China. Chinese medicine treatment has a great advantage in delaying the development of chronic kidney disease. Many researchers have discussed the treatment of chronic primary glomerular disease based on the theory of wind. However, differences exist in the status of wind in kidney disease. Previous studies have focused on clinical theory and personal experience, which lacks specific study on objective syndrome, indicators and pathogenic mechanisms.
Objective:To observe the differences of clinical symptoms, syndromic types and pathological types between the windpathogen group and non-windpathogen group. To determine whether chronic kidney disease is associated with windpathogen by analyzing the difference of many factors including symptoms、physical signs、 blood pressure、blood biochemical indexes、blood and urine routine、24hupro、 CRP、renal pathology、TNF-α and IL-6in both blood and urine.
Methods:Test1included128patients. Clinical data was collected to explore the relationship between pathogenic wind syndrome and other TCM syndromes, and the characteristics of pathogenic wind in chronic primary glomerular disease.106patients were brought into the investigation in test2. Col lected serum and urine samples of40patients, used ELISA method to measure the levels of serum and urine IL-6, TNF-alpha, and SPSS18.0to analyze the data.
Results:
1Pathogenic wind syndrome is the most common syndrome (60.7%) in patients with chronic kidney disease. The most common symptoms in windpathogen patients include foamy urine (56.25%), puff iness of face (53.13%) and repeated at tack by exopathy (50.78%)
2Pathogenic wind syndrome was often mixed with dampness-heat syndrome (27.34%) in excess pathogenic factors. Windpathogen exists extensively in various pathological types and in CKD1-4.
3The quantitative of proteinuria in24hour was significantly increased in windpathogen group, and serum albumin was decreased significantly. The amount of patients who have wind syndrome increased as24hour urinary protein increased.
4The level of IL-6、TNF-α in serum and urine of patients with chronic primary glomerular disease were significantly higher than the healthy control group (P<0.05); urine TNF-α levels in patients of CKD4were significantly higher than CKD2period.
5The level of IL-6in serum of patients with pathogenic wind syndrome was significant ly higher than the non-windpathogen group (P<0.05). The level of TNF-α in urine of patients with pathogenic wind syndrome was significantly higher than the non-windpathogen group (P<0.05). No difference exist both in serum TNF-α and in urine IL-6between the patients with pathogenic wind syndrome and non-windpathogen group (P>0.05)
Conclusion:
(1) TCM syndrome type differences exist in patients with chronic kidney disease. Pathogenic wind syndrome is the most common syndrome in patients with chronic kidney disease. The most common symptoms in windpathogen patients include foamy urine, puffiness of face and repeated attack by exopathy. Pathogenic wind syndrome was often mixed with dampness-heat syndrome.(2) The quantitative of proteinuria in24hour was significantly increased in windpathogen group, and serum albumin was decreased significantly. The amount of patients increased as24hour urinary protein increased.(3) The level of IL-6、TNF-α in serum and urine of patients with chronic primary glomerular disease were significantly higher than the healthy control group (P<0.05); The level of IL-6in serum of patients with pathogenic wind syndrome was significant ly higher than the non-windpathogen group (P<0.05). The level of TNF-α in urine of patients with pathogenic wind syndrome was significantly higher than the non-windpathogen group (P<0.05).
引文
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