Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study

XIE Lifen; ZHANG Lili; LUO Qin; WU Mengni; QIN Linsen; ZHANG Qiaoying; QI Jieying; GUAN Haiyu; NIE Xiaoli

doi:10.13288/j.11-2166/r.2023.23.009

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Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study

更新时间：2023-11-24

- Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study
  增强出版
- Journal of Traditional Chinese Medicine Vol. 64, Issue 23, Pages: 2419-2426(2023)
- 作者机构：
  
  南方医科大学中西医结合医院，广东省广州市海珠区石榴岗路13号，510315
- 作者简介：
- 基金信息：
- DOI：10.13288/j.11-2166/r.2023.23.009
  CLC：
- Received：25 May 2023，
  
  Revised：2023-09-22，
  
  Published：02 December 2023
- 稿件说明：
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谢丽芬,张莉莉,罗芹等.慢性肾脏病维持性血液透析蛋白质能量消耗患者中医证型及临床影响因素分析——横断面调查[J].中医杂志,2023,64(23):2419-2426.

XIE Lifen,ZHANG Lili,LUO Qin,et al.Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study[J].Journal of Traditional Chinese Medicine,2023,64(23):2419-2426.
谢丽芬,张莉莉,罗芹等.慢性肾脏病维持性血液透析蛋白质能量消耗患者中医证型及临床影响因素分析——横断面调查[J].中医杂志,2023,64(23):2419-2426. DOI： 10.13288/j.11-2166/r.2023.23.009.

XIE Lifen,ZHANG Lili,LUO Qin,et al.Traditional Chinese Medicine Syndromes and Influencing Factors of Protein Energy Wasting in Chronic Kidney Disease Patients Undergoing Maintenance Hemodialysis：a Cross-sectional Study[J].Journal of Traditional Chinese Medicine,2023,64(23):2419-2426. DOI： 10.13288/j.11-2166/r.2023.23.009.

摘要

目的

探讨慢性肾脏病维持性血液透析（MHD）蛋白质能量消耗（PEW）患者的中医证型分布情况及疾病发生的影响因素。

方法

纳入164例MHD患者，按照是否诊断为PEW分为PEW组和非PEW组，收集两组患者临床资料，包括一般资料（性别、年龄、身高、体重等）、疾病资料（病程、合并疾病、透析龄等）、实验室指标（血常规、肝功能、肾功能、电解质、血脂等）、握力、中医四诊信息。将两组临床资料中差异有统计学意义（

＜0.05）的指标作为自变量，是否诊断为PEW作为因变量，采用Logistic回归分析PEW发生的影响因素。

结果

164例MHD患者中PEW组患者96例（58.5%），非PEW组68例（41.5%）。PEW组患者年龄、卧床比例、深静脉置管比例、水肿比例、低握力比例及合并2型糖尿病、心脑血管疾病、感染、贫血的比例，以及丙氨酸氨基转移酶、门冬氨酸氨基转移酶水平显著高于非PEW组；体重指数、自我照顾比例、动静脉内瘘比例、红细胞计数，及血红蛋白、血清总蛋白、血清白蛋白水平显著低于非PEW组（

＜0.05）。PEW组患者纳呆腹胀、畏寒喜暖、少气乏力、畏寒肢冷、神疲乏力、纳差、少尿、恶心呕吐出现频率显著高于非PEW组（

＜0.05），PEW组阴阳俱虚证、湿浊证占比显著高于非PEW组，而肝肾阴虚证、风动证显著低于非PEW组（

＜0.05）。Logistic回归分析结果显示，低体重指数（＜22 kg/m

）、不能自我照顾、低握力、低血清白蛋白（＜38 g/L）、感染、高龄、畏寒肢冷、纳差是MHD患者发生PEW的危险因素（

＜0.05）。

结论

MHD-PEW患者以阴阳俱虚证为本证，多兼见湿浊证，在临床中低体重指数、低血清白蛋白、感染、高龄可能是MHD患者发生PEW的影响因素。

Abstract

Objective

To investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）.

Methods

According to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （

＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference.

Results

Out of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （

＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （

＜0.05）. The incidence of both

yin

and

yang

deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney

yin

deficiency syndrome and stirring of wind syndrome were lower （

＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m

）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （

＜0.05）.

Conclusion

The root syndrome of MHD-PEW patients is both

yin

and

yang

deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.

关键词

Keywords

references

FOUQUE D ， KALANTAR-ZADEH K ， KOPPLE J ， et al . A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease ［J］. Kidney Int ， 2008 ， 73 （ 4 ）： 391 - 398 .

