基于心肾代谢综合征探讨无症状期下肢动脉粥样硬化早期肾损伤与中医证素的相关性

A study on the correlation between early renal injury and traditional Chinese medicine syndrome elements in asymptomatic lower extremity atherosclerosis based on cardiovascular-kidney-metabolic syndrome

关键词:  无症状期下肢动脉粥样硬化  早期肾损伤  心肾代谢综合征  中医证素

Key words:  asymptomatic lower extremity atherosclerosis  early renal injury  cardiovascular-kidney-metabolic syndrome  TCM

摘要:

[目的] 本研究基于心肾代谢综合征（CKM）理论框架，探讨无症状期下肢动脉粥样硬化（LEAD）患者早期肾损伤与中医证素的相关性。[方法] 回顾性分析216例无症状期LEAD患者，按尿微量白蛋白（MAU）水平分为MAU正常组（MAU<30 mg/L，140例）与MAU异常组（MAU≥30 mg/L，76例），比较两组中医证素分布差异，采用Spearman相关分析与二元Logistic回归分析证素与肾功能指标的关系。[结果] MAU异常组年龄、高血压病病史比例、动脉斑块负荷（Crouse积分）、血肌酐、胱抑素C均高于正常组，踝肱指数（ABI）和估算肾小球滤过率（eGFR）较低（P<0.05）。中医证素分布以痰浊（50.0%）、气虚（47.7%）、血瘀（43.5%）为主，MAU异常组痰浊证素比例（61.8%）显著高于正常组（43.6%，P<0.05）。Logistic回归显示，高血压病病史（OR=2.106）、ABI（OR=0.153）、痰浊证素（OR=2.043）是MAU异常的独立影响因素（P<0.05）。[结论] 无症状期LEAD患者早期肾损伤是高血压、血管病变与代谢紊乱共同作用的结果。痰浊证素占比最高且在MAU异常组显著偏高，提示其在“代谢-血管-肾脏”交互损伤中可能起核心作用，为中西医结合干预提供新思路。

Abstract:

[Objective] Based on the cardiovascular-kidney-metabolic（CKM） framework，this study aimed to explore the correlation between early renal injury and traditional Chinese medicine（TCM） syndrome elements in patients with asymptomatic lower extremity arterial atherosclerosis（LEAD）. [Methods] A retrospective analysis was conducted on 216 asymptomatic LEAD patients，who were categorized into a normal microalbuminuria（MAU） group（MAU<30 mg/L，140 cases） and an abnormal MAU group（MAU≥30 mg/L，76 cases）. The distribution of TCM syndrome elements was compared between groups. Spearman correlation and binary logistic regression were used to examine associations between syndrome elements and renal function indicators. [Results] The abnormal MAU group had significantly higher age，proportion of hypertension history，Crouse score，serum creatinine，and cystatin C，but lower ankle-brachial index（ABI） and estimated glomerular filtration rate（eGFR），P<0.05. The predominant TCM syndrome elements were phlegm-turbidity（50.0%），qi deficiency（47.7%），and blood stasis（43.5%）. The proportion of phlegm-turbidity was significantly higher in the abnormal MAU group（61.8%） than in the normal group（43.6%，P<0.05）. Logistic regression identified history of hypertension（OR=2.106），ABI（OR=0.153），and phlegm-turbidity（OR=2.043） as independent influencing factors for abnormal MAU（P<0.05）. [Conclusion] Early renal injury in asymptomatic LEAD patients results from the synergistic effects of hypertension，vascular lesions，and metabolic disorders. The high prevalence of phlegm-turbidity syndrome element and its significant association with MAU abnormality suggest its core role in the “metabolic-vascular-renal” injury axis，providing a new perspective for integrated Chinese and Western medicine interventions.