摘要
目的通过对慢性肾脏病(chronic kidney disease,CKD)患者甲状腺功能测定的分析,探讨甲状腺功能减退及正常甲状腺功能病态综合征与CKD的中医辨证分型的关系。方法回顾性分析经中医辨证的CKD患者临床资料,记录患者一般情况及中医辨证分型,测定甲状腺功能。依据甲状腺功能分析CKD患者甲状腺功能异常与中医辨证分型的关系。结果共有CKD 1~5期患者220例进入本研究,男130例,女90例,平均年龄(35.8±13.9)岁;入选患者中原发性肾病综合征72例,继发性肾病综合征10例,肾炎综合征70例,慢性肾衰竭68例。有49例CKD患者行肾活检,病理诊断IgA肾病24例,局灶节段性肾小球硬化6例,非典型膜性病变9例,膜性肾病8例,轻度系膜增生2例。甲状腺功能异常者26例(占11.8%),其中血清T3降低18例(占69.2%),血清T3、T4降低4例(占15.4%),血清T3降低、血清促甲状腺素(thyroid stimulating hormone,TSH)升高1例(占3.9%),血清T4降低3例(占11.5%)。CKD 5期组患者血清T3低于CKD 1~2期组及CKD 3~4期组,差异有统计学意义(P<0.05),三组间血清T4、血清TSH无统计学差异(P>0.05)。对CKD患者甲状腺功能异常者进行中医辨证分型发现,甲状腺功能异常中单以T3降低,T4、TSH无异常者主要表现为脾肾阳虚型,次要表现为脾肾气虚型;以T3、T4均降低,伴或不伴TSH升高者主要表现为阴阳两虚型,次要表现为气阴两虚型及脾肾阳虚型。结论 CKD患者甲状腺功能异常主要表现为血清T3浓度下降,T4正常或下降,促甲状腺素浓度处于正常范围,甲状腺素水平与中医辨证分型存在一定的关系,对CKD患者合并非甲状腺疾病综合征进行中医辩证施治,以温补肾阳、补脾益气为主要治疗原则,可辅助治疗亚临床甲状腺功能减退及正常甲状腺功能病态综合征。
Objective By analyzing serum thyroid hormone in patients with chronic kidney disease （CKD）, to discuss the relationship between hypothyroidism and normal hypothyroidism and syndrome differentiation of CKD. Methods The general data of patients and syndrome differentiation of traditional Chinese medicine were recorded, and the serum thyroid hormone levels were determined. The abnormal thyroid hormone was analyzed in patients with CKD and the relationship between syndrome differentiation of traditional Chinese med{eine and abnormal thyro{d hormone was evaluated. Resuits 220 CKD patients with stage 1-5 were enrolled in this study. There were 130 males and 90 fe- males with the average age of （35.8 ± 13. 9） years old. There are 72 cases of primary nephrotic syndrome, and 10 cases of secondary nephrotie syndrome. Of 70 eases of nephritis syndrome, there were 28 cases of lupus nephritis. Of 68 eases of chronic renal failure, 49 patients received renal biopsy. Pathologically, there were 24 cases of IgA nephropathy, 6 cases of segmental glomerular sclerosis in the loci segment, 9 cases of atypical film stasis, 8 cases of membranous nephropathy, and .2 cases of mild mesangial hyperplasia. Twenty-six cases had abnormal thyroid function （11.8%）, in which the serum T3 of 18 cases （69. 2%） was decreased. The serum T3 and T4 levels in 4 cases （15. 4%） were decreased. In one case （3. 9%）, the serum T3 and thyroid stimulating hormone （TSH） levels were in- creased. The serum T4 levels in 3 cases （11.5 %） were decreased. The serum T3 levels in the patients with CKD 5 were significantly lower than in those with CKD 1-2 and CKD 3-4 （P〈0. 05）. There was no significant difference in serum T4 and serum TSH levels among three groups （P〉0. 05）. Through syndrome differentiation of traditional Chinese medicine in CKD patients with abnormal thyroid hor- mone, it was found that the patients with decreased T2, and normal T4 and TSH showed the main manifestation of spleen kidney Yang deficiency type, and the secondary manifestation of Qi deficiency type in spleen and kidney. The patients with decreased T3 and T4 with/without increase of TSH showed the main manifestation of deficiency type of both yin and yang, and the secondary manifestation of Qi Yin deficiency and spleen kidney Yang deficiency type. Conclusions In CKD patients, serum T3 level was decreased, T4 level was normal or decreased, and TSH level was in the normal range. There is a certain relationship between the thyroid hormone level and syndrome differentiation of traditional Chinese medicine. For CKD patients combined with non-thyroid disease syndrome, traditional Chinese medicine dialectical treatment with warming Yang, tonifying spleen and replenishing qi as the main therapeutic principles can treat subclinical hypothyroidism and normal thyroid sick syndrome.
出处
《临床肾脏病杂志》
2017年第9期530-533,共4页
Journal Of Clinical Nephrology
基金
湖北省自然科学基金面上项目(No.2014CFC1038)
关键词
慢性肾脏病
甲状腺功能
中医
辩证施治
Chronic kidney disease
Thyroid hormone
Traditional Chinese medicine
Dialectical treatments
