糖尿病肾病Ⅲ期患者尿蛋白谱特征及其与中医证候的回归分析  

Characteristic of urinary protein spectrum in patients with stage Ⅲ diabetic nephropathy and its regression analysis with traditional Chinese medicine symptom

作　　者：万毅刚[1] 孟宪杰[2] 沈山梅[1] 罗浔阳[1] 顾刘宝[3] 史喜苗[2] 姚建 

机构地区：[1]南京大学医学院附属鼓楼医院,江苏南京210008 [2]南京中医药大学中西医结合鼓楼临床医学院,江苏南京210029 [3]江苏省老年医学研究所,江苏南京210024 [4]Department of Molecular Signaling University of Yamanashi,Japan Yamanashi 409-3898

出　　处：《中国中药杂志》2013年第23期4157-4163,共7页China Journal of Chinese Materia Medica

基　　金：江苏省中医药局科技项目(LZ11116);南京市卫生青年人才培养工程项目

摘　　要：分析III期(丹麦Mogensen分期)糖尿病肾病(diabetic nephropathy,DN)患者尿蛋白谱特征及其与中医证候的依存性,为阐明DN患者中医证候辨证规律提供依据。采用回顾性调查方法,收集108例Ⅲ期DN患者中、低分子量尿蛋白、尿酶和中医证候等相关资料,进行尿蛋白与中医证候的多因素回归分析。其中,尿蛋白包括24 h尿蛋白定量(24 h urinary protein,Upro)、尿白蛋白(urinary albumin,UAlb)、尿视黄醇结合蛋白(urinary retinal binding protein,URBP)、尿半胱氨酸蛋白酶抑制剂C(urinary cystatin C,UCysC)、尿N-乙酰-β-D-氨基葡萄糖苷酶(urinary N-acety1-β-D-glucosaminidase,UNAG)等;中医证候包括38项DN患者常见证候。结果表明,108例Ⅲ期DN患者Upro,UAlb,URBP,UCysC以及UNAG都异常升高;其主要中医证型是气阴两虚证;气阴两虚证患者与非气阴两虚证患者相比,UAlb明显升高,2组之间差异有统计学意义(P<0.05);Upro升高与易饥多食、倦怠乏力、腰膝酸软等证候有依存关系;UAlb升高与口干欲饮等证候有依存关系;URBP升高与肢体麻木、气短等证候有依存关系;UCysC升高与小便清长等证候有依存关系;UNAG升高与小便频数等证候有依存关系。对于108例Ⅲ期DN患者而言,尿蛋白谱的特征是UAlb,URBP,UCysC以及UNAG异常升高;尿蛋白的主要病位在"肾、脾";其主要病机是"脾肾两虚";UAlb是气阴两虚证者的客观证素;UNAG和UCysC可能是肾气虚证的客观证素。To analyze the characteristic of urinary protein spectrum in patients with stage Ⅲ diabetic nephropathy（DN） and its compliance with traditional Chinese medicine （TCM）symptom, for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in DN. Adopting the traditional epidemiological retrospective method, thirty-eight TCM syndromes and urinary protein with medium or low molecular weight, as well as urinary enzyme, including 24 h urinary protein （ Upro）, urinary albumin（ UAlb）, u- rinary retinal binding protein（ URBP）, urinary cystatin C （ UCysC ）, urinary N-acetyl-,8-D-glucosaminidase（ UNAG）, were collected from 108 patients with stage Ⅲ DN, and a multiple factor regression analysis between them was conducted. As the results, the levels of Upro, UAlb, URBP, UCysC, and UNAG were increased in 108 patients with stage Ⅲ DN. Qi-Yin deficiency type was the major type. The level of UAlb in patients with Qi-Yin deficiency type was significantly higher than those without Qi-Yin deficiency type（P 〈 0. 05）. The elevation of Upro with the factors as swift digestion with rapid hungering, lassitude and lack of strength, weakness of waist and knees was complied, the elevation of UAlb with the factors as dry mouth with desire to drink, the elevation of URBP with the fac- tors as numbness of extremities, shortness of breath, the elevation of UCysC with the factors as clear urine in large amounts, and the el- evation of UNAG with the factors as frequent micturition, were complied respectively. In conclusion, for 108 stage Ⅲ DN patients. The increase in urinary protein spectrum including UAlb, URBP, UCysC, and UNAG is the major characteristic. Shen and Pi are the major organs related to the appearance of urinary protein;Pi-Shen deficiency is the basic pathogenesis. The level of UAlb is taken as one of the objective syndrome factors for Qi-Yin deficiency type. The levels of UNAG and UCysC are possibly the objective syndrome factors for Shen-Qi deficiency type.

关 键 词：糖尿病肾病 中医证候 尿蛋白 回归分析 

分 类 号：R259[医药卫生—中西医结合]