慢性肾脏病MIA综合征中医证候的初步探讨
|
摘要
近年来,营养不良、炎症及动脉粥样硬化三者之间的相互因果关系逐渐被人们所认识,Stenvinkel等对109名透析前终末期肾功能衰竭患者进行研究发现,有22%存在营养不良、炎症及动脉粥样硬化三种情况。随后的研究提示存在营养不良、炎症及动脉粥样硬化综合征(MIAs)。MIAs严重影响着慢性肾衰竭患者的生存质量和预后。目前中医药对CRF营养不良、CRF炎症、CRF动脉粥样硬化各个部分的研究非常活跃,以中医药为主治疗慢性肾衰竭取得较好的疗效,故中西医结合治疗CRF可能有较好的前景。但目前MIAs的中医研究尚处于初步阶段,故对MIAs中医病因病机、辨证分型进行研究,以给予针对性的中医药治疗非常重要。
研究目的：总结出CKD-MIA综合征的中医证候分布规律,主要证候特征；分析MIAs证型与临床营养不良、炎症和动脉粥样硬化的相关性；为中医药对CKD-MIA综合征的辨证立法、遣方用药提供临床基础资料。
研究方法：采用横断面调查,对所有纳入病例进行中医辨证、中医虚损证和邪实证评分、SGA评分、透析患者同时进行MIS评分；采集入口学、病史及各种临床资料,包括：性别、年龄、身高、体重,计算体重指数BMI=BW (kg)/身高2(m2)、血压、个人嗜好、血肌酐、尿素氮、血清白蛋白、前白蛋白、转铁蛋白、总胆固醇、甘油三酯、钙、磷、全段甲状旁腺素、血红蛋白、超敏C反应蛋白、白介素6、肿瘤坏死因子α及颈动脉超声测定颈动脉内-中膜厚度；记录既往诊断明确的心脑血管及周围动脉疾病。血透患者透析前取血。分析各项临床指标之间的关系及其与虚损证和邪实证积分之间的关系。资料相关分析采用Spearman相关分析,组间比较采用秩和检验,P<0.05认为具有显著差异。
研究结果：
1.慢性肾脏病MIA综合征患者临床症状：最常见的临床症状为倦怠乏力、腰酸膝软、气短懒言、面色晦暗、畏寒肢冷、肢体麻木、食少纳呆、胸闷憋气、口干咽燥、头身困重。
2.慢性肾脏病MIA综合征患者临床证候：最常见虚损证证型为脾肾气虚(43.9%),最常见的邪实证为血瘀证(73.17%)及各种湿邪(包括湿浊、湿热、水湿、痰湿)MIA综合征患者中,轻中度营养不良患者脾肾气虚证型多见,重度营养不良患者阴阳两虚证型多见。虚损证积分与邪实证积分之间存在正相关。
3.营养不良、炎症和动脉硬化指标之间的关系：Hs-CRP与MIS存在正相关,Hs-CRP与PA存在负相关,Hs-CRP与CHO、LDL存在负相关,说明微炎症状态是引起营养不良与动脉粥样硬化的重要原因。
4.营养不良、炎症和动脉硬化指标和中医证候之间的关系：
1)邪实证积分与理化指标中的ALB水平呈负相关,提示MIA患者的临床邪实症状可能随着白蛋白水平的降低而加重。
2)炎症因子IL-6与湿浊证、湿热证存在正相关,说明湿浊、湿热证与血清IL-6水平升高有一定相关性。
3) IMT与湿热证、血瘀证存在正相关,说明湿热瘀血互阻,结聚血脉,可能是CKD患者动脉粥样硬化发生的病机之一。
上面的结果提示以下结论：慢性肾衰竭MIA综合征的证型特点是虚实夹杂,其临床最常见的中医虚损证型是脾肾气虚,其邪实的特点是多湿多瘀；经过对CKD-MIA患者的营养不良、炎症和动脉硬化临床指标和中医的正虚、邪实证候的相关性分析,印证了在MIA患者中,存在因虚致实和因实致虚的密切相关的两种病机变化。根据患者存在的正虚和邪实证候的临床实际,扶正驱邪仍然为MIA治疗的重要法则,且健脾益肾,益气活血,祛湿泻浊可能是MIA综合征主要治法。
本课题纳入慢性肾脏病MIA综合征患者41例。采用流行病学方法进行横断面研究,将所采集的中医症状、临床资料、理化检查数据、各种辅助检查运用现代统计学方法对MIA综合征的中医证候进行了初步分析。
In recent years, malnutrition, inflammation and atherosclerosis of causal relationship among each other was gradually known by people, Stenvinkel etc found that 22 percent of 109 before dialysis patients with end-stage renal failure existing malnutrition, inflammation and atherosclerotic three kinds of cases. Subsequent research suggests the presence of malnutrition, inflammation and atherosclerosis syndrome (MIAs).MIAs affects the survival of patients with chronic renal failure quality and prognosis. Traditional Chinese medicine in CRF patients MIAs research mainly is very active, chronic renal failure with Chinese medicine treatment of MIAs achieved good curative effect, so combining traditional Chinese and western medicine treatment to MIAs may have good prospects. But now MIAs Traditional Chinese medicine research is still at a Preliminary stage, So it is very important to explore the etiology, pathogenesis, differential diagnosis of CKD-MIAs to give it target treatments
Objective: to summarize. traditional. Chinese medical syndrome distribution law and main syndrome features of CKD-MIA syndrome; to explore the relationships among MIAs syndrome types, clinical nutrition, inflammation and atherosclerosis; to provide the clinical based data for Traditional Chinese medicine in order to instruct dialectical legislation and the oprescription of CKD-MIA syndromes.
Methods:cross-sectional survey was adopted to collect materials and differ ential diagnosis of 41 CKD-MIAs patients with the inclusive criteria and the ir degrees of excessive-syndromes and deficiency-syndrome were scored, and S GA score, dialysis patients by MIS score simultaneously. Explore the relatio nship between the scores and various clinical index such as blood urea nitro gen (BMI= BW/height2), blood pressure, personal hobby, past medical hist ory, serum creatinine, urea nitrogen, serum albumin, former albumin, transfe rrin, cholesterol, triglyceride, calcium, phosphorus, the entire section of parathyroid hormone, hemoglobin, high-sensitivity C-reactive protein, interl eukin-6, tumor necrosis factor-αand carotid ultrasound determination abnor mal carotid intimal-media thickness;Record previous diagnosis cerebrovascula r and peripheral artery disease. hemodialysis patients take blood Before dial ysis. Spearman Correlation and Rank Sum Test were used. P< 0.05 is consid ered significant.
Results:
1. clinical symptoms of chronic kidney disease: the most common symptom were lassitude and weakness, waist sour knee soft, shortness of breath and lazy to talk,dim complexion, chills limb cold, numbness of the limbs,poor appetite, Bosom frowsty breath-holding, mouth parched and throat scorched, Head body trapped heavy.
