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1 40 Website htp://xuebao.ahtcm.edu.cn!"! #$%&'" " ()* 7+,- 1, 2, 1, 2, 1, 1, 1,! " 1,#$ 1 (1../01 12,./ ;2../ ,./ ) [] % & ' ( (chronickidneydiseases,ckd) ) ( * +, -. / 0 ) 1 (bonemineraldensity,bmd) ) 23 7(bonemorphogeneticprotein 7,BMP 7)4$5678 9:; <=>?64@' CKD3~5A*+,-.BCDE 32@(FGH IJ2@),KLMN 20@ O, >6789:;, HP1Q, R E8S TUDV%&O WXY(bloodureanitrogen,BUN), (serum creatinine,scr) (calcium,ca) (phosphorus,p) Z(alkalinephosphatase,ALP) [\]^ _X(parathyroidhormone,iPTH) BMP 74$5`2 4/0 BMD ab c ( 犘 <0.05) 4S 8S,O, D T ( 犘 <0.05), D ( 犘 <0.05) BUN SCr P ipth ALP, 5 Ca ( 犘 <0.05) MN,CKD (@ BMD BMP 7 ( 犘 <0.05);O U BMD BMP 7 ( 犘 <0.05), BMD BMP 7 6 ( 犘 <0.05) ' CKD )(*+,-. BMD BMP 74$ ;6789 : ; ' CKD ) (, C 5 BMP 7 [ ] (; )(;6789:;;*+,;)1 ;) 23 7 [ ]R692 [DOI] /j.issn !(chronickidneydiseases,CKD)9 :(; <=>?@AB+CDE7 "! CKD & ' + < F G H,I&'7JKLM NO CKD3 " +56 P"!,QR&'STGU,V W&'7JKL+OX, 9(;DYO + 1 Z7[ D \]^_ P;`, ab" ( c + S T [1], 01, [2] 56 [3 5] F, CKD3~5 &' a CKD + ;, 56 ( ) CKD "! # $ % & ' 2 4 " (bone mineraldensity, BMD)\ " ( ) * 7(bone morphogenetic protein 7,BMP 7) +,- 1!"# CKD [6] 1 >( ) 3, $%&': (1963 ),,` 1 (glomerularfiltraterate,gfr) ; H :! ; >, (, 2 3 GFR<60mL/min( ;1.73 m 2 +(? GFR, Y), CKD 1CKD1 :GFR 90 ml/min;2ckd 2 :GFR ; 60~89 ml/min; 3CKD3 :GFR ; 30~59 ml/min;4ckd 4 :GFR ; 15~29 ml/min;5ckd5 :GFR< 15mL/min, "! [7] ! +! K\" P 17, ] (calcium,ca) (phosphorus,p) U [ (parathyroidhormone,ipth) (alka linephosphatase,alp);2 ", ; " " W ;3X! ;"K"# $Z "% O& ' ]+Q % 0 P S T 5 6 ( ) * ^ + CKD # $ % [8] +,,-.,/ 0 <,1,,,", 234, 056,789:,;

2 Website htp://xuebao.ahtcm.edu.cn 41 < 0 < =>3 6 9,?@\A@ B 1.3 C 1 D 18~55 E;2 3 CKD \01 % ';a0 CKD3 & 'ipth>70pg/ml,ckd4 &'ipth>110pg/ml;ckd5 &'ipth> 300pg/mL;3 0 FGKHI W JcK L M^;4 K9NO Y +&' 1.4 P 1 3!Q C ';29 2R S TUcV P ';39 UWXY WX';4 3, c< > Z[\! +]^';5_` abc;k[ Z[ ^_c ';6 \ D 55 E 9: : : HI';7( F U U 7 F! : +"K" # ab( + "!';8 a bab,, W,,- ' /01 12 P+64 Q CKD "!