| Objective:Cross-sectional investigation was carried out to observe the distribution of TCM syndromes associated with complications associated with calcium and phosphorus metabolism abnormality(CKD-MBD)in patients with maintenance hemodialysis(MHD)and its relationship with serum klotho protein level.To explore the objective index of TCM syndrome differentiation in patients with MBD.Methods:The clinical information of MHD patients with MBD was collected and the serum Klotho protein level and related laboratory indexes were detected simultaneously.The relationship between Klotho and TCM syndrome type and CKD-MBD related laboratory indexes was analyzed.Results:(1)General information:154 patients were collected,including 88 males(57.14%)and 66 females(42.86%).The average age of the patients was(58.9±13.8)years.The shortest dialysis age was 3 months,the longest was 145 months,and the median dialysis age was 29.5 months.The primary diseases were chronic glomerulonephritis in 60 cases(38.96%),diabetic nephropathy in 48 cases(31.17%),hypertension nephropathy in 17 cases(11.04%),polycystic kidney in 4 cases(2.60%),chronic interstitial nephritis in 2 cases(1.29%).One case(0.65%)had urinary acid nephropathy and 22 cases(13.29%)had unknown cause.There were 138 cases of hypertension(89.61%),53 cases of diabetes mellitus(34.41%),71 cases of coronary heart disease(46.10%)and 21 cases of cerebral infarction(13.63%).(2)The distribution of TCM syndrome type:? The frequency distribution of deficiency syndrome and standard syndrome:among 154 patients,the frequency of deficiency of liver and kidney yin syndrome was the highest,followed by deficiency of spleen and kidney qi and yang deficiency of spleen and kidney.? Frequency distribution of both deficiency and reality;The frequency of liver-kidney yin deficiency syndrome in turn is as follows:blood stasis syndrome,damp-turbid syndrome,damp-heat syndrome;The frequency of spleen-kidney qi deficiency syndrome in turn is as follows:blood stasis syndrome,damp-turbid syndrome,damp-heat syndrome;The frequency of spleen-kidney yang deficiency syndrome in turn is as follows:blood stasis syndrome,water-qi syndrome,damp-turbid syndrome;There was significant difference in frequency distribution of both deficiency and reality(P<0.05).?Distribution of deficiency syndrome and standard syndrome in different age groups;the proportion of liver-kidney yin deficiency syndrome increased with age.In all age groups,the frequency of blood stasis syndrome was higher than that of other signs,but there was no significant difference in the distribution of deficiency syndrome and standard syndrome among different age groups(P>0.05).? Distribution of this deficiency syndrome and standard syndrome in each dialytic age:with the increase of dialysis age,the frequency of liver-kidney yin deficiency syndrome increased,and the proportion of blood stasis syndrome and damp-heat syndrome showed an increasing trend.The distribution of deficiency syndrome in each dialytic age had statistical significance(P<0.05),but there was no statistical difference in the distribution of standard evidence in each dialytic age(P>0.05).?The distribution of deficiency syndrome and standard syndrome in each complicated disease;138 cases(89.61%)were complicated with hypertension.This deficiency syndrome is characterized by deficiency of liver and kidney yin,deficiency of spleen and kidney yang,deficiency of spleen and kidney qi.The syndrome of blood stasis and dampness were the most common syndrome of standard syndrome.The patients with diabetes mellitus were characterized by deficiency of liver and kidney yin,deficiency of spleen and kidney yang,standard demonstration syndrome were blood stasis and dampness.The patients with coronary heart disease were characterized by deficiency of liver and kidney yin,deficiency of spleen and kidney yang,standard demonstration syndrome were blood stasis and dampness.The patients with cerebral infarction were deficiency of liver and kidney yin,deficiency of spleen and kidney yang,standard demonstration syndrome were blood stasis and dampness.There was no significant difference between the deficiency syndrome and the standard evidence in the distribution of the complicated diseases(P>0.05).(3)The distribution of Klotho protein level in TCM syndrome types:?The difference of the distribution of klotho protein in this deficiency syndrome:spleen-kidney qi deficiency syndrome,liver-kidney yin deficiency syndrome,spleen-kidney yang deficiency syndrome,the lowest concentration of klotho protein was found in spleen-kidney qi deficiency syndrome,the difference was statistically significant(P<0.05).? The difference of the distribution of klotho protein in mark syndrome:the klotho protein concentration in damp-heat syndrome was the lowest.Compared with blood stasis syndrome,the difference was statistically significant(P<0.05).(4)The relationship between Klotho protein and laboratory indexes:? Distribution difference of Klotho protein level in MHD patients and healthy persons:compared with 42 healthy controls,the concentration of klotho protein in MHD patients was significantly lower than that in healthy controls(P<0.05).? The relationship between the level of klotho protein and the concentration of serum calcium(Ca),phosphorus(P),parathyroid hormone(PTH):according to the ideal value level,ca,p,pth was divided into three groups:high/lower ideal group and ideal group.There was no significant difference in the concentration of klotho protein among the three groups of Ca.P(P>0.05).The concentration of klotho protein in the ideal group of PTH was significantly higher than that in the group of lower ideal value(P<0.05).Conclusion:? The syndrome type of TCM in hemodialysis patients with MBD is the deficiency of liver and kidney yin and the syndrome of blood stasis.? The level of klotho protein in hemodialysis patients with MBD was significantly lower than that in healthy subjects.?In hemodialysis patients with MBD,the klotho protein level of spleen and kidney qi deficiency syndrome was lower than that of liver and kidney yin deficiency syndrome,suggesting that the low level of Klotho protein level may be an objective index of syndrome differentiation of qi deficiency syndrome. |
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