2. clinical syndrome of chronic kidney disease:The most common deficiency-syndrome among MIAs patients was Qi-deficiency in spleen and kidney, accounting for 43.9% and the most common excessive-syndrome among them was blood-stasis, accounting for 73.17%, and various dampness syndromes such as retention of dampness, damp-heat, pathogenic dampness, and phlegm-damp. among MIAs patients, The type of Qi-deficiency in spleen and kidney is more common in Mild-to-moderate malnutrition kidney and Yin and Yang deficiency syndrome is more common in Severe malnutrition.Scores of deficiency-syndrome had a positive correlation with that of excessive-syndrome
3. The relationship among Malnutrition, inflammation and the arteriosclerosis: CRP levels had a positive correlation with MIS score, CRP levels might be negatively correlated to PA levels, CRP levels might be negatively correlated to CHO and LDL levels among them, explain that micro inflammation is the important reasons for causing malnutrition and atherosclerosis.
4. The relationship between the syndromes and Malnutrition, inflammation and atherosclerosis index:
1) Scores of deficiency-syndrome had a nagative correlation with ALB levels, suggesting served patients for clinical symptoms and the firm with albumin levels lower and heavier. suggesting that the deficiency-syndrome might tend to increase as the level of albumin levels decreased.
2) Inflammatory factor IL-6 had a positive correlation with dampness and damp-heat.
3) IMT had a positive correlation with damp-heat and blood-stasis. indicates that the damp-heat and blood stasis were mutual resistance in vascellum, may be one of the pathogenesis of atherosclerosis.
The above results indicate the following conclusions:The characteristic syndrome of ARAS patients was deficiency in the origin and excess in superficiality, with Qi-dificiency of spleen and kidney as its most common clinical deficiency-syndrome, and blood-stasis and pathogenic dampness as its most common pathogenic factors. After Analysing to the clinical indicators of malnutrition、inflammation、atherosclerosis and deficiency-syndrome or excessive-syndrome. Proved by MIA patients, existing the two kinds of pathological changes that it is closely relation between coexistent deficiency and excess. According to patients with existing of deficiency-syndrome and excessive-syndrome, centralizer exorcisms is still one important rule for treatment, and Strengthening spleen, nourishing kidney, promoting blood circulation and removing dampness may be mainly Treatment for MIA syndrome.
研究目的：总结出CKD-MIA综合征的中医证候分布规律,主要证候特征；分析MIAs证型与临床营养不良、炎症和动脉粥样硬化的相关性；为中医药对CKD-MIA综合征的辨证立法、遣方用药提供临床基础资料。
研究方法：采用横断面调查,对所有纳入病例进行中医辨证、中医虚损证和邪实证评分、SGA评分、透析患者同时进行MIS评分；采集入口学、病史及各种临床资料,包括：性别、年龄、身高、体重,计算体重指数BMI=BW (kg)/身高2(m2)、血压、个人嗜好、血肌酐、尿素氮、血清白蛋白、前白蛋白、转铁蛋白、总胆固醇、甘油三酯、钙、磷、全段甲状旁腺素、血红蛋白、超敏C反应蛋白、白介素6、肿瘤坏死因子α及颈动脉超声测定颈动脉内-中膜厚度；记录既往诊断明确的心脑血管及周围动脉疾病。血透患者透析前取血。分析各项临床指标之间的关系及其与虚损证和邪实证积分之间的关系。资料相关分析采用Spearman相关分析,组间比较采用秩和检验,P<0.05认为具有显著差异。
研究结果：
1.慢性肾脏病MIA综合征患者临床症状：最常见的临床症状为倦怠乏力、腰酸膝软、气短懒言、面色晦暗、畏寒肢冷、肢体麻木、食少纳呆、胸闷憋气、口干咽燥、头身困重。
2.慢性肾脏病MIA综合征患者临床证候：最常见虚损证证型为脾肾气虚(43.9%),最常见的邪实证为血瘀证(73.17%)及各种湿邪(包括湿浊、湿热、水湿、痰湿)MIA综合征患者中,轻中度营养不良患者脾肾气虚证型多见,重度营养不良患者阴阳两虚证型多见。虚损证积分与邪实证积分之间存在正相关。
3.营养不良、炎症和动脉硬化指标之间的关系：Hs-CRP与MIS存在正相关,Hs-CRP与PA存在负相关,Hs-CRP与CHO、LDL存在负相关,说明微炎症状态是引起营养不良与动脉粥样硬化的重要原因。
4.营养不良、炎症和动脉硬化指标和中医证候之间的关系：
1)邪实证积分与理化指标中的ALB水平呈负相关,提示MIA患者的临床邪实症状可能随着白蛋白水平的降低而加重。
2)炎症因子IL-6与湿浊证、湿热证存在正相关,说明湿浊、湿热证与血清IL-6水平升高有一定相关性。
3) IMT与湿热证、血瘀证存在正相关,说明湿热瘀血互阻,结聚血脉,可能是CKD患者动脉粥样硬化发生的病机之一。
上面的结果提示以下结论：慢性肾衰竭MIA综合征的证型特点是虚实夹杂,其临床最常见的中医虚损证型是脾肾气虚,其邪实的特点是多湿多瘀；经过对CKD-MIA患者的营养不良、炎症和动脉硬化临床指标和中医的正虚、邪实证候的相关性分析,印证了在MIA患者中,存在因虚致实和因实致虚的密切相关的两种病机变化。根据患者存在的正虚和邪实证候的临床实际,扶正驱邪仍然为MIA治疗的重要法则,且健脾益肾,益气活血,祛湿泻浊可能是MIA综合征主要治法。
本课题纳入慢性肾脏病MIA综合征患者41例。采用流行病学方法进行横断面研究,将所采集的中医症状、临床资料、理化检查数据、各种辅助检查运用现代统计学方法对MIA综合征的中医证候进行了初步分析。
In recent years, malnutrition, inflammation and atherosclerosis of causal relationship among each other was gradually known by people, Stenvinkel etc found that 22 percent of 109 before dialysis patients with end-stage renal failure existing malnutrition, inflammation and atherosclerotic three kinds of cases. Subsequent research suggests the presence of malnutrition, inflammation and atherosclerosis syndrome (MIAs).MIAs affects the survival of patients with chronic renal failure quality and prognosis. Traditional Chinese medicine in CRF patients MIAs research mainly is very active, chronic renal failure with Chinese medicine treatment of MIAs achieved good curative effect, so combining traditional Chinese and western medicine treatment to MIAs may have good prospects. But now MIAs Traditional Chinese medicine research is still at a Preliminary stage, So it is very important to explore the etiology, pathogenesis, differential diagnosis of CKD-MIAs to give it target treatments
Objective: to summarize. traditional. Chinese medical syndrome distribution law and main syndrome features of CKD-MIA syndrome; to explore the relationships among MIAs syndrome types, clinical nutrition, inflammation and atherosclerosis; to provide the clinical based data for Traditional Chinese medicine in order to instruct dialectical legislation and the oprescription of CKD-MIA syndromes.