#$%&' [9] a ;P 32 Q\ 32 Q,P 0 4Q(P \ 2Q), P \ C B+!Q ;30Q P 0, 17 Q, 13 Q; D 30~53 E, K D (44.63±6.61)E; % 15 Q,W J! 12 Q, 2Q,( '1Q;CKD3 9Q,4 15Q,5 6 Q 0, 20 Q, 10 Q; D31~52E, K D(42.23±6.66)E; %18Q,W J!9Q, 2Q,( ' 1Q;CKD3 11Q,4 10Q,5 9Q & ' = ( K D \!!O, K B ( 犘 >0.05), 20QY./ AB' ;,a0 11 Q, 9 Q; D30~55E, K D(43.32±6.24)E a BMP BMD P &'K GP, K )* 1, 8+ L, Z b > +,M^W J,,Z FGK cp +K P b ( 7 c,./01 12 _ V, 20g, ^ Z ) P, 20 g, 1 K; % O ; b [ (bloodureanitro gen,bun); b (serum creatinine,scr); b! 1Q (modi ficationofdietinrenaldisease,mdrd) [10] B (estimatedglomeru larfiltraterate,egfr); Ca P ALP ipth K b W 7 ; BMP 7 b, Z[, _ C V, ; A;BMD b! LunarDPX L X!, 2 4 BMD " T "T =(&' BMD-"? BMD K )/ "? BMD 2.3 "! # + $, ! +! K\" P [7] \ 0 P S T 5 6 ( ) [8] 1 :STGU(+, -. / 0< 1 " : ; ) QR,% % 70%; Ca P ipth ALP 3& BMD 2% ';2 :STGU QR,30% % % <70%; Ca P ipth ALP 1 &, BMD ' 2%';3 :S T G U Q R,% % <30%; Ca P ipth ALP K, BMD ' 2.4 B b SPSS19.0 ' B L b K ± ( 珚狓 ± 狊 ),Y P K, b( 狋 ; P K \ K, b ) * + 狋,,Y P 0-, b Wilcoxon.\ ; P \, b Mann Whitney 犝 ; ST +, b.\ (Mann Whitney 犝 );P 01%, b [/30B<1 L + 犘 <0.05 B

3 42 Website htp://xuebao.ahtcm.edu.cn ST &'ST +, B ( 犘 <0.05),P 1 = 狀 / Q 1! ( / Q / Q K. 犣犘 P &'01% [/30 B+ ( 2 \ 3), [( ) 01% +` B ( 犘 <0.05), [( =) 0 1 % + ` B ( 犘 <0.05), \ = 01% + b B ( 犘 < 0.05) ( 4), &' P 0 1 % B ( 犘 > 0.05); P 4 01% K P ( 犘 <0.05),P 8 K P 4 ( 犘 <0.05);P 4 \8,P K ( 犘 <0.05) 2 )*+,-(./)0 1 2( L ) 23 4K \ K 犉犘 = )*/,-( 3) K \ K 犉犘 = & ' P BUN SCr\ egfr P BUN SCr\ egfr, K B ( 犘 >0.05) I P, P BUN \egfr 6 ( 犘 > 0.05),SCr 7 W ( 犘 <0.05);P P BUN SCr ( 犘 <0.05),eGFR 7W( 犘 <0.05);P P BUN SCr \egfr 7W ( 犘 <0.05) 5 = 狀 4 4% 1 (( 珚狓 ± 狊 ) 01% P P 4 P ±6.35 a 42.00±6.45 b# 30.60±6.61 c# P ±8.10 a 36.37±7.75 b 17.30±6.94 c : Y =, Y8 9+ :N, 犘 <0.05; Y :, N Y 8 + = N, 犘 >0.05, Y8 + =N, 犘 < %5 67 BUN SCr8eGFR9: (( 珔狓 ± 狊 ) = 23 BUN/ (mmol/l) SCr/ ( μ mol/l) egfr/ (ml/min) 15.35± ± ±11.67 ( 狀 =30) 13.14± ± ± ± ± ± 2.26 P 15.23± ± ±11.00 ( 狀 =30) 9.86± ± ± ±2.89 # 81.20± # 7.04± 2.97 # :IY P : 犘 <0.05; I :# 犘 < &'P Ca P ipth \ ALP P Ca P ipth \ ALP, K B ( 犘 >0.05);IP, P Ca 7 W ( 犘 < 0.05), P ipth \ ALP K ( 犘 < 0.05) P Ca 7W \ P ipth \ ALP K ( 犘 <0.05) 6 6 4%5 67; Ca P ipth 8 ALP9: (( 珚狓 ± 狊 ) = 23 Ca/(mmol/L) P/(mmol/L) ipth/(pg/ml) ALP/(U/L) 1.97± ± ± ±38.70 ( 狀 =30) 2.04± ± ± ± ± ± ± ±17.90 P 1.93± ± ± ±37.30 ( 狀 =30) 2.16± ± ± ± ±0.14 # 0.23±0.16 # ± # 38.70±19.37 # :IY P, 犘 <0.05;I,# 犘 < \! Q 2 4 BMD BMP 7 I,! Q BMD \ BMP 7K ( 犘 <0.05), 7 P & ' 2 4 BMD BMP 7, B ( 犘 >0.05); &'P BMD \ BMP 7K 7 W ( 犘 <0.05), P BMD \ BMP 77W K ( 犘 <0.05) 8