CARRERO JJ ， THOMAS F ， NAGY K ， et al . Global prevalence of protein-energy wasting in kidney disease： a meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism ［J］. J Ren Nutr ， 2018 ， 28 （ 6 ）： 380 - 392 .

CARRERO JJ ， STENVINKEL P ， CUPPARI L ， et al . Etiology of the protein-energy wasting syndrome in chronic kidney disease： a consensus statement from the International Society of Renal Nutrition and Metabolism （ISRNM）［J］. J Ren Nutr ， 2013 ， 23 （ 2 ）： 77 - 90 .

郭花斌，辛宝，张祺，等 . 维持性血液透析患者蛋白质能量消耗的中医药防治进展［J］. 医学综述， 2019 ， 25 （ 18 ）： 3677 - 3681 .

Kidney Disease ： Improving Global Outcomes （KDIGO） CKD Work Group . KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease ［J］. Kidney Int Suppl ， 2013 ， 3 （ 1 ）： 1 - 150 .

LEVEY AS ， STEVENS LA ， SCHMID CH ， et al . A new equation to estimate glomerular filtration rate ［J］. Ann Intern Med ， 2009 ， 150 （ 9 ）： 604 - 612 .

郑筱萸 . 中药新药临床研究指导原则（试行）［M］. 北京：中国医药科技出版社， 2002 ： 163 - 165 .

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 .

KOVESDY CP ， KOPPLE JD ， KALANTAR-ZADEH K . Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease： reconciling low protein intake with nutritional therapy ［J］. Am J Clin Nutr ， 2013 ， 97 （ 6 ）： 1163 - 1177 .

VETTORETTI S ， CALDIROLI L ， ARMELLONI S ， et al . Sarcopenia is associated with malnutrition but not with systemic inflammation in older persons with advanced CKD ［J］. Nutrients ， 2019 ， 11 （ 6 ）： 1378 .

MATOS CM ， SILVA LF ， SANTANA LD ， et al . Handgrip strength at baseline and mortality risk in a cohort of women and men on hemodialysis： a 4-year study ［J］. J Ren Nutr ， 2014 ， 24 （ 3 ）： 157 - 162 .

叶琼，邵国建，刘琦，等 . 握力测量在维持性血液透析患者营养评估中的应用［J］. 现代实用医学， 2016 ， 28 （ 4 ）： 432 - 433 .

胡美玲 . 维持性血液透析患者握力水平与营养状况的相关性分析［D］. 百色：右江民族医学院， 2019 .

BONANNI A ， MANNUCCI I ， VERZOLA D ， et al . Protein-energy wasting and mortality in chronic kidney disease ［J］. Int J Environ Res Public Health ， 2011 ， 8 （ 5 ）： 1631 - 1654 .

HU Z ， WANG H ， LEE IH ， et al . Endogenous glucocorticoids and impaired insulin signaling are both required to stimulate muscle wasting under pathophysiological conditions in mice ［J］. J Clin Invest ， 2009 ， 119 （ 10 ）： 3059 - 3069 .

MEUWESE CL ， CARRERO JJ ， STENVINKEL P . Recent insights in inflammation-associated wasting in patients with chronic kidney disease ［J］. Contrib Nephrol ， 2011 ， 171 ： 120 - 126 . doi： 10.1159/000327228 http://dx.doi.org/10.1159/000327228 .

KALANTAR-ZADEH K ， KOPPLE JD ， BLOCK G ， et al . A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients ［J］. Am J Kidney Dis ， 2001 ， 38 （ 6 ）： 1251 - 1263 .

TOYODA K ， KURAGANO T ， KAWADA H ， et al . Effect of progression in malnutrition and inflammatory conditions on adverse events and mortality in patients on maintenance hemodialysis ［J］. Blood Purif ， 2019 ， 47 （ Suppl 2 ）： 3 - 11 .

KALANTAR-ZADEH K ， KILPATRICK RD ， KUWAE N ， et al . Revisiting mortality predictability of serum albumin in the dialysis population： time dependency， longitudinal changes and population-attributable fraction ［J］. Nephrol Dial Transplant ， 2005 ， 20 （ 9 ）： 1880 - 1888 .

CABEZAS-RODRIGUEZ I ， CARRERO JJ ， ZOCCALI C ， et al . Influence of body mass index on the association of weight changes with mortality in hemodialysis patients ［J］. Clin J Am Soc Nephrol ， 2013 ， 8 （ 10 ）： 1725 - 1733 .

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