Methods:cross-sectional survey was adopted to collect materials and differ ential diagnosis of 41 CKD-MIAs patients with the inclusive criteria and the ir degrees of excessive-syndromes and deficiency-syndrome were scored, and S GA score, dialysis patients by MIS score simultaneously. Explore the relatio nship between the scores and various clinical index such as blood urea nitro gen (BMI= BW/height2), blood pressure, personal hobby, past medical hist ory, serum creatinine, urea nitrogen, serum albumin, former albumin, transfe rrin, cholesterol, triglyceride, calcium, phosphorus, the entire section of parathyroid hormone, hemoglobin, high-sensitivity C-reactive protein, interl eukin-6, tumor necrosis factor-αand carotid ultrasound determination abnor mal carotid intimal-media thickness;Record previous diagnosis cerebrovascula r and peripheral artery disease. hemodialysis patients take blood Before dial ysis. Spearman Correlation and Rank Sum Test were used. P< 0.05 is consid ered significant.
Results:
1. clinical symptoms of chronic kidney disease: the most common symptom were lassitude and weakness, waist sour knee soft, shortness of breath and lazy to talk,dim complexion, chills limb cold, numbness of the limbs,poor appetite, Bosom frowsty breath-holding, mouth parched and throat scorched, Head body trapped heavy.
2. clinical syndrome of chronic kidney disease:The most common deficiency-syndrome among MIAs patients was Qi-deficiency in spleen and kidney, accounting for 43.9% and the most common excessive-syndrome among them was blood-stasis, accounting for 73.17%, and various dampness syndromes such as retention of dampness, damp-heat, pathogenic dampness, and phlegm-damp. among MIAs patients, The type of Qi-deficiency in spleen and kidney is more common in Mild-to-moderate malnutrition kidney and Yin and Yang deficiency syndrome is more common in Severe malnutrition.Scores of deficiency-syndrome had a positive correlation with that of excessive-syndrome
3. The relationship among Malnutrition, inflammation and the arteriosclerosis: CRP levels had a positive correlation with MIS score, CRP levels might be negatively correlated to PA levels, CRP levels might be negatively correlated to CHO and LDL levels among them, explain that micro inflammation is the important reasons for causing malnutrition and atherosclerosis.
4. The relationship between the syndromes and Malnutrition, inflammation and atherosclerosis index:
1) Scores of deficiency-syndrome had a nagative correlation with ALB levels, suggesting served patients for clinical symptoms and the firm with albumin levels lower and heavier. suggesting that the deficiency-syndrome might tend to increase as the level of albumin levels decreased.
2) Inflammatory factor IL-6 had a positive correlation with dampness and damp-heat.
3) IMT had a positive correlation with damp-heat and blood-stasis. indicates that the damp-heat and blood stasis were mutual resistance in vascellum, may be one of the pathogenesis of atherosclerosis.
The above results indicate the following conclusions:The characteristic syndrome of ARAS patients was deficiency in the origin and excess in superficiality, with Qi-dificiency of spleen and kidney as its most common clinical deficiency-syndrome, and blood-stasis and pathogenic dampness as its most common pathogenic factors. After Analysing to the clinical indicators of malnutrition、inflammation、atherosclerosis and deficiency-syndrome or excessive-syndrome. Proved by MIA patients, existing the two kinds of pathological changes that it is closely relation between coexistent deficiency and excess. According to patients with existing of deficiency-syndrome and excessive-syndrome, centralizer exorcisms is still one important rule for treatment, and Strengthening spleen, nourishing kidney, promoting blood circulation and removing dampness may be mainly Treatment for MIA syndrome.
引文
[1]Stenvinkel, P. Inflammatory and Atherosclerotic Interactionsin the Depleted Uremic Patient[J]. Blood-Purif,2001,19(1):53-61.
[2]Kalantar-Zadeh K, Stenvinkel P,Pillon L et al. Inflammation and nutrition i-n renal insufficiency. Adv Ren Replace Thery.2003,10 (3):155-69.
[3]郑法雷.尿毒症性营养不良-恶液质综合征的发病机制与防治.中国中西医结合肾病杂志,2007,8(1)：1-3.
[4]任可,丁昕宇,曹钋等.血液透析患者营养状况与中医证候关系的临床观察.北京中医药大学学报,2008,15(3)：11-13.
[5]李建英,于俊生,刘先英等.中医药改善慢性肾衰竭营养不良研究近况.中华中医药学刊,2009,27(3)：633-636.
[6]傅晓骏.谈“疲浊蕴毒”与慢性肾衰竭[J].中国中西医结合肾病杂志,2002,3(5)：293.
[7]沈庆法.肾脏病湿热证的研究[J].浙江中医学院学报,2000,24(1)：39-42.
[8]杨霓之,左琪,桂定坤等.中药对血透患者营养不良-炎症反应综合征的影响[J].中国中西医结合肾病杂志,2006,7(12)：704-707.
[9]朱辟疆,周逊,赵华等.慢性肾功能衰竭微炎症状态与中医证型关系研究.现代中西医结合杂志,2008,17(5)：652-654.
[10]张琼,罗彪,张茂平等.中药对维持性血液透析患者微炎症状态的影响.中国中西医结合肾脏病杂志,2008,9(9)：826-827.
[11]马晓娟,殷惠军,陈可冀.血瘀证与炎症相关性的研究进展.中国中西医结合杂志,2007,27(7)：669-672.
[12]于敏,陈芝,刘晓玲等.从微炎症发病机制探讨中医治疗慢性肾衰竭的思路与方法中国中医急症,2009,18(4)：568-571.
[13]范砚超,张国平,唐明等.从毒论治动脉粥样硬化初探.山东中医杂志,2004,23(5)：261-263.
[14]牛崇峰.从中医“湿瘀互结证”认识动脉粥样硬化的成因.江苏中医药,2008,40(3)：24-25.
[15]朱明,陆曙.动脉粥样硬化中医病机探讨.陕西中医,2007,28(12)：1655-1657.
[16]孟凡国.动脉粥样硬化的中医病因病机初探.云南中医中药杂志,2004,25(2)：55-56.
[17]曾垂义,朱明军,王振涛.动脉粥样硬化的病因病机浅义.辽宁中医药大学学报,2006,8(5)：18-20.
[18]成绍武.中医对动脉粥样硬化的认识及防治研究进展.湖南中医药导报,2003,9(7)：23-25.
[19]赵凯,张磊,奚九一.清法治疗动脉粥样硬化闭塞症初探.中医杂志,2006,47(2)：144- 145.
[20]王永炎.关于提高脑血管疾病疗效难点的思考.中国中西医杂志,1997,17(2)：195-196.
[21]黄河清.谈肝气虚衰与动脉粥样硬化[J].四川中医,1997,15(2)：7-8.
[22]范英昌,张柏丽,陆一竹.调肝导浊法中药抗高血脂及动脉粥样硬化的研究[J].辽宁中医杂志,2002,29(8)：509-510.
[23]张艳,杨关林,于睿等.动脉粥样硬化中医虚瘀痰毒病因病机实质研究探讨.时珍国医国药,2007,18(6)：1513-1514.
