【目的】基于“虚-湿-热-瘀”病机探讨外周血中性粒细胞计数与淋巴细胞计数比值 （NLR） 、标化SUA[血尿酸与血肌酐比值 （SUA/Scr） ]与早期糖尿病肾病 （early diabetic kidney disease，EDKD） 中医证型的相关性，为EDKD患者中医精准化治疗提供客观化依据。 【方法】回顾性分析197例EDKD患者 （包括单纯气阴两虚证42例、气阴两虚兼湿证44例、气阴两虚兼热证53例、气阴两虚兼瘀证58例） 的临床资料，对比不同中医证型EDKD患者脂代谢指标、肾功能指标、NLR、标化SUA的水平差异，探讨NLR、标化SUA与EDKD中医证型的相关性。 【结果】（1）不同中医证型EDKD患者的性别、糖化血红蛋白（HbA1c） 比较，差异均无统计学意义 （P＞0.05） ；年龄方面，气阴两虚兼瘀证组年龄大于气阴两虚证组 （P＜0.05） ；病程方面，气阴两虚兼瘀证组病程大于其余各组 （P＜0.01） ；体质量指数 （BMI） 方面，气阴两虚证组＜气阴两虚兼瘀证组＜气阴两虚兼热证组＜气阴两虚兼湿证组 （P＜0.05） 。 （2） 气阴两虚证组的总胆固醇 （TC） 水平低于气阴两虚兼湿证组和气阴两虚兼瘀证组 （P＜0.05） ，气阴两虚证组的甘油三酯 （TG） 水平低于气阴两虚兼瘀证组 （P＜0.05） ，气阴两虚兼热证组的血肌酐 （Scr） 水平高于气阴两虚证组和气阴两虚兼湿证组 （P＜0.05） ，气阴两虚证组的肾小球滤过率 （eGFR） 水平高于气阴两虚兼热证组和气阴两虚兼瘀证组 （P＜0.05） ，气阴两虚兼热证组的NLR水平高于其余3组 （P＜0.05） ，气阴两虚兼瘀证组的标化SUA水平低于气阴两虚兼湿证组和气阴两虚兼热证组 （P＜0.05） 。 （3） 无序多分类Logistic回归分析结果显示，BMI、SUA是气阴两虚兼湿证的影响因素，BMI、SUA、NLR是气阴两虚兼热证的影响因素，BMI、TC、标化SUA是气阴两虚兼瘀证的影响因素，差异均有统计学意义 （P＜0.05或P＜0.01） 。 【结论】NLR和标化SUA可作为EDKD中医证型的参考指标，NLR水平升高可能会加速气阴两虚兼热证的发生，标化SUA水平降低可能会加速气阴两虚兼瘀证的发生。

Objective To investigate the correlation of peripheral blood neutrophil-to-lymphocyte ratio （NLR） and standardized serum uric acid （SUA） ，i.e.，the ratio of SUA to serum creatinine（SUA/Scr），with the traditional Chinese medicine（TCM）syndrome types of early diabetic kidney disease（EDKD） from the pathogenies of deficiency-dampness-heat-stasis，thus to provide an objective basis for the precise TCM treatment of EDKD patients. Methods A retrospective study was conducted. The clinical data collection was carried out in 197 EDKD patients，including 42 cases of qi and yin deficiency syndrome（qi-yin deficiency group），44 cases of qi and yin deficiency complicated with dampness syndrome（qi-yin deficiency with dampness group） ，53 cases of qi and yin deficiency complicated with heat syndrome（qi-yin deficiency with heat group），and 58 cases of qi and yin deficiency complicated with stasis syndrome（qi-yin deficiency with stasis group）. The differences in lipid metabolism indicators，renal function indicators，NLR，and standardized SUA of EDKD patients with various TCM syndromes were compared，and then the correlation of NLR and standardized SUA with the TCM syndromes of EDKD was investigated. Results （1）There were no statistically significant differences in the gender and glycosylated hemoglobin（HbA1c）level among EDKD patients with different TCM syndromes（P＞0.05）. The age of qi-yin deficiency with stasis group was older than that of qi-yin deficiency group（P＜0.05），and the duration of EDKD in qi-yin deficiency with stasis group was longer than that in the other syndrome groups（P＜0.01）. The body mass index （BMI）presented an ascending order in the qi-yin deficiency group，qi-yin deficiency with stasis group，qi-yin deficiency with heat group，and qi-yin deficiency with dampness group（P＜0.05）. （2）The total cholesterol（TC）level in qi-yin deficiency group was lower than that in qi-yin deficiency with dampness group，and qi-yin deficiency with stasis group（P＜0.05），the triglyceride （TG） level in qi-yin deficiency group was lower than that in qi-yin deficiency with stasis group（P＜0.05），Scr level in qi-yin deficiency with heat group was higher than that in qi-yin deficiency group and qi-yin deficiency with dampness group（P＜0.05），the estimated glomerular filtration rate（eGFR）level in qi-yin deficiency group was higher than that in qi-yin deficiency with heat group and qi-yin deficiency with stasis group （P＜0.05） ，the NLR level in qi-yin deficiency with heat group was higher than that in the other three syndrome groups （P＜0.05），and the level of standardized SUA in qi-yin deficiency with stasis group was lower than that in qi-yin deficiency with dampness group and qi-yin deficiency with heat group（P＜0.05）. （3）The results of the non-ordinal multinomial logistic regression analysis showed that BMI and SUA were the influencing factors for qi-yin deficiency with dampness syndrome；BMI，SUA，and NLR were the influencing factors for qi-yin deficiency with heat syndrome；BMI，TC，and standardized SUA were the influencing factors for qi-yin deficiency with stasis syndrome. The differences were all statistically significant （P＜0.05 or P＜0.01）. Conclusion NLR and standardized SUA can be used as the reference indicators for the differentiation of TCM syndromes of EDKD. The elevated level of NLR may accelerate the development of qi- yin deficiency with heat syndrome，and the decreased level of standardized SUA may accelerate the development of qi-yin deficiency with stasis syndrome.

R259.872

全国名老中医专家传承工作室建设项目 （编号：国中医药人教函[2022]75号）