Study Of Relationship Between Traditional Chinese Medicine Syndrome Differentiation-Type Of Chronic Renal Insufficiency And Mineral & Bone Disorder

Objective:To make TCM Syndrome Differentiation(TCM-SD) for chronic renal insufficiency(CRI) patients and determine some index relative to Mineral&Bone disorder of these patients.And then,the prevalence of different TCM-SDTs of CRI patients and its' correlation with those index mentioned above were study.By doing this, it may provide reliable basis for making TCD differentiation objectively and treating exactly.Methods:40 CRI patients have been divided into 5 types by TCM differentiation standard, which were Syndrome of Qi deficiency of spleen and kidney(QSK),Syndrome of Yang deficiency of spleen and kidney(YSK),Syndrome of deficiency of both Qi and Yin(QY),Syndrome of Yin deficiency of liver and kidney(YLK),Syndrome of deficiency of both Yin and Yang(YY).While for control group,there were 25 healthy persons enrolled.And then,serum Ca,P,Alkaline phosphatase(AP),parathyroid hormone(PTH),bone density of this two groups have been measured and compared.In addition,correlation of TCM-SDT and those index mentioned above have also been studied.Results:1.The incidence rate ofQSK,YSK,QY,YLK and YYwas 32%,30%,18%,15%and 5%respectively.2.The serum creatinine concentration of YSK,QY,QSK and YLK was 524.62±134.89 umol/L,725.62±170.14umol/L,688.33±82.39umol/L,846.00±177.85umol/L, 1346.50±99.70umol/L respectively.And that of QSK was significantly lower than other 4 types.3.Compared to control group,serum Ca and P of CRI patients were significantly abnormal.And the concentration of serum Ca of QSK,QY,YLK and YSK were 1.94±0.25mmol/L,1.92±0.38mmol/L 1.89±0.19mmol/L and 1.67±0.34mmol/L respectively.While for serum P,the figures of YSK,YLK,QY and QSK were 2.47±0.519mmol/L,2.40±0.65mmol/L,2.09±0.3 lmmol/L and 1.97±0.50mmol/L respectively.There also existed significantly difference between QSK and YSK patients(P＜0.01).4.The concentration of serum AP of YSK,QY,QSK and YLK was 99.00±33.35U/L, 91.43±13.72U/L,80.92±22.31U/L and 69.33±24.48U/L respectively.And concentration of YSK and QY were significantly higher than control group(P＜0.05),there also existed significantly difference between YSK and YLK patients(P＜0.05).5.As for concentration of serum iPTH,the figure of YLK,QY,YSK and YY was 434.67±191.86pg/ml,415.29±270.74pg/ml,340.67±270.74pg/ml and 199.93±121.23 pg/ml respectively which were all significantly higher than control group (QSP vs control group,P＜0.05;other types vs control group,P＜0.01).In addition, there also existed significantly difference between QSP and YLK patients(P＜0.05).6.The figure of bone density of QSK,YSK,YLK and YY was 0.32±1.04,-1.09±1.144, -1.52±2.07 and -2.04±1.86 respectively.And that of YSK,YLK and YY were significantly lower than QSK and control group(P＜0.01).Conclusion:1.The level of serum creatinine of QSK patient was significantly lower than other TCD types,so QSK may be the major TCM type at early stage of CRI.And then, the TCD type may develope from QSK,YSK/YLK,QY to YY graduallay.2.Abnormality of Ca & P metabolism and secondary hyperparathyroidism which occurred in QSD patients suggested the importance and necessity of correcting these abnormalities at early stage and/or QSD of CRI patients.3.Bone densitometry of YSK,YLK,QY patients were obviously reduced, demonstrating osteoporosis occurred in these patients.At the same time,OBD has been found to be associated with TCM-SDT.4.iPTH and OBD could be looked as markers for making TCM-SDT and judging its turnover of CRI patients.