4 Website htp://xuebao.ahtcm.edu.cn BMD 8 BMP 79: (( 珚狓 ± 狊 ) = 狀 BMD/(g/cm 2 ) BMP 7/(pg/mL) ± ±13.57!Q ±0.14 # 28.91±9.18 # :I,# 犘 < = 23 4% <= BMD >; BMP 79: (( 珚狓 ± 狊 ) 狀 BMD/ (g/cm 2 ) BMP 7/ (pg/ml) ± ± 8.02 ( 狀 =30) ± ± ± ± 1.76 P ± ±10.29 ( 狀 =30) ± ± ? ±0.07 # 14.45± 5.97 # :IY P, 犘 <0.05; I,# 犘 <0.05 "! 01 0; N!, ' a 0 1 " " c < 01 Y 3 H =,> ' N? 7, B,C "D,"D E)"?," +7 C,a@ " A ' ;,"!+F7! [a0a F,G(,aA 7 D," * * [11] H 0 1 ;, "! a ",a,"+! IJKH, I LOM X _ 2,N ; &'"!+`! O [12] ;, "!` ( ;,L P ; Q"!!,L R N STc UGU V W XY ;, [, H!, L,# 7,, S,N R,@ A! `! [13] W c [14] : ST,Z "!! O [! A 7D`",", H# \,S], ^ _ N,N S, ",!! L ;, N \ ;, S%*, \H % ;, ` abc F, a % ; ;,P,< P,H *G, AL H P [15]. / ! 01 :, 0 ; `, c, $ # J N +, #$H ` "! CKD + F G H,a F! ^ 1U _ 5 6,! + F 7 F 0, Ca P H I [,ipth,1,25 (OH) 2D 3 (%, ()* ] 0!+NO [ [16 17] "!1U+! F! ^ CKD + P,BMD "! & '! O + ; < c [18] b X! BMD 201 Q &' BMD, I D =N ( +? N Y BMD,, &' BMD ( 犘 <0.05), I G & ' BMD ( 犘 >0.05),, &' BMD O CKD "! P\ < + < [19] BMP 7 " F " 1c & b,i "\! QM M, = I" + \ " \! O M X [20] "+ ^ U, "! ;: F U (secondaryhyperparathyroid ism,spth)+ W ^ "! SPTH + "!\/3"! [21] $ Z " % S T + BMP 77 ( % \ SPTH a ( + ` ( 7 BMP 7 + ` *, W,BMP 77(%, " W ; ( +(",a" (% `,ipth,a " J,a"K,a( ", ( ($Z +, ", $ Z " % [22] c [23] 5 6 F,. BMP 7 Q R ", Q BMP 7 +7W," + L G,Ca P ipth QR 5 6, CKD "! # $ % & ' 2 4 BMD BMP 7 AB?, QR CKD "!#$%&'+ST,7W Ca, P ipth ALP, V W 2 4 BMD, L P"!, QR CKD & ' + +,a ^ I Q R

5 44 Website htp://xuebao.ahtcm.edu.cn 7W BMP 7 L [1], X,W,c.!3~5 &' K " H I + [J].0! S, 2012,11(7): [2],,. " 3 ][ _P "! + S T 5 6 [J] U X, 2009,38(4): [3],,,c. #$% a %GU,-+ [J].01 STUX,2011,23(7): [4],,,c.G _ P + S T 5 6[J].. / 0 1 S T U X,2001,13 (4): [5],,,c. P! 30Q S T [J].0 1 S T U X,2009,21(5): [6] NationalKidneyFoundation K/DOQIClinicalPractice Guidelinesfor Chronic Kidney Disease: Evaluation, classificationandstratification [J].Am J Kidney Dis, 2002,39(Suppl1):S261 S266. [7],, X.0 1!! K\" P [J].!I TUUX,2013,22(6): [8].0 S T 5 6 ( ): [M]. : 0!1,2002: [9].1 B [M].3. :? E 7, 2002:256. [10]W!eGFR.MDRD!!