糖尿病肾病湿热证与微炎症的相关性分析  

Study on the Correlation Between Damp-Heat Syndrome and Microinflammation in Diabetic Kidney Disease

作　　者：陈雪吟 陈耿杭 杨丽虹[1] 刘少南[1,2] 张蕾 毛炜[1] 郭新峰[1,2] CHEN Xue-Yin;CHEN Geng-Hang;YANG Li-Hong;LIU Shao-Nan;ZHANG Lei;MAO Wei;GUO Xin-Feng(Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120 Guangdong,China;State Key Laboratory of Dampness Syndrome of Chinese Medicine,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120 Guangdong,China)

机构地区：[1]广东省中医院,广东广州510120 [2]省部共建中医湿证国家重点实验室,广东广州510120

出　　处：《广州中医药大学学报》2023年第11期2689-2696,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82004206);省部共建中医湿证国家重点实验室项目(编号:SZ2021ZZ0401,SZ2021ZZ16,SZ2021ZZ43)。

摘　　要：【目的】分析糖尿病肾病(diabetic kidney disease,DKD)湿热证与微炎症状态的相关性。【方法】采用回顾性研究方法,纳入2011年1月至2016年12月期间及2017年1月至2019年12月期间在广东省中医院住院,未进行肾脏替代治疗、未合并感染性疾病的DKD患者101例和38例,分别按中医证型分为湿热组36例、20例与非湿热组65例、18例。前者主要比较2组患者炎症指标[白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)]的水平差异,后者主要比较2组患者血清细胞因子的表达差异。【结果】(1)炎症指标方面:101例患者住院2周后的WBC、NEUT、LYM等炎症指标均处于正常参考值范围,但湿热组的WBC与LYM较入院时升高(P<0.05),且湿热组的WBC与NEUT的升高幅度大于非湿热组(P<0.05)。以升高10%为截点定义是否上升,湿热组WBC、LYM、NEUT上升的患者比例高于非湿热组(P<0.05)。应用Point-Biserial相关性分析探讨住院2周后WBC、LYM、NEUT水平与湿热证之间的相关性,结果显示,湿热证与LYM存在正相关(r=0.28,P=0.013),与WBC、NEUT未见明显相关性(WBC:r=0.24,P=0.065;NEUT:r=0.18,P=0.35);WBC、LYM、NEUT变化差值与湿热证之间存在正相关(WBC:r=0.30,P=0.01;LYM:r=0.14,P<0.01;NEUT:r=0.06,P=0.01)。(2)细胞因子方面:38例患者中,湿热组的血清趋化因子配体1(CX3CL1)、白细胞介素8(IL-8)、巨噬细胞炎症蛋白3α(MIP-3α)、巨噬细胞炎症蛋白1β(MIP-1β)、γ-干扰素(IFN-γ)、抑炎因子白细胞介素4(IL-4)、促炎因子白细胞介素5(IL-5)、白细胞介素7(IL-7)及肿瘤坏死因子α(TNF-α)较非湿热组均表现出升高趋势,但差异均无统计学意义(P>0.05)。【结论】与DKD非湿热证患者相比,DKD湿热证患者更可能处于炎症指标在正常参考值范围内小幅度上升的微炎症状态,多数在炎性反应中发挥重要作用的细胞因子在湿热证患者中有高于非湿热证患者的趋势。Objective To investigate the correlation between damp-heat syndrome and microinflammatory state in diabetic kidney disease(DKD).Methods A retrospective study was carried out in DKD hospitalized patients without renal replacement therapy and without co-infectious diseases from Guangdong Provincial Hospital of Chinese Medicine,and 101 qualified patients were collected from January 2011 to December 2016 and 38 qualified patients were collected from January 2017 to December 2019.The 101 patients were classified into 36 cases of damp-heat group and 65 cases of non-damp-heat group,and the 38 patients were divided into 20 cases of dampheat group and 18 cases of non-damp-heat group according to the traditional Chinese medicine(TCM)syndrome.The differences in the levels of inflammatory indicators of white blood cell(WBC)count,neutrophil(NEUT)count,and lymphocyte(LYM)count were compared between the two groups of 101 patients,and the differences in the expression of serum cytokines were compared between the two groups of 38 patients.Results(1)After 2 weeks of hospitalization,the inflammatory indexes of WBC,NEUT,and LYM count of 101 patients were all in the normal reference range,but the WBC count and LYM count in the damp-heat group were increased compared with those at the admission(P<0.05),and the degree of the increase of the WBC count and NEUT count in the damp-heat group was greater than that in the non-damp-heat group(P<0.05).When the cut-off point of 10%elevation was used to define whether it was elevated or not,the proportion of patients with elevated WBC,LYM,and NEUT was higher in the damp-heat group than that in the non-damp-heat group(P<0.05).Point-Biserial correlation analysis was applied to investigate the correlation of the levels of WBC,LYM,and NEUT after 2 weeks of hospitalization with the damp-heat syndrome,and the results showed that LYM count was positively correlated with the damp-heat sydrome(r=0.28,P=0.013),while was not significantly correlated with WBC count(r=0.24,P=0.065)or NEUT count(r=0.18,P=0.35

关 键 词：糖尿病肾病 微炎症 湿热证 细胞因子 炎症指标 

分 类 号：R259.872[医药卫生—中西医结合]