[24]张红敏,王丽英,谢春光.中医释义动脉粥样硬化及2型糖尿病低度炎症的发生条件.时珍国医国药2005；15(7)：170-173.
[25]周仲英,金妙文.滋肾养肝化痰消瘀法治疗动脉粥样硬化的理论探讨.南京中医药大学学报(自然科学版)2002；18(3)：137-139.
[26]于俊生,陈兆昌.动脉粥样硬化从痰瘀毒论治探讨.山东中医杂志2002；21(8)：451-454
[27]马晓昌,尹太英,陈可冀,等.冠心病中医辨证分型与冠状动脉造影所见相关性比较研究.中国中西医结合杂志2001；21(9)：654-656
[28]范伏元,王莘智,相允平,等.健脾化浊生血合剂对维持透析患者营养状态的作用研究[J].中国中医药信息杂志,2006,13(3)：11-13.
[29]徐大基,李奋,林启展.健脾补肾中药对维持性血液透析患者贫血状态及生存质量的影响[J].福建中医药,1997,28(6)：33-35.
[30]宁越峰,杨柳竹,闫笑迎,等.加味八珍汤治疗慢性肾功能不全患者营养不良[J].中国煤炭工业医学杂志,2002,5(7)：928.
[31]冯志,谢桂权.健脾补肾法对血液透析患者瘦素水平和营养状况的影响.中国中西医结合肾病杂志,2007,8(8)：473-475.
[32]徐成江,刘明日,钟百灵.参芪健胃汤治疗腹膜透析患者厌食症疗效观察[J].中华肾脏病杂志,2000,16(5)：327.
[33]王桦,章文平.中药治疗慢肾衰营养不良疗效观察[J].辽宁中医杂志,2008,35(3)：390-392.
[34]杨霓芝,左琪,桂定坤,等.中药对血透患者营养不良-炎症综合征的影响.中国中西医结合肾病杂志,2006,7(12)：704-706.
[35]吴立友,赖申昌,饶家珍,等.肾衰方治疗慢性肾功能衰竭湿热证营养不良的临床研究[J].辽宁中医杂志,2008,35(4)：547-548.
[36]马志刚魏连波黄琳等.肾切除慢性肾衰竭大鼠营养不良与慢性炎症状态以及肾衰养真胶囊的干预试验.陕西中医,2004,25(8)：762-764.
[37]陈国姿,田锦鹰,马祖等.叶氏肾衰方治疗慢性肾衰竭营养不良31例疗效观察.新中 医,2008,40(7)：25-26.
[38]欧阳斌,杨洪涛.益肾和胃降浊方治疗慢性肾衰竭营养不良54例临床观察.中国中西医结合肾病杂志,2008,9(8)：707-708.
[39]魏连波,张颖,汪南海.肾衰养真颗粒治疗慢性肾脏病4、5并发营养不良的临床观察+中国中西医结合肾病杂志2009,10(8)：696-699.
[40]杜雅静,于俊生,庄文青,等.补肾排毒合剂对慢性肾衰大鼠营养状态的影响.山东中医杂志,2004,23(8)：496-497.
[41]许风雷,环文英,吴泰相,等.冬虫夏草治疗慢性肾病临床疗效的系统评价.中国循证医学,2006,6(11)：804-806
[42]沈建明,邓妍妍,叶婷婷等大黄对尿毒症非透析患者微炎症和氧化应激状态的影响.郧阳医学院学报,2008,27(5)：423-425
[43]蒲超,杨亦彬,孙全林等复方丹参片对维持性血液透析患者氧化应激微炎症状态的干预作用.中国中西医结合杂志,2006,26(9)：791-794
[44]吕芳.金水宝胶囊改善慢性肾衰竭患者微炎症和营养不良作用的观察.中医药临床杂志,2010,22(5)：430-431.
[45]于敏,陈芝,刘晓玲等.从微炎症发病机制探讨中医治疗慢性肾衰竭的思路与方法.中国中医急症,2009,18(4)：468-571
[46]左琪,杨霓芝,王立新.中药对维持性血透患者微炎症影响的临床研究[J].云南中医学院学报,2006,29(3)：18-21
[47]毕礼明.临床常用中药防治腹膜功能衰竭的研究进展与讨论[J].甘肃中医,2007,20(5)：16-17
[48]刘彦珠,刘维琴,秦腊梅,等.健脾消痰化瘀法对高脂血症患者脂质过氧化的影响[J].北京中医药大学学报,1997,20(3)：50
[49]赵学军,李任先,刘国普,等.理脾化痰方对食饵性动脉粥样硬化症家兔血管平滑肌细胞增殖和凋亡的调控[J].广州中医药大学学报,2001,18(2)：144-148
[50]张大宁,张勉之.补肾活血法治疗动脉粥样硬化56例.陕西中医002；23(2)：128-129
[51]祝世讷.中西医学差异与交融[M].第1版.北京：人民卫生出版社,2000.249
[52]薛源.益寿调脂片抗动脉粥样硬化的实验研究[J].江苏中医,2001,22(8)：42-44
[53]郑源庞,周振鹤,龚康敏,等.补肾护脉方对家兔实验性动脉粥样硬化各项指标的影响[J].中国实验方剂学杂志,1998,4(5)：27-29
[54]黄河清,吴伟康,程超.四逆汤抗实验性动脉粥样硬化的作用及其机制[J].中国动脉硬化杂志,2000,8(4)：302-304
[55]余虹,万青,石欣,等.调脂胶囊治疗颈动脉粥样硬化斑块37例临床观察[J].中医杂志,2003,44(9)：664-665.
[56]王玉洁.通脉降脂药物治疗动脉粥样硬化症33例疗效观察.郑州大学学报(医学版) 2004；39(6)：1079-1081
[57]周仲瑛,金妙文,吴 敏,等.滋肾养肝化痰消瘀法治疗动脉粥样硬化42例的临床研究.江苏中医药2003；23(2)：13-15
[58]Stenvinkel P, Heimburger O, Paultre F, et al.Strong association between mal-nutrition, inflammation, and atherosclerosis in chronic renal failure. K-idney Int,1999,55:1899-1911.
[59]Stenvinkel P.Holmberg I,heimburger O, et al.A study of plasmalogen as an index of oxidative stress in patients with chronic renal failure. Evide-nce of increased oxidative stress in malnourished patients [J].Nephrol Dial Transplant,1998,13:2 594.
[60]董捷,范敏华等.腹膜透析患者合并营养不良-慢性炎-心血管疾病综合征的临床表现[J].中华内科杂志,2002,41：856-856.
[61]黄慧俐,黄芸,胡建军.维持性血液透析患者中MIA综合征的临床分析.中华保健医学杂志,2008,10(1)：41-43.
[62]C M Avesani, J J Carrero, J Axelsson et al. Inf lammat ion and wasting in chronic kidney disease:Partners in crime. Kidney International (2006) 70,S8-S13.
[63]Kaizu Y, Kimura M, Yoneyama T,et al.Interleukin-6may mediate malnutrition in chronic emodialysispatients. Am J Kidney Dis.1998;31(1):93-100.