&'0+Q \$ [J].0!UX,2006,22 (10): [11].,. " P "!+ST [J].0!0 1 3!UX,2004,5(12): [12]O. "! 0 1 % I V + 6[J].01ST56,2013,5(20): [13],,,c. ALJ P "!32Q S T 5 6 [J]. 0 1,2012,44(10): [14]W,W,,c. J QR " + 56[J].0!1,2000,15(6): [15],. P : [J]. 01 STUX,2006,18(1): [16],. " + I S T:Z 7 [ D ]\ U [ + &[J].1 UX,2002,25(5):1 3. [17]!", #$.! 7 [M]. :? E7,2012: [18],,%&',c. &' " [J].0! " K " # U X,2006,12(3): ,245. [19],,,c. Y! & ' BMD IIGF 1 + N O 5 6 [J].0! " K "#UX,2014,20(1): [20],O." F7)* 7 " + b [J].0!"K"#UX,2006,12(5): [21] (,)*." F7)* 7I \!56 [J]. 81,2009,21(3): [22]HruskaKA,SaabG,ChaudharyLR,etal.Kidney bone,bone kidney,andcel celcommunicationsinre nalosteodystrophy[j].seminnephrol,2004,24(1): [23], +,,c.. "!, " BMP 7 " +, - [J].- 0 1UX,2013,35(4): (DE : ; : ) 犈犳犲犮狋狊狅犳犇犪犺狌犪狀犵犡犻犲狕犺狌狅犌狉犪狀狌犾犲犚犲狋犲狀狋犻狅狀犈狀犲犿犪狅狀犅狅狀犲犕犻狀犲狉犪犾犇犲狀狊犻狋狔犪狀犱犛犲狉狌犿犅狅狀犲犕狅狉狆犺狅犵犲狀犲狋犻犮犘狉狅狋犲犻狀 7 犻狀犖狅狀犱犻犪犾狔狊犻狊犆犺狉狅狀犻犮犓犻犱狀犲狔犇犻狊犲犪狊犲犪狀犱犚犲狀犪犾犗狊狋犲狅犱狔狊狋狉狅狆犺狔犘犪狋犻犲狀狋狊狑犻狋犺犇犪犿狆犺犲犪狋犛狔狀犱狉狅犿犲犎犝犛犺狌狀 1 犼犻狀, 犉犃犖犌犕犲犻 2 狊犺狌犪狀犵, 犠犃犖犌 1 犇狅狀犵, 犆犃犗犢狌犪狀狉狌 2, 犚犈犖犓犲 1 犼狌狀, 犑犐犖犎狌犪 1, 犕犃犗犢犪狀 1 狆犻狀犵, 1 1 犠犈犐犔犻狀犵, 犠犃犖犌犢犻狆犻狀犵 (1. 犜犺犲犉犻狉狊狋犃犳犳犻犾犻犪狋犲犱犎狅狊狆犻狋犪犾狅犳犃狀犺狌犻犝狀犻狏犲狉狊犻狋狔狅犳犆犺犻狀犲狊犲犕犲犱犻犮犻狀犲, 犃狀犺狌犻犎犲犳犲犻 , 犆犺犻狀犪 ;2. 犌狉犪犱狌犪狋犲犇犻狏犻狊犻狅狀, 犃狀犺狌犻犝狀犻狏犲狉狊犻狋狔狅犳犆犺犻狀犲狊犲犕犲犱犻犮犻狀犲, 犃狀犺狌犻犎犲犳犲犻 , 犆犺犻狀犪 ) [ 犃犫狊狋狉犪犮狋 ] 犗犫犼犲犮狋犻狏犲 Toobservethelumbarvertebralbonemineraldensity(BMD)andserumbonemor phogeneticprotein 7 (BMP 7)innon dialysischronickidneydisease(ckd)andrenalosteodystrophypa tientswithdamp heatsyndrome,andtoinvestigatetheinterventionalefectofdahuangxiezhuogranule retentionenema. 犕犲狋犺狅犱狊 Sixty fournon dialysisckd (stages3 5)patientswithdamp heatsyndrome wererandomlydividedintotreatmentgroup ( 狀 =32)andcontrolgroup ( 狀 =32),with2caseslostto folow upineachgroup,and20healthypersonswereselectedasnormalgroup.thetreatmentgroupand

6 Website htp://xuebao.ahtcm.edu.cn 45!FG./0^b1 P 0 : 1,2, 1 (1. 01, ;2../01 > 12./0 1,./ ) [] E, UI E, I,, I,ab (,N >,K E,,>, [ ] UI ; ;ab ; [ ]R743.3;R245 [DOI] /j.issn , 20&' +W 3: ]H, ;K( ` ) ],` ; 4 G \ 7+8, <,-&'+ 9 7 \7JKL,Y <&'+O : ] B,!70%~75% ;!