Yang Hai-Ming, Meng Xian-Jie, Wu Wei, Liu Ying-Lu, Zhai Xiao-Juan
Department of Traditional Chinese Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Department of Nephrology, Yancheng Hospital of Traditional Chinese Medicine, Yancheng 224001, China.
Zhongguo Zhong Yao Za Zhi. 2017 Oct;42(20):4027-4034. doi: 10.19540/j.cnki.cjcmm.20170901.010.
To analyze the interdependent relationship between serum bone metabolic markers and traditional Chinese medicine (TCM) syndromes in patients with chronic kidney disease (stages 3 and 4)-related mineral and bone disorder (CKD-MBD), in order to provide the objective basis for exploring the rules of TCM syndrome differentiation in patients with CKD-MBD. The retrospective survey was conducted to collect 105 cases with CKD (stages 3 and 4)-MBD. General clinical indexes, frequency of TCM syndromes and distribution of TCM syndrome type were investigated. Furthermore, serum bone metabolic markers, including calcium (Ca2+), phosphonium (P3+), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), procollagen type 1 amino-N-terminal propeptide (P1NP) and β-crosslaps (β-CTX) were analyzed, respectively. Meanwhile, bone mineral density (BMD) was assessed. And then, the multivariate regression analysis was performed for serum bone metabolic markers and TCM syndromes. The results showed that the general clinical features of the 105 patients included old age, hypertension, fracture, loss of bone mass and mild abnormalities of serum bone metabolic markers. High-frequency TCM syndromes were related to Yang deficiency in Spleen and Kidney, Qi deficiency in Spleen and Kidney and blood stasis. Moreover, Yang deficiency in Spleen and Kidney and blood stasis were found as the most frequent characteristics of the distribution of TCM syndromes type. The clinical characteristics of patients with the syndrome type of Yang deficiency in Spleen and Kidney were probably old age, increase in TCM syndrome scores and abnormalities in iPTH and P1NP. In addition, the interdependent relationship between abnormality in Ca2+ and syndromes of hair loss, tooth shake and sexual dysfunction, abnormality in P3+ and syndromes of aches in waist and knees, abnormality in iPTH and syndromes of soreness and weakness in waist and knees, lassitude, fatigue and extreme chilliness, abnormality in ALP and syndromes of loose stools, abnormality in P1NP and syndromes of fear of chills, tendency of warmth and loose stools, and abnormality in β-CTX and syndromes of chills and pain in waist and knees. In general, among the 105 cases with CKD (stages 3 and 4)-MBD were clinically characterized by mild changes in serum bone metabolic markers; And their main TCM syndrome was the deficiency in spleen and kidney. Serum bone metabolic markers with mild changes have an interdependent relationship with main TCM syndromes, and can be considered as an objective syndrome factor of TCM syndrome differentiation.
分析慢性肾脏病3、4期相关矿物质和骨异常（CKD-MBD）患者血清骨代谢标志物与中医证型的相互关系，为探索CKD-MBD患者中医辨证规律提供客观依据。采用回顾性调查方法，收集105例CKD 3、4期MBD患者。调查一般临床指标、中医证候出现频率及中医证型分布情况。此外，分别分析血清骨代谢标志物，包括钙（Ca2+）、磷（P3+）、全段甲状旁腺激素（iPTH）、碱性磷酸酶（ALP）、Ⅰ型前胶原氨基端前肽（P1NP）和β-胶原降解产物（β-CTX）。同时评估骨密度（BMD）。然后对血清骨代谢标志物与中医证型进行多因素回归分析。结果显示，105例患者的一般临床特征为老年、高血压、骨折、骨量丢失及血清骨代谢标志物轻度异常。高频中医证候与脾肾阳虚、脾肾气虚、血瘀有关。此外，脾肾阳虚和血瘀是中医证型分布中最常见的特征。脾肾阳虚证型患者的临床特征可能为老年、中医证候积分增加及iPTH和P1NP异常。此外，Ca2+异常与脱发、齿摇、性功能减退证候，P3+异常与腰膝酸痛证候，iPTH异常与腰膝酸软、倦怠乏力、畏寒肢冷证候，ALP异常与大便溏薄证候，P1NP异常与畏寒、喜温、大便溏薄证候，β-CTX异常与腰膝冷痛证候之间存在相互关系。总体而言，105例CKD 3、4期MBD患者临床以血清骨代谢标志物轻度改变为特征；其主要中医证型为脾肾亏虚。血清骨代谢标志物轻度改变与主要中医证型存在相互关系，可作为中医辨证的客观证候要素。