[64]Jkrizler TA, Hakim RM。Nutrition in end-stage renal disease。Kidney Int.1 996,50:343-357
[65]Kalra SP,Kalra PS.Is neuropeptide Y a naturally occurring appetitetransd-ucer[J]?Curr Opin Endocrinol Diab,1996,3:157.
[66]周伟东,邓聪,龙海波等.慢性肾衰营养不良大鼠血浆神经肽的表达及复方α-酮酸的干预.南方医科大学学报,2009；29(7)：1387-1389.
[67]Carmine Z, Francesca M,Giovanni T, et al.Prospective Study ofneuropeptide Y as an adverse cardiovascular risk factor in end-stagerenal disease [J]. J Am Soc Nephrol,2003,14:2611-7.
[68]Bruce R. Bistrian. Interaction between nutrition and inflammation in end-stage renal disease. Blood Purif.2000,18:333-336.
[69]Stenvinkel P. Blood Purif.2001,19:143-154.
[70]Stenvinkel P, Heimburger O, Paultre F, etal. Nephrol Dial Transplant.2000 Jul; 15(7):953-960.
[71]Ortega O, Rodriguez I,Gallar P, et al. Significance of high C-reative prote-in levels in pre- dialysis patients. Nephrol DialTransplant,2002,17 (6):1105-1109.
[72]Kaizu Y, Ohkawa S,Odamaki M,et al.Assoeiant between inflam-matory madiato-r and muscle mass in long term hemodialysis pa-tients[J]. Am J Kidney D-is,2003,42 (2):295-302.
[73]Vila N, Castillo J,Davalos A,et al. Proinflammatory cytokinesand early neu-rological worsening in ischemic:stroke[J].Stroke,2003,31(10):2 325-2 329.
[74]Connor TJ, Song C,Leonard BE,et al.An assessment of theeffects of central interleukin-1 berta,-2,-6 and tumor nec-rosis factor alpha administrat-ion on some behavioural. neuro-chemical.endocrine and immune parameters in the rat[J]. Neu- roscience,1998,84(3):923.
[75]Whicher J,Biasucci L,Rafai N. Inflammation, the acute phasresponse and ath-erosclerosis. Clin Chem Lad Med,1999,3(5):495-503.
[76]Zoccali C. Biomarkers in chronic kidney disease:utility and issues toward-s better understanding. Curr Opin Nephrol Hypertens,2005,14(6):1-6.
[77]Tonneli M, Saks F, Pfeffer M, et al.Cholesterol and RecurrentEvents (CARE) Trail Investigators. Biomarkers of inf lamina-tion and progression of chronic kidney disease. Kidney Int,2005,68(1):237-245.
[78]Eustace JA, Astor B, Muntner PM,et al. Prevalence of acidosisand inflammation and their association with low serum inchronic kidney disease. Kidney Int,2004,65 (3):1031-1040.
[79]StenvinkelP. Inflammatory and atherosclerotic interactions in the de pleted uremic patient. Blood Purif,2002,19 (5):53-61.
[80]Yeun JY, LevineRA, MantadilokV, etal. C-reactive protein predictsall-cause and cardiovascularmortality in hemodialysispatients. Am JKidneyDis,2000, 35(3):469-476.
[81]NohH, Lee SW, Kang SW,et al,Serum C-reactive protein:a pre-dictor of morta-lity in continuous ambulatory peritoneal dialysis pa-tients. PeritDial Int,1998,18(2):387-394.
[82]Peter A. Evaluation and treatment of coronary artery diseasein patients w-ith end-stage renal disease.Kidney Int,2005,67 (Suppl 95):51-58.
[83]Amann K,Ritz C, Adamczak M, et al.Why is coronary heartdisease of uraemic patients so frequent and so devastating?Nephrol Dial Transplant,2003,18 (4):631-640.
[84]Stenvinkel P. Blood Purif,2001; 19:143-151
[85]Bruce R. Bistrian. Blood Purif,2000; 18:333-336
[86]Himmelfarb J, StenvinkelP,IkizlerTA, et al. The elephant in uremiaoxidants-tress as a unifying conceptofcardiovasculardisease in uremiakidney In t,2002,62:1524-1538.
[87]BoazM,Smetana S, WeinsteinT,etal. Secondary preventionwithantioxidants of cardiovascular disease in endstage renal disease (SPACE):randomised pla-cebo-controlled trial. Lancet,2000,356:1213-1218.
[88]TepelM,van derGietM, StatzM,et al. The antioxidant acetyl-cysteine reduc-es cardiovascular events in patientswith end stage renalfailure:a rand omized, controlled trial. Circulation 2003,107:992-995.
[89]Wick G,Perschinka H, Millonig G. Atherosclerosis as anautoimmune disease:a-n update. Trends Immunol,2001,22 (12):665-669.
[90]Ridker PM, Cannon CP, Morrow D, et al. C-reactive protein levelsand outcome-s after statin therapy. N Engl JMed,2005,352 (1):20-28.
[91]Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progres-sion of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med, 1995,123; 754-762.
[92]谌卫,郭志勇,吴灏等.复方α-酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究.中西医结合学报,2008,6(5)：473-477.
[93]杜丰,王艳秋,苏雪松等.左卡尼丁联合促红细胞生成素治疗维持性血液透析患者肾性贫血.实用药物与临床,2010,13(2)：113-114.
[94]Nazanin Noori, Kopple,Kovesdy et al. Mid-Arm Muscle Circumference and Qua-lity of Life and Survival in Maintenance Hemodialysis Patients. CJASN December 2010,12 (5):2258-2268.
[95]Macdougall IC. Could anti- inflammatory cytokine therapy improvepoor tre-atment outcomes in dialysis patients? Nephrol Dial Trans-plant,2004,19 Suppl5:V73-78.
[96]Schouten WE, Grooteman MP, van Houte AJ, et al. Effects ofdialyser and dialysate on the acute phase reaction in clini-cal bicarbonate dialysis. Nephrol Dial Transplant,2000,15 (3):379-384
[97]Tellingen A, Schalkwijk CG,Teerlink T, et al.Influence ofdifferent haemodi a-lysis modalities on AGE peptide levels:intradialytic versus ong-term r-esults.Nephron Clin Pract,2005,22; 100(1):c1-c7
[98]Tellingen A, Grooteman MP, Schoorl M, et al. Enhanced long-term reduction of plasma leptin concentrations by super-flux polysulfone dialysers. Nephrol Dial Transplant,2004,19(5):1198-1203
[99]贾凤玉.维持性血液透析治疗技术对MIA综合征的影响.中国血液净化,2005,4(8)：453-454,461.
[100]Jofre R, Rodriguez-Benitez P, Lopez-Gomez JM, etal. Inflammatory syndrome in patients on hemodialysis[J]. J Am Soc Nephrol,2006,17 (12):274-280.
[101]Jeznach-Steinhagen A,S otwinski R,Szczygie B. Malnutrition Inflammation atherosclerosis in patients on hemodialysis[J]. Rocz Panstw Zakl Hig,200 7,58(1):83-88.
