补肾泄浊法对慢性肾脏病3-5期患者中医证候及矿物质骨代谢的影响

摘要

Objective:To investigate the effect of Bushen Xiezhuo method on TCM syndrome and MBD of patients in stage 3-5 of chronic kidney disease.Methods:71 patients with chronic kidney disease in stage 3-5,in line with the United States 2002 K/DOQI chronic kidney disease diagnostic criteria and staging criteria,as well as of 2009 KDIGO CKD-MBD defined standards,were divided into the Chinese medicine group and the control group by random number table,according to the designed treatment plan,and the TCM syndrome scores of each group before and after treatment were observed.Double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to determine the level of Klotho protein in peripheral blood,determination of parathyroid hor mone and 25 hydroxyvitamin D3 by radioimmunoassay.BUN,Scr,Ca,P and AKP in blood were determined byBECKAN-800 automatic biochemical analyzer.Results:1)In the CKD3-4 stage,compared with before treatment,TCM syndrome scores significantly decreased in Chinese medicine group (P＜ 0.05).The TCM syndrome score of the control group was lower than before,but the difference was not statistically significant (P＞ 0.05).In stage CKD5 patients,there was no significant change in TCM syndrome scores before and after treatment in the Chinese medicine group and the control group.2)In the CKD3-4 stage,compared with before treatment,P and PTH levels of Chinese medicine group decreased significantly (P＜0.05 or P＜0.01).Ca,Klotho and 25(OH)D3 levels,compared with those before treatment,increased significantly(P＜ 0.05).Compared with before treatment,P level of the control group was decreased significantly (P＜ 0.05);Ca and 25 (OH)D3,compared with those before treatment,increased significantly (P＜ 0.05).The differences in AKP,PTH and Klotho level had no statistical significance (P＞ 0.05).3)In the CKD3-4 stage,Klotho and 25 (OH)D3 levels,compared with those before treatment,increased significantly (P＜ 0.05).Compared with before treatment,AKP level of Chinese medicine group decreased significantly (P＜ 0.05).Although Ca had an upward trend,P and PTH had a downward trend,but the difference was not statistically significant.The level of 25 (OH)D3 in the control group was significantly lower than that before treatment (P＜ 0.05),but there was no significant difference in the levels of Ca,P,PTH,AKP and Klotho (P ＞ 0.05).Conclusion:Bushen Xiezhuo may improve the Klotho and 25 (OH) D3 levels,and reduce PTH expression by adjusting the calcium and phosphorus metabolism level of patients with CKD-MBD in stage 3-5,so as to improve the disorder of mineral and bone metabolism in patients,and reduce the clinical integral of TCM syndromes.%目的 观察补肾泄浊法对慢性肾脏病3-5期患者中医证候及矿物质骨代谢的影响并探讨其机制.方法 将患者71例采用随机数字表法分为中药组和对照组,分别观察两组患者治疗前后中医证候积分.同时采用双抗体夹心酶联免疫吸附(ELISA)法测定外周血中Klotho蛋白水平,免疫放射法测定甲状旁腺激素、25羟维生素D3.血液中BUN、Scr、Ca、P、AKP采用BECKAN-800全自动生化分析仪测定.结果 在CKD3-4期,与治疗前比较,中药组中医证候积分显著降低(P＜0.05),对照组中医证候积分虽较前降低趋势,但差异无统计学意义(P＞0.05).在CKD5期患者中,中药组及对照组在治疗前后其中医证候积分无明显变化(P＞0.05).在CKD3-4期,与治疗前比较,中药组的P、PTH水平较治疗前显著下降(P＜0.05或P＜0.01),Ca、Klotho及25(OH)D3水平较治疗前显著升高(P＜0.05);对照组P水平较治疗前显著下降(P＜0.05),Ca、25(OH)D3较治疗前显著升高(P＜0.05),AKP、PTH、Klotho水平变化差异无统计学意义(P＞0.05).在CKD5期,中药组的Klotho与25(OH)D3较治疗前显著升高(P＜0.05),以及AKP水平较治疗前显著下降(P＜0.05),而Ca虽较前有上升趋势、P、PTH虽有下降趋势,但差异均无统计学意义.对照组25(OH)D3水平较治疗前显著下降(P＜0.05),而Ca、P、PTH、AKP、Klotho水平变化均无显著性差异(P＞0.05).结论 补肾泄浊方可能通过调节CKD3-5期患者血中钙、磷代谢水平,提高Klotho、25(OH)D3水平,降低PTH的表达,从而改善患者矿物质和骨代谢紊乱,同时可减轻患者中医证候临床积分.