&' Y +4 ] [1],2 0 + F! ; 21% ~ 38% [2 3] 0 01 c <, $%&': (1976 ),, 567,<` 1 01 :=P;, 1>;, b P N 3, QRGU\4./01 > 12./0` 1 a ;\!, ap 0 : Z B 1 HIJ KLMNO I, L C : 0D E c >, :T, S,:@?, I, L O./0 ;,0 IOM ; X 5 :A ): controlgroupreceivedbasictreatment;additionaly,thetreatmentgroupreceiveddahuangxiezhuogran uleretentionenemaoncedaily.thecourseoftreatmentwas8 weeksforbothgroups.thechangesin bloodureanitrogen(bun),serumcreatinine(scr),calcium (Ca),phosphorus(P),alkalinephosphatase (ALP),parathyroidhormone(iPTH),BMP 7,andlumbarvertebralBMD (L 2 4 )ofthetwogroupswere determinedbeforeandafterthetreatment. 犚犲狊狌犾狋狊 Thetreatmentgrouphadasignificantlybeterclinical outcomethanthecontrolgroup( 犘 <0.05).After4and8weeksoftreatment,bothgroupsshowedsignifi cantdecreasesintraditionalchinese medicine (TCM)syndromescorecompared withtheprevioustime points( 犘 <0.05),andthetreatmentgrouphadasignificantlylowerTCMsyndromescorethanthecontrol group( 犘 <0.05).Thetreatmentgroupwassignificantlysuperiortothecontrolgroupintermsofdecreasesin BUN,SCr,andserumP,iPTH,andALPandincreasesinserumCaandestimatedglomerularfiltrationrate( 犘 < 0.05).TheL 2 4 BMDandBMP 7levelweresignificantlylowerinthepatientsthaninthenormalgroup ( 犘 < 0.05);thetwoindicesincreasedsignificantlyaftertreatmentinthetreatmentgroupandcontrolgroup( 犘 <0.05), andsignificantlyhigherincreaseswereobservedinthetreatmentgroup ( 犘 <0.05). 犆狅狀犮犾狌狊犻狅狀 TheL 2 4 BMD andbmp 7levelinnon dialysisckdandrenalosteodystrophypatientswithdamp heatsyndromearesignificantly lowerthanthoseinhealthypersons.dahuangxiezhuogranuleretentionenemacanefectivelypreventnon dialysis CKDandrenalosteodystrophy,anditsmechanismofactionmayberelatedtotheimprovementinrenalfunction andtheincreaseinserumbmp 7level. [ 犓犲狔狑狅狉犱狊 ]chronickidneydisease;renalosteodystrophy;dahuang Xiezhuo Granule;damp heatsyn drome;bonemineraldensity;bonemorphogeneticprotein 7

12 ca:\,; M/X]^* 5M( % +1,- ' V 6P 犜犪犫犾犲 1 犆犺犲犿犻犮犪犾狆狉狅狆犲狉狋犻犲狊狅犳狋犺犲狋犲狊狋犳犻犲犾犱 S /g kg 1 nitrogen S /g kg 1 phosphorus S /g kg 1 potassium / mg kg 1 Alka

$12 ca:\,; M/X]^* 5M( % +1,- ' V 6P 犜犪犫犾犲 1 犆犺犲犿犻犮犪犾狆狉狅狆犲狉狋犻犲狊狅犳狋犺犲狋犲狊狋犳犻犲犾犱 S /g kg 1 nitrogen S /g kg 1 phosphorus S /g kg 1 potassium / mg kg 1 Alka$ 2014(12):46~51 HeilongjiangAgriculturalSciences 3 %CE>Z[ K CBY I, H ( )M, 810016) : (4 Z [, \,; M/X]^ HK * (5M( % 89: :N3P2K2(N326.25kg hm 2,P2O5138kg hm 2,K2O90kg hm 2 ) ;X]^9 U(A)^ c _ 9 ^ -, ^ c -.