[102]Detsky AS, Mclaughlin JR, Baker JP, et al. What is subjective global assessment of nutri-tional status?JPEN,1987,11:8
[103]Fung F,Sherrard DJ,Gillen DL,et al.Increased risk for cardiovas-cular m-ortality among malnourished end-stage renal disease pa-tients[J]. Am J-Kidney Dis,2002,40 (2):307-314.
[104]Stenvinkel P, Heimburger O, Lindholm B et al.Are there two types of maln-utrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome. Nephrology Dialysis Transplantation,2000,15 (7):953-960.
[105]李建英,于俊生,胡维华等.慢性肾衰竭营养不良患者中医证型分布特点研究.世界中西医结合杂,2009,10(4)：724-726.
[106]董捷,王海燕.腹膜透析病人营养不良、炎症和心血管疾病的关系初探[J].中华肾脏病杂志,2002,18(5)：317,321.
[107]Ridker PM,Cushman M,Stamfer MJ,et al·Inflammation,asprin,and therisk o f cardiovascular disease in apparently health men [J]:English Med,1997,3 36:973-979.
[108]张茂华,迟素芳,谢英姿.代谢综合症病因病机的比较研究.中医药临床杂志,2008,20(5)：509-511.
[109]李桓,王松鹏,胡兴旺.肥胖从脾胃肝肾论治初探.光明中医,2009,24(3)：514.
[110]朱辟疆,周逊,赵华等.慢性肾功能衰竭微炎症状态与中医证型关系研究.现代中西医结合杂志,2008,17(5)：652-654.
[111]范砚超,张国平,唐明等.从毒论治动脉粥样硬化初探.山东中医杂志,2004,23(5)：261-263.
[112]牛崇峰.从中医“湿瘀互结证”认识动脉粥样硬化的成因.江苏中医药,2008,40(3)：24-25.
[2]Kalantar-Zadeh K, Stenvinkel P,Pillon L et al. Inflammation and nutrition i-n renal insufficiency. Adv Ren Replace Thery.2003,10 (3):155-69.
[3]郑法雷.尿毒症性营养不良-恶液质综合征的发病机制与防治.中国中西医结合肾病杂志,2007,8(1)：1-3.
[4]任可,丁昕宇,曹钋等.血液透析患者营养状况与中医证候关系的临床观察.北京中医药大学学报,2008,15(3)：11-13.
[5]李建英,于俊生,刘先英等.中医药改善慢性肾衰竭营养不良研究近况.中华中医药学刊,2009,27(3)：633-636.
[6]傅晓骏.谈“疲浊蕴毒”与慢性肾衰竭[J].中国中西医结合肾病杂志,2002,3(5)：293.
[7]沈庆法.肾脏病湿热证的研究[J].浙江中医学院学报,2000,24(1)：39-42.
[8]杨霓之,左琪,桂定坤等.中药对血透患者营养不良-炎症反应综合征的影响[J].中国中西医结合肾病杂志,2006,7(12)：704-707.
[9]朱辟疆,周逊,赵华等.慢性肾功能衰竭微炎症状态与中医证型关系研究.现代中西医结合杂志,2008,17(5)：652-654.
[10]张琼,罗彪,张茂平等.中药对维持性血液透析患者微炎症状态的影响.中国中西医结合肾脏病杂志,2008,9(9)：826-827.
[11]马晓娟,殷惠军,陈可冀.血瘀证与炎症相关性的研究进展.中国中西医结合杂志,2007,27(7)：669-672.
[12]于敏,陈芝,刘晓玲等.从微炎症发病机制探讨中医治疗慢性肾衰竭的思路与方法中国中医急症,2009,18(4)：568-571.
[13]范砚超,张国平,唐明等.从毒论治动脉粥样硬化初探.山东中医杂志,2004,23(5)：261-263.
[14]牛崇峰.从中医“湿瘀互结证”认识动脉粥样硬化的成因.江苏中医药,2008,40(3)：24-25.
[15]朱明,陆曙.动脉粥样硬化中医病机探讨.陕西中医,2007,28(12)：1655-1657.
[16]孟凡国.动脉粥样硬化的中医病因病机初探.云南中医中药杂志,2004,25(2)：55-56.
[17]曾垂义,朱明军,王振涛.动脉粥样硬化的病因病机浅义.辽宁中医药大学学报,2006,8(5)：18-20.
[18]成绍武.中医对动脉粥样硬化的认识及防治研究进展.湖南中医药导报,2003,9(7)：23-25.
[19]赵凯,张磊,奚九一.清法治疗动脉粥样硬化闭塞症初探.中医杂志,2006,47(2)：144- 145.
[20]王永炎.关于提高脑血管疾病疗效难点的思考.中国中西医杂志,1997,17(2)：195-196.
[21]黄河清.谈肝气虚衰与动脉粥样硬化[J].四川中医,1997,15(2)：7-8.
[22]范英昌,张柏丽,陆一竹.调肝导浊法中药抗高血脂及动脉粥样硬化的研究[J].辽宁中医杂志,2002,29(8)：509-510.
[23]张艳,杨关林,于睿等.动脉粥样硬化中医虚瘀痰毒病因病机实质研究探讨.时珍国医国药,2007,18(6)：1513-1514.
[24]张红敏,王丽英,谢春光.中医释义动脉粥样硬化及2型糖尿病低度炎症的发生条件.时珍国医国药2005；15(7)：170-173.
[25]周仲英,金妙文.滋肾养肝化痰消瘀法治疗动脉粥样硬化的理论探讨.南京中医药大学学报(自然科学版)2002；18(3)：137-139.
[26]于俊生,陈兆昌.动脉粥样硬化从痰瘀毒论治探讨.山东中医杂志2002；21(8)：451-454
[27]马晓昌,尹太英,陈可冀,等.冠心病中医辨证分型与冠状动脉造影所见相关性比较研究.中国中西医结合杂志2001；21(9)：654-656
[28]范伏元,王莘智,相允平,等.健脾化浊生血合剂对维持透析患者营养状态的作用研究[J].中国中医药信息杂志,2006,13(3)：11-13.
[29]徐大基,李奋,林启展.健脾补肾中药对维持性血液透析患者贫血状态及生存质量的影响[J].福建中医药,1997,28(6)：33-35.
[30]宁越峰,杨柳竹,闫笑迎,等.加味八珍汤治疗慢性肾功能不全患者营养不良[J].中国煤炭工业医学杂志,2002,5(7)：928.
[31]冯志,谢桂权.健脾补肾法对血液透析患者瘦素水平和营养状况的影响.中国中西医结合肾病杂志,2007,8(8)：473-475.
[32]徐成江,刘明日,钟百灵.参芪健胃汤治疗腹膜透析患者厌食症疗效观察[J].中华肾脏病杂志,2000,16(5)：327.
[33]王桦,章文平.中药治疗慢肾衰营养不良疗效观察[J].辽宁中医杂志,2008,35(3)：390-392.
[34]杨霓芝,左琪,桂定坤,等.中药对血透患者营养不良-炎症综合征的影响.中国中西医结合肾病杂志,2006,7(12)：704-706.
