慢性肾脏病患者动脉硬化中医证型分布与血klotho蛋白、FGF23水平的相关性研究

摘要

Objective:To study the relationship between klotho、FGF23 level and atherosclerosis in Chronic Kidney Disease patients and the syndrome patterns in TCMD iferential Diagnostics.Methods:Selected 296 CKD patients with atherosclerosis according to intima-media thickness of carotid artery measured by Color Doppler ultrasound.All patients we re carried out syndrome differentiation according to the stand ard of the syndrome differentiation of TCM.All patients were detected serum klotho,FGF23.Investigated the relation ship between the laboratory parameters and the syndrome patterns in TCM differential diagnostic.Results:This deficiency syndrome type thickening of CIMT group with spleen and kidney empty most (50.3％),followed by the spleen kidney yang deficiency syndrome (17.4％),qi and yin deficiency syndrome (16.1％),liver and kidney yin deficiency syndrome (9.3％),yin and yang are two virtual at least (6.8％),compared with the justification of CIMT group of corresponding normal distribution had significant difference (P ＜ 0.05).Evil empirical thickening of CIMT group in the empirical model with dampness syndrome most (36.6％),followed by blood stasis (33.5％),moisture (13％),damp heat syndrome (9.9％),turbidity toxin syndrome (6.8％),atleast compared with the justification of CIMT group of corresponding normal distribution had significant difference (P ＜ 0.05).Blood klotho protein thickening of CIMT group was obviously lower CIMT group,normal FGF23 levels are higher than that of normal CIMT group,had significant difference (P ＜ 0.05).This type deficiency syndrome of spleen and kidney deficiency group compared with the other groups,blood klotho protein significantly decreased(P ＜ 0.05),FGF23 levels increased significantly(P ＜ 0.05),and the empirical of dampness and blood stasis group,respectively,compared with other groups FGF23 increased significantly (P ＜ 0.05),Logistic regression analysis showed that age,FGF23 and HsCRP,comorbid diabetes,spleen and kidney deficiency syndrome,blood stasis syndrome,damp turbidity are independent risk factors of CIMT thickening.Conclusion:Patients with chronic kidney disease (CKD) klotho protein,hardening of the arteries and blood FGF23 levels are closely related,the spleen and kidney deficiency and dampness syndrome,blood stasis performance is the most obvious.%目的:探讨慢性肾脏病动脉硬化患者中医证型与血klotho蛋白、FGF23水平的关系,探究中医病机及辨证论治的规律.方法:296例慢性肾脏病患者,根据彩超测定颈动脉内膜厚度进行分组,按照慢性肾衰竭中医辨证分型标准进行辨证分型.检测血清klotho蛋白、FGF23水平等指标,分析不同中医证型与各项参数的关系.结果:CIMT增厚组在本虚证型中以脾肾气虚最多(50.3％),依次为脾肾阳虚证(17.4％),气阴两虚证(16.1％),肝肾阴虚证(9.3％),阴阳两虚最少(6.8％),与CIMT正常组对应的证型分布比较均差异有统计学意义(P＜0.05).CIMT增厚组在邪实证以湿浊证最多(36.6％),依次为血瘀证(33.5％),水气证(13％),湿热证(9.9％),浊毒证最少(6.8％),与CIMT正常组对应的证型分布比较差异有统计学意义(P＜0.05).CIMT增厚组血klotho蛋白明显较CIMT正常组降低,FGF23水平较CIMT正常组升高,有统计学意义(P＜0.05).本虚证型中脾肾气虚组血klotho蛋白明显低于其他组(P＜0.05),FGF23水平明显升高(P＜0.05),邪实证中湿浊组及血瘀组分别与其他组比较FGF23明显升高(P＜0.05),Logistic回归分析表明年龄、FGF23和HsCRP、伴发糖尿病、脾肾气虚证、血瘀证、湿浊证是CIMT增厚的独立危险因素.结论:慢性肾脏病患者动脉硬化与血klotho蛋白、FGF23水平密切相关,在脾肾气虚证、湿浊证、血瘀证表现最明显.