Wan Yi-gang, Sun Wei, Wang Jing
Department of Traditional Chinese Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):801-5.
To analyze the characteristics of TCM syndrome distribution and its correlation with urinary protein in patients with early chronic kidney diseases (CKD), for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in CKD.
Adopting traditional epidemiological retrospective method, the TCM syndrome and urinary protein related indexes, including 24 h urinary protein (Upro), urinary albumin (UAlb), urinary beta2-microglobulin (Ubeta2-MG), urinary N-acetyl-beta-D-glucosaminidase (UNAG), urinary beta-galactosidase (UGAL), etc, were collected from 199 patients with early CKD, and a multiple factor regression analysis between them was conducted.
In patients with early stage CKD, the TCM symptoms, as independent factors closely related to urinary protein, were aching loins, poor appetite and indigestion, yellow and brownish urine, regurgitation acid, profuse nocturnal urine, edema, foamy urine, cough, aversion to cold and cold limbs, etc; the elevation of UAlb with the factors of Pi-Shen qi-deficiency as aching loins, poor appetite and indigestion was correlated; elevation of UNAG with edema, foamy urine, profuse nocturnal urine, cough; UGAL with Pi-Shen yang-deficiency factors as aching loins, aversion to cold and cold limbs; and elevation of Ubeta2-MG with edema were correlated respectively as well. Levels of UAlb and UNAG in patients of Pi-Shen qi-deficiency type were significantly higher than those in patients of Gan-Shen yin-deficiency type, Fei-Shen qi-deficiency type, and Pi-Shen yang-deficiency type, respectively (all P < 0.05).
For early stage CKD patients, Shen and Pi are the major organs related to the appearance of urinary protein; Pi-Shen deficiency is the basic pathogenesis. Level of UAlb, which is associated with Pi-Shen qi-deficiency type, could be taken as one of microcosmic syndrome factors for the syndrome type; UNAG also be related with that syndrome to certain extent; and heat-damp syndrome might be an independent type.
分析早期慢性肾脏病（CKD）患者中医证候分布特点及其与尿蛋白的相关性，为明确CKD中医辨证规律提供依据。
采用传统流行病学回顾性方法，收集199例早期CKD患者的中医证候及尿蛋白相关指标，包括24小时尿蛋白（Upro）、尿白蛋白（UAlb）、尿β2-微球蛋白（Ubeta2-MG）、尿N-乙酰-β-D-氨基葡萄糖苷酶（UNAG）、尿β-半乳糖苷酶（UGAL）等，并对其进行多因素回归分析。
早期CKD患者中，与尿蛋白密切相关的独立因素为中医症状有腰酸、食欲不振及消化不良、尿黄赤、泛酸、夜尿增多、水肿、泡沫尿、咳嗽、畏寒肢冷等；UAlb升高与脾肾气虚型因素腰酸、食欲不振及消化不良相关；UNAG升高与水肿、泡沫尿、夜尿增多、咳嗽相关；UGAL与脾肾阳虚型因素腰酸、畏寒肢冷相关；Ubeta2-MG升高与水肿也分别相关。脾肾气虚型患者的UAlb和UNAG水平分别显著高于肝肾阴虚型、肺肾气虚型及脾肾阳虚型患者（均P<0.05）。
对于早期CKD患者，肾与脾是出现尿蛋白的主要相关脏腑；脾肾亏虚是基本病机。与脾肾气虚型相关的UAlb水平可作为该证型微观辨证因子之一；UNAG在一定程度上也与该证型相关；且湿热证可能为独立证型。