[35]吴立友,赖申昌,饶家珍,等.肾衰方治疗慢性肾功能衰竭湿热证营养不良的临床研究[J].辽宁中医杂志,2008,35(4)：547-548.
[36]马志刚魏连波黄琳等.肾切除慢性肾衰竭大鼠营养不良与慢性炎症状态以及肾衰养真胶囊的干预试验.陕西中医,2004,25(8)：762-764.
[37]陈国姿,田锦鹰,马祖等.叶氏肾衰方治疗慢性肾衰竭营养不良31例疗效观察.新中 医,2008,40(7)：25-26.
[38]欧阳斌,杨洪涛.益肾和胃降浊方治疗慢性肾衰竭营养不良54例临床观察.中国中西医结合肾病杂志,2008,9(8)：707-708.
[39]魏连波,张颖,汪南海.肾衰养真颗粒治疗慢性肾脏病4、5并发营养不良的临床观察+中国中西医结合肾病杂志2009,10(8)：696-699.
[40]杜雅静,于俊生,庄文青,等.补肾排毒合剂对慢性肾衰大鼠营养状态的影响.山东中医杂志,2004,23(8)：496-497.
[41]许风雷,环文英,吴泰相,等.冬虫夏草治疗慢性肾病临床疗效的系统评价.中国循证医学,2006,6(11)：804-806
[42]沈建明,邓妍妍,叶婷婷等大黄对尿毒症非透析患者微炎症和氧化应激状态的影响.郧阳医学院学报,2008,27(5)：423-425
[43]蒲超,杨亦彬,孙全林等复方丹参片对维持性血液透析患者氧化应激微炎症状态的干预作用.中国中西医结合杂志,2006,26(9)：791-794
[44]吕芳.金水宝胶囊改善慢性肾衰竭患者微炎症和营养不良作用的观察.中医药临床杂志,2010,22(5)：430-431.
[45]于敏,陈芝,刘晓玲等.从微炎症发病机制探讨中医治疗慢性肾衰竭的思路与方法.中国中医急症,2009,18(4)：468-571
[46]左琪,杨霓芝,王立新.中药对维持性血透患者微炎症影响的临床研究[J].云南中医学院学报,2006,29(3)：18-21
[47]毕礼明.临床常用中药防治腹膜功能衰竭的研究进展与讨论[J].甘肃中医,2007,20(5)：16-17
[48]刘彦珠,刘维琴,秦腊梅,等.健脾消痰化瘀法对高脂血症患者脂质过氧化的影响[J].北京中医药大学学报,1997,20(3)：50
[49]赵学军,李任先,刘国普,等.理脾化痰方对食饵性动脉粥样硬化症家兔血管平滑肌细胞增殖和凋亡的调控[J].广州中医药大学学报,2001,18(2)：144-148
[50]张大宁,张勉之.补肾活血法治疗动脉粥样硬化56例.陕西中医002；23(2)：128-129
[51]祝世讷.中西医学差异与交融[M].第1版.北京：人民卫生出版社,2000.249
[52]薛源.益寿调脂片抗动脉粥样硬化的实验研究[J].江苏中医,2001,22(8)：42-44
[53]郑源庞,周振鹤,龚康敏,等.补肾护脉方对家兔实验性动脉粥样硬化各项指标的影响[J].中国实验方剂学杂志,1998,4(5)：27-29
[54]黄河清,吴伟康,程超.四逆汤抗实验性动脉粥样硬化的作用及其机制[J].中国动脉硬化杂志,2000,8(4)：302-304
[55]余虹,万青,石欣,等.调脂胶囊治疗颈动脉粥样硬化斑块37例临床观察[J].中医杂志,2003,44(9)：664-665.
[56]王玉洁.通脉降脂药物治疗动脉粥样硬化症33例疗效观察.郑州大学学报(医学版) 2004；39(6)：1079-1081
[57]周仲瑛,金妙文,吴 敏,等.滋肾养肝化痰消瘀法治疗动脉粥样硬化42例的临床研究.江苏中医药2003；23(2)：13-15
[58]Stenvinkel P, Heimburger O, Paultre F, et al.Strong association between mal-nutrition, inflammation, and atherosclerosis in chronic renal failure. K-idney Int,1999,55:1899-1911.
[59]Stenvinkel P.Holmberg I,heimburger O, et al.A study of plasmalogen as an index of oxidative stress in patients with chronic renal failure. Evide-nce of increased oxidative stress in malnourished patients [J].Nephrol Dial Transplant,1998,13:2 594.
[60]董捷,范敏华等.腹膜透析患者合并营养不良-慢性炎-心血管疾病综合征的临床表现[J].中华内科杂志,2002,41：856-856.
[61]黄慧俐,黄芸,胡建军.维持性血液透析患者中MIA综合征的临床分析.中华保健医学杂志,2008,10(1)：41-43.
[62]C M Avesani, J J Carrero, J Axelsson et al. Inf lammat ion and wasting in chronic kidney disease:Partners in crime. Kidney International (2006) 70,S8-S13.
[63]Kaizu Y, Kimura M, Yoneyama T,et al.Interleukin-6may mediate malnutrition in chronic emodialysispatients. Am J Kidney Dis.1998;31(1):93-100.
[64]Jkrizler TA, Hakim RM。Nutrition in end-stage renal disease。Kidney Int.1 996,50:343-357
[65]Kalra SP,Kalra PS.Is neuropeptide Y a naturally occurring appetitetransd-ucer[J]?Curr Opin Endocrinol Diab,1996,3:157.
[66]周伟东,邓聪,龙海波等.慢性肾衰营养不良大鼠血浆神经肽的表达及复方α-酮酸的干预.南方医科大学学报,2009；29(7)：1387-1389.
[67]Carmine Z, Francesca M,Giovanni T, et al.Prospective Study ofneuropeptide Y as an adverse cardiovascular risk factor in end-stagerenal disease [J]. J Am Soc Nephrol,2003,14:2611-7.
[68]Bruce R. Bistrian. Interaction between nutrition and inflammation in end-stage renal disease. Blood Purif.2000,18:333-336.
[69]Stenvinkel P. Blood Purif.2001,19:143-154.
[70]Stenvinkel P, Heimburger O, Paultre F, etal. Nephrol Dial Transplant.2000 Jul; 15(7):953-960.
[71]Ortega O, Rodriguez I,Gallar P, et al. Significance of high C-reative prote-in levels in pre- dialysis patients. Nephrol DialTransplant,2002,17 (6):1105-1109.
[72]Kaizu Y, Ohkawa S,Odamaki M,et al.Assoeiant between inflam-matory madiato-r and muscle mass in long term hemodialysis pa-tients[J]. Am J Kidney D-is,2003,42 (2):295-302.
[73]Vila N, Castillo J,Davalos A,et al. Proinflammatory cytokinesand early neu-rological worsening in ischemic:stroke[J].Stroke,2003,31(10):2 325-2 329.
