胡振奋,黄蔚霞,吴睿轩,邵思思,吴芊葭

• 1:浙江省温州市中医院

摘要(Abstract)：

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。

关键词(KeyWords)： 补肾泄浊法;慢性肾脏病;矿物质和骨代谢紊乱;中医证候;Klotho

Abstract:

Keywords:

基金项目(Foundation): 浙江省中医药科学研究基金项目(2015ZA198);; 温州市中医药科研课题(2014ZA001)

作者(Author): 胡振奋,黄蔚霞,吴睿轩,邵思思,吴芊葭

参考文献(References)：

• [1]Block GA,Klassen PS,Lazarus JM,et al.Mineral metabolism,mortality,and morbidity inmaintenance hemodialysis[J].J Am Soc Nephrol,2004,15(8):2209-2215.
• [2]National Kidney Foundation.K/DOQI.Clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1-S266.
• [3]梅长林.2009年KDIGO慢性肾脏病矿物质和骨异常(CKD-MBD)临床实践指南解读[J].中华肾脏病杂志,2010,26(1):63-66.
• [4]中华中医药学会肾病分会.慢性肾衰竭的诊断、辨证分型及疗效评定(试行方案)[J].上海中医药杂志,2006,40(8):8-9.
• [5]郭艳香.降磷散粉(海螵蛸)治疗腹膜透析患者高磷血症的研究[J].浙江临床医学,2008,10(9):1236.
• [6]刘连升,胡岗.海螵蛸对25例尿毒症血液透析患者血磷和甲状旁腺素的影响[J].中医杂志,2005,46(11):837-838.
• [7]马克昌,高子范,冯坤,等.骨碎补提取液对小鸡骨发育的促进作用[J].中医正骨,1990,2(4):7.
• [8]胡江平,罗方.强骨胶囊治疗肾性骨病临床观察[J].中国卫生产业,2012,13:79.
• [9]Ming Chang Hu,Makoto Kuro-o,Orson W.Moe.The emerging role of Klotho in clinical nephrology[J].Nephrol Dial Transplant,2012,27:2650-2657.
• [10]John GB,Cheng CY,Kuro-o M,et al.Role of Klotho in Aging,Phosphate Metabolism,and CKD[J].Am J Kidney Dis,2011,58:127-134.
• [11]Aline Martin,Valentin David,Darryl Quarle L,et al.Regulation and function of the FGF23/klotho endocrine pathways[J].Physiol Rev,2012,92:131-155.
• [12]de Oliveira RB,Okazaki H,Stinghen AE,et al.Vascular calcification in chronic kidney disease:a review[J].J Bras Nefrol,2013,35(2):147-161.
• [13]Ming chang Hu,Mingjun Shi,Jianning Zhang,et al.Klotho deficiency causes vascular calcification in chronic kidney disease[J].J Am Soc Nephrol,2011,22:124-136.
• [14]Krajisnik T,Olauson H,Mirza MA,et al.Z.Parathyroid klotho and fgf-receptor 1 expression decline with renal function in hyperparathyroid patients with chronic kidney disease and kidney transplant recipients[J].Kidney Int,2010,78(10):1024-1032.
• [15]Komaba H,Goto S,Fujii H,et al.Depressed expression of klotho and fgf-receptor 1 in hyperplastic parathyroid glands from uremic patients[J].Kidney Int,2010,77(3):232-238.