CAJ | 학술논문

目的：探讨糖尿病肾病(DN)患者中医证型与甲状腺激素水平的相关性。方法：收集2011年1月至2013年12月山东省中医药大学第二附属医院肾病内科收治的DN患者164例，根据中医辨证分为本证5型：阴虚燥热型18例、肝肾阴虚型24例、气阴两虚型55例、脾肾气虚(或阳虚)型32例、阴阳两虚型35例；标证3型：湿浊证41例、血瘀证51例、痰瘀证33例；另选同期单纯糖尿病患者21例作为对照组。比较分析DN本证、标证及对照组患者间的甲状腺激素水平。结果：本证中阴虚燥热型T3、FT3、T4、FT4均明显高于对照组， TSH低于对照组(P＜0.05)；肝肾阴虚型、气阴两虚型、脾肾气虚(阳虚)型、阴阳两虚型T3、FT3、T4、FT4明显低于对照组，TSH高于对照组(P＜0.05)；不同证型T3、FT3、T4、FT4水平依次为阴阳两虚型＜脾肾气虚(阳虚)型＜气阴两虚型＜肝肾阴虚型(P＜0.05)。湿浊证、血瘀证、痰瘀证T3、FT3、T4、FT4均低于对照组(P＜0.05)， TSH高于对照组(P＜0.05))。结论：甲状腺激素水平与DN的中医证型密切关系，可作为反映DN进展和转归的客观指标。
목적：탐토당뇨병신병(DN)환자중의증형여갑상선격소수평적상관성。방법：수집2011년1월지2013년12월산동성중의약대학제이부속의원신병내과수치적DN환자164례，근거중의변증분위본증5형：음허조열형18례、간신음허형24례、기음량허형55례、비신기허(혹양허)형32례、음양량허형35례；표증3형：습탁증41례、혈어증51례、담어증33례；령선동기단순당뇨병환자21례작위대조조。비교분석DN본증、표증급대조조환자간적갑상선격소수평。결과：본증중음허조열형T3、FT3、T4、FT4균명현고우대조조， TSH저우대조조(P＜0.05)；간신음허형、기음량허형、비신기허(양허)형、음양량허형T3、FT3、T4、FT4명현저우대조조，TSH고우대조조(P＜0.05)；불동증형T3、FT3、T4、FT4수평의차위음양량허형＜비신기허(양허)형＜기음량허형＜간신음허형(P＜0.05)。습탁증、혈어증、담어증T3、FT3、T4、FT4균저우대조조(P＜0.05)， TSH고우대조조(P＜0.05))。결론：갑상선격소수평여DN적중의증형밀절관계，가작위반영DN진전화전귀적객관지표。
Objective:To explore the relativity between TCM patterns of diabetic nephropathy (DN) and the level of thyroid hormone. Methods: Altogether 164 DN patients admitted to nephrology department of Shandong Provincial Hospital of Integrative Medicine were collected from January, 2011 to December, 2013, according to syndrome differentiation, they were grouped into five kinds of the root causes: 18 cases of Yin-deficiency and dryness-heat pattern, 24 cases of liver-kidney Yin-deficiency pattern, 55 cases of Qi-Yin dual deficiency pattern, 32 cases of spleen-kidney Qi-deficiency (Yang-deficiency) pattern, 35 cases of Yin-Yang dual deficiency pattern;three types of the branch causes:41 cases of dampness-turbidity pattern, 51 cases of blood stasis pattern and 33 cases of phlegm stasis pattern;meanwhile, 21 patients with diabetes mellitus were selected as the control group. The levels of thyroid hormone in the groups were compared. Results:The levels of T3, FT3, T4 and FT4 in Yin-deficiency and dryness-heat pattern of the root causes were higher than these of the control group notably, the level of TSH was lower than that of the control group obviously (P<0.05); the levels of T3, FT3, T4 and FT4 in the patients of liver-kidney Yin-deficiency pattern, Qi-Yin dual deficiency pattern, spleen-kidney Qi-deficiency (Yang-deficiency) pattern, Yin-Yang dual deficiency pattern were lower than these of the control group evidently, TSH level was higher than that of the control group notably (P<0.05);the levels of T3, FT3, T4 and FT4 in different patterns were in the order:Yin-Yang dual deficiency pattern<spleen-kidney Qi-deficiency (Yang-deficiency) pattern<Qi-Yin dual deficiency pattern<liver-kidney Yin-deficiency pattern(P<0.05). The levels of T3, FT3, T4 and FT4 in the patients of dampness-turbidity pattern, blood stasis pattern and phlegm stasis pattern were lower than these of the control group clearly(P<0.05), TSH level was higher than the control group remarkably (P<0.05). Conclusion:The level of thyroid hormone is closely related to TCM patterns of DN, and it could be used as an objective index of reflecting the development and consequence of DN.