[74]Connor TJ, Song C,Leonard BE,et al.An assessment of theeffects of central interleukin-1 berta,-2,-6 and tumor nec-rosis factor alpha administrat-ion on some behavioural. neuro-chemical.endocrine and immune parameters in the rat[J]. Neu- roscience,1998,84(3):923.
[75]Whicher J,Biasucci L,Rafai N. Inflammation, the acute phasresponse and ath-erosclerosis. Clin Chem Lad Med,1999,3(5):495-503.
[76]Zoccali C. Biomarkers in chronic kidney disease:utility and issues toward-s better understanding. Curr Opin Nephrol Hypertens,2005,14(6):1-6.
[77]Tonneli M, Saks F, Pfeffer M, et al.Cholesterol and RecurrentEvents (CARE) Trail Investigators. Biomarkers of inf lamina-tion and progression of chronic kidney disease. Kidney Int,2005,68(1):237-245.
[78]Eustace JA, Astor B, Muntner PM,et al. Prevalence of acidosisand inflammation and their association with low serum inchronic kidney disease. Kidney Int,2004,65 (3):1031-1040.
[79]StenvinkelP. Inflammatory and atherosclerotic interactions in the de pleted uremic patient. Blood Purif,2002,19 (5):53-61.
[80]Yeun JY, LevineRA, MantadilokV, etal. C-reactive protein predictsall-cause and cardiovascularmortality in hemodialysispatients. Am JKidneyDis,2000, 35(3):469-476.
[81]NohH, Lee SW, Kang SW,et al,Serum C-reactive protein:a pre-dictor of morta-lity in continuous ambulatory peritoneal dialysis pa-tients. PeritDial Int,1998,18(2):387-394.
[82]Peter A. Evaluation and treatment of coronary artery diseasein patients w-ith end-stage renal disease.Kidney Int,2005,67 (Suppl 95):51-58.
[83]Amann K,Ritz C, Adamczak M, et al.Why is coronary heartdisease of uraemic patients so frequent and so devastating?Nephrol Dial Transplant,2003,18 (4):631-640.
[84]Stenvinkel P. Blood Purif,2001; 19:143-151
[85]Bruce R. Bistrian. Blood Purif,2000; 18:333-336
[86]Himmelfarb J, StenvinkelP,IkizlerTA, et al. The elephant in uremiaoxidants-tress as a unifying conceptofcardiovasculardisease in uremiakidney In t,2002,62:1524-1538.
[87]BoazM,Smetana S, WeinsteinT,etal. Secondary preventionwithantioxidants of cardiovascular disease in endstage renal disease (SPACE):randomised pla-cebo-controlled trial. Lancet,2000,356:1213-1218.
[88]TepelM,van derGietM, StatzM,et al. The antioxidant acetyl-cysteine reduc-es cardiovascular events in patientswith end stage renalfailure:a rand omized, controlled trial. Circulation 2003,107:992-995.
[89]Wick G,Perschinka H, Millonig G. Atherosclerosis as anautoimmune disease:a-n update. Trends Immunol,2001,22 (12):665-669.
[90]Ridker PM, Cannon CP, Morrow D, et al. C-reactive protein levelsand outcome-s after statin therapy. N Engl JMed,2005,352 (1):20-28.
[91]Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progres-sion of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med, 1995,123; 754-762.
[92]谌卫,郭志勇,吴灏等.复方α-酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究.中西医结合学报,2008,6(5)：473-477.
[93]杜丰,王艳秋,苏雪松等.左卡尼丁联合促红细胞生成素治疗维持性血液透析患者肾性贫血.实用药物与临床,2010,13(2)：113-114.
[94]Nazanin Noori, Kopple,Kovesdy et al. Mid-Arm Muscle Circumference and Qua-lity of Life and Survival in Maintenance Hemodialysis Patients. CJASN December 2010,12 (5):2258-2268.
[95]Macdougall IC. Could anti- inflammatory cytokine therapy improvepoor tre-atment outcomes in dialysis patients? Nephrol Dial Trans-plant,2004,19 Suppl5:V73-78.
[96]Schouten WE, Grooteman MP, van Houte AJ, et al. Effects ofdialyser and dialysate on the acute phase reaction in clini-cal bicarbonate dialysis. Nephrol Dial Transplant,2000,15 (3):379-384
[97]Tellingen A, Schalkwijk CG,Teerlink T, et al.Influence ofdifferent haemodi a-lysis modalities on AGE peptide levels:intradialytic versus ong-term r-esults.Nephron Clin Pract,2005,22; 100(1):c1-c7
[98]Tellingen A, Grooteman MP, Schoorl M, et al. Enhanced long-term reduction of plasma leptin concentrations by super-flux polysulfone dialysers. Nephrol Dial Transplant,2004,19(5):1198-1203
[99]贾凤玉.维持性血液透析治疗技术对MIA综合征的影响.中国血液净化,2005,4(8)：453-454,461.
[100]Jofre R, Rodriguez-Benitez P, Lopez-Gomez JM, etal. Inflammatory syndrome in patients on hemodialysis[J]. J Am Soc Nephrol,2006,17 (12):274-280.
[101]Jeznach-Steinhagen A,S otwinski R,Szczygie B. Malnutrition Inflammation atherosclerosis in patients on hemodialysis[J]. Rocz Panstw Zakl Hig,200 7,58(1):83-88.
[102]Detsky AS, Mclaughlin JR, Baker JP, et al. What is subjective global assessment of nutri-tional status?JPEN,1987,11:8
[103]Fung F,Sherrard DJ,Gillen DL,et al.Increased risk for cardiovas-cular m-ortality among malnourished end-stage renal disease pa-tients[J]. Am J-Kidney Dis,2002,40 (2):307-314.
[104]Stenvinkel P, Heimburger O, Lindholm B et al.Are there two types of maln-utrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome. Nephrology Dialysis Transplantation,2000,15 (7):953-960.
[105]李建英,于俊生,胡维华等.慢性肾衰竭营养不良患者中医证型分布特点研究.世界中西医结合杂,2009,10(4)：724-726.
[106]董捷,王海燕.腹膜透析病人营养不良、炎症和心血管疾病的关系初探[J].中华肾脏病杂志,2002,18(5)：317,321.
[107]Ridker PM,Cushman M,Stamfer MJ,et al·Inflammation,asprin,and therisk o f cardiovascular disease in apparently health men [J]:English Med,1997,3 36:973-979.
[108]张茂华,迟素芳,谢英姿.代谢综合症病因病机的比较研究.中医药临床杂志,2008,20(5)：509-511.
[109]李桓,王松鹏,胡兴旺.肥胖从脾胃肝肾论治初探.光明中医,2009,24(3)：514.
[110]朱辟疆,周逊,赵华等.慢性肾功能衰竭微炎症状态与中医证型关系研究.现代中西医结合杂志,2008,17(5)：652-654.
[111]范砚超,张国平,唐明等.从毒论治动脉粥样硬化初探.山东中医杂志,2004,23(5)：261-263.
[112]牛崇峰.从中医“湿瘀互结证”认识动脉粥样硬化的成因.江苏中医药,2008,40(3)：24-25.