蛋白尿之中西醫觀點

Western medicine viewpoint of Proteinuria

10.7102/JTCIM.201912_17(2).0002

柯馨婷(Ko, Hsin-Ting)；呂琇蓉(Lu, Hsiu-Jung)；王育才(Wang, Yu-Tsai)

蛋白尿 ； 中醫 ； 腎病症候群 ； 高血壓 ； 末期腎病變 ； proteinuria ； Traditional Chinese Medicine ； nephrotic syndrome ； hypertension ； end-stage renal disease

中醫內科醫學雜誌

17卷2期（2019 / 12 / 01）

11 - 20

繁體中文

蛋白尿就是尿液中有過多的蛋白質。微量白蛋白尿期是可以回復的；一旦進入巨量白蛋白尿期，則為不可回復的狀態。尿液中排出過多蛋白質的問題在於腎絲球基底膜的機械或負電荷屏障或腎小管的重吸收作用。蛋白尿的檢驗方法主要是偵測尿中的白蛋白，就腎臟本身而言，檢測尿蛋白可以早期發現腎臟病、了解目前腎臟病的嚴重程度以及預後。造成微量白蛋白尿的可能原因包括高血壓、高血糖、高血脂、老化、肥胖、抽菸、對鹽分敏感、以及內皮細胞功能失常。對於糖尿病或是非糖尿病患者，除了腎臟的併發症之外，微量白蛋白尿也是心血管疾病發生及死亡率的獨立危險因子；尤有甚者，末期腎病變也具有顯著的遺傳相對危險性。中醫古籍中與蛋白尿最相關的記載是尿濁。中醫尿濁的證型主要有濕熱內蘊、腎陽虛衰、腎陰虧虛、和脾虛氣陷。不可諱言的，隨著身體的老化，腎功能只會越來越差；但是，中西醫藥物聯合治療蛋白尿，加上病患確實配合限制蛋白質的飲食與適量的飲水與運動，可以降低高血壓或是糖尿病等疾病對於腎功能的影響，有助於維持基本腎功能與減輕尿蛋白，進而延年益壽。

Proteinuria is the presence of excess proteins in the urine. The condition is reversible during the stage of microalbuminuria, but irreversible once falling into the macroalbuminuria stage. The problems of proteinuria lie in the mechanical or electrical barrier of the glomerulus or the reabsorption of renal tubules. The methods of detecting proteinuria are targeting the albumin. With regarding to the kidney, detection of proteinuria allows us to discover early kidney diseases, realize the severity of the kidney disease and its prognosis. The causes of microalbuminuria include mainly increased BMI, increased blood pressure, altered lipid levels, smoking, insulin resistance or hyperinsulinemia, salt sensitive, elderly, and endothelial dysfunction. For patients with diabetes or without diabetes, in addition to the complications of kidney diseases, microalbuminuria is also an independent risk factor of the incidence and mortality rate of cardiovascular diseases; moreover, end-stage renal disease also exhibits significant relative risk of heredity. The most similar disease to proteinuria described in ancient Traditional Chinese Medicine books is turbid urine. The major syndromes of the turbid urine include accumulation of damp-heat, kidney-yang deficiency, shortage of the kidney-yin and sinking of qi due to spleen deficiency. Undoubtedly, with ageing, the renal function is going to be worsening gradually; however, the integrated treatment of Chinese and western medicine combined with the corporation of patients' control of adequate intake of proteins and water can effectively lower the ill-effects resulting from hypertension and diabetes and maintain a basic renal function, leading to a longer and happier life.

1. 陳玟,楊曜旭(2019)。慢性腎絲球腎炎病人使用中藥之分析：基於醫院的橫斷面研究。J Chin Med，30(1)，60-81。
   連結：
2. (2018).慢性腎臟病健康管理手冊.衛生福利部國民健康署.
3. The Effects of Restricted Protein Diet Supplemented With Ketoanalogue on Renal Function, Blood Pressure, Nutritional Status, and Chronic Kidney Disease-Mineral and Bone Disorder in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis.Journal of Renal Nutrition
4. Carroll, MF,Temte, JL(2000).Proteinuria in adults: a diagnostic approach.Am Fam Physician,62(6),1333-1340.
5. Christian, M.T.,Watson, A.R.(2004).The investigation of proteinuria.Current Paediatrics,14(7),547-555.
6. Diskin, CJ,Stokes, TJ,Dansby, LM,Carter, TB,Radcliff, L(2000).Surface tension, proteinuria, and the urine bubbles of Hippocrates.Lancet.,355(9207),901-902.
7. Garg, JP,Bakris, GL(2002).Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease.Vasc Med,7,35-43.
8. Hillege, HL,Fidler, V,Diercks, GF(2002).Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population.Circulation,106,1777-1782.
9. Jiang, Z,Zhang, X,Yang, L,Li, Z,Qin, W(2016).Effect of restricted protein diet supplemented with keto analogues in chronic kidney disease: a systematic review and meta-analysis.Int Urol Nephrol,48(3),409-418.
10. Kashif, W,Siddiqi, N,Dincer, AP,Dincer, HE,Hirsch, S(2003).Proteinuria: how to evaluate an important finding.Cleve Clin J Med,70(6),535-547.
11. Keane, WF,Eknoyan, G(1999).Proteinuria, albuminuria, risk, assessment, detection, elimination (PARADE): a position paper of the National Kidney Foundation.Am J Kidney Dis.,33(5),1004-1010.
12. Perry, H. M.,Miller, J. P.,Fornoff, J. R.(1995).Early predictors of 15-year end-stage renal disease in hypertensive patients.Hypertension,25,587-594.
13. Poortmans, J,Jeanloz, RW(1968).Quantitative immunological determination of 12 plasma proteins excreted in human urine collected before and after exercise.J Clin Invest,47(2),386-393.
14. Waller, KV,Ward, KM,Mahan, JD,Wismatt, DK(1989).Current concepts in proteinuria.Clin Chem,35(5),755-765.
15. Wu, HH,Kuo, CF,Li, IJ,Weng, CH,Lee, CC,Tu, KH,Liu, SH,Chen, YC,Yang, CW,Luo, SF,See, LC,Yu, KH,Huang, LH,Zhang, W,Doherty, M,Tian, YC(2017).Family Aggregation and Heritability of ESRD in Taiwan: A Population-Based Study.Am J Kidney Dis,70(5),616-626.
16. 李佩賢,張弘育,董淳武,徐永建,雷振宙,張洵浩,施雅雪,林俊良(2009)。一個容易被忽略的徵兆：微白蛋白尿。內科學誌，20，275-284。
17. 陳苓怡,陳鴻鈞(2011)。我真的有慢性腎臟病嗎？腎絲球濾過率與慢性腎臟病分期。高醫醫訊月刊，31(4)，5。
18. 陳榮洲（編）(2003).中醫內科證治學.弘祥出版社.
19. 陳輝,陳朝霞(2018)。中西醫結合治療慢性腎臟病3~4 期臨床觀察。中國中醫藥現代遠程教育，16(13)
20. 游志勤(2007)。蛋白尿之臨床驗案一則。台灣中醫臨床醫學雜誌，13(4)，322-327。
21. 黃清意,賴世偉,林正介(2006)。蛋白尿與微量白蛋白尿。基層醫學，21(6)，163-167。