慢性肾脏病5D期伴矿物质和骨代谢紊乱中医证素特点及与冠状动脉钙化相关性研究  

Study on the Characteristics of Traditional Chinese Medicine Syndrome Factors in Chronic Kidney Disease 5D Patients with Mineral and Bone Disorder and Their Correlation with Coronary Artery Calcification

作　　者：刘建璟 徐苏苏 徐莹银 许丽璇 LIU Jianjing;XU Susu;XU Yingyin;XU Lixuan(Lishui District Hospital of Traditional Chinese Medicine,Jiangsu Provincial Hospital of Integrate Chinese and Western Medicine South Branch,Nanjing 211200,Jiangsu,China)

机构地区：[1]南京市溧水区中医院,江苏省中西医结合医院南部分院,江苏南京211200

出　　处：《实用中医内科杂志》2023年第5期134-137,共4页Journal of Practical Traditional Chinese Internal Medicine

基　　金：南京市溧水区中医院项目(LSZYJN202005)。

摘　　要：目的通过调查中心慢性肾脏病(chronic kidney disease,CKD)5D期伴矿物质和骨代谢紊乱(mineral and bone disorder,MBD)患者的中医证素特点,分析其与血管钙化程度的相关性。方法收集2019年12月—2020年12月在南京市溧水区中医院透析中心CKD5D期伴MBD患者77例,进行证素判别,分析证候权值,总结证素特点,随机抽取其中47例患者行血Ca、P、PTH检测、胸部CT平扫,采用Siemens CaScoring钙化积分软件,进行冠状动脉钙化积分(CACS,Agaston评分)计算,分析其证素特点与血管钙化程度之间的相关性。结果①77例CKD5D期伴MBD患者中医证素共涉及7个病位证素,其中病位证素前四位的是肾、脾、心、肌肤,分别达100.0%、63.6%、40.3%、37.7%。②本研究涉及10个病性证素,其中实性证素5个,虚性证素5个,按频率排名前5病性证素分别是阴虚、湿、气虚、血瘀、水停,实性病性证素出现频率较高的是湿、血瘀、水停,虚性病性证素出现频率较高的是阴虚、气虚、血虚。③CKD5D期伴MBD患者病位证素以3个病位出现频率最高,占41.6%,其次是2个病位相兼,占32.4%;病性证素以4个病性出现频率最高,占44.2%。④随机抽取的47例CKD5D期伴MBD患者冠状动脉钙化发生率高达87.2%,以轻中度钙化为主,比例分别高达36.2%、29.8%,与病位证素心、病性证素血瘀密切相关,血管钙化程度与高钙血症、高磷血症、高PTH血症密切相关(P<0.05)。结论CKD5D期伴MBD患者病位、病性证素组合分布错综复杂、虚实相兼,多种病位、病性可兼夹存在,以肾、脾、心、阴虚、湿、气虚、血瘀多见,冠状动脉钙化较为普遍,与心、血瘀证素密切相关,钙磷代谢程度与冠状动脉钙化密切相关。Objective To investigate the characteristics of Traditional Chinese Medicine syndromes of chronic kidney disease(CKD)5D patients with MBD in our center,and analyze its correlation with the degree of vascular calcification.Methods A total of 77 patients with CKD5D and mineral and bone disorder(MBD)in this dialysis center of Lishui District Hospital of Traditional Chinese Medicine from December 2019 to December 2020 were collected.The syndrome factors were discriminated,the syndrome weights were analyzed,and the characteristics of syndrome factors were summarized.Among them,47 patients were randomly selected for blood Ca and P,PTH detection,chest CT scan,Siemens CaScoring calcification score software was used to calculate the coronary artery calcification score(CACS,Agaston score),and the correlation between the characteristics of the syndrome and the degree of vascular calcification was analyzed.Results①Traditional Chinese Medicine syndrome factors of 77 patients with CKD5D stage with MBD involved 7 disease location syndrome factors,among which the top four disease location syndrome factors were kidney,spleen,heart,and skin,which reached 100.0%,63.6%,40.3%,37.7%.②This study involves 10 disease-related syndrome elements,including 5 solid-type syndrome factors and 5 deficiency-type syndrome factors.The top 5 disease-related syndrome factors by frequency are Yin deficiency,dampness,Qi deficiency,blood stasis,and water.Stop,the more frequent occurrence of solid venereal syndrome factors are wetness,blood stasis,and water stop,and the more frequent occurrence of deficiency venereal syndrome factors are yin deficiency,qi deficiency,and blood deficiency.③The 3 disease locations of patients with MBD in CKD stage 5D have the highest frequency of occurrence,accounting for 41.6%,followed by 2 disease locations,accounting for 32.4%;disease syndromes appearing in 4 disease locations The frequency is the highest,accounting for 44.2%.④The incidence of coronary artery calcification in 47 randomly selected patients with CK

关 键 词：慢性肾脏病-矿物质和骨代谢紊乱 血液透析 证素 血管钙化 

分 类 号：R277.5[医药卫生—中医学]