An Analysis Of The Clinical And TCM Syndrome Characteristics Of The 60 Cases Of The Early Diabetic Nephropathy Patients

The diabetic nephropathy (DN) is one of the most common and intractable diabetes clinical microvascular complications, a research report of the ADA Meeting in june2006from25countries and35research center reveal that40%of the patients with end-stage renal failure is caused by diabetic nephropathy, diabetic nephropathy has become one of the important cause of end-stage renal failure in the word. Diabetic nephropathy is a progressive disease, but it is possible to make a clinical diagnosis of diabetic nephropathy after the continuous proteinuria appear. At the same time,patients is generally inevitable progress to the final renal failure,therefore,to diagnosis and treat of the diabetic nephropathy seems very important. At present, the traditional Chinese medicine is widely used in the treatment of early diabetic nephropathy. The clinical effect of traditional Chinese medicine medicinal broth, Chinese medicine preparations,and proprietary Chinese medicine of traditional Chinese medicine (TCM)is remarkable under the guidance of method.For the doctor of traditional Chinese medicine,the treatment of diseases is based on syndrome differentiation. As a result,the study of Chinese medicine syndrome types and symptoms for early diabetic nephropathy is very necessary. This study collected100cases of patients with type 2 diabetes, and 60 cases of it is early diabetic nephropathy patients,and analyze their clinical features, Chinese medicine syndrome, and explore some laboratory indexes of correlation.[Objective] Summary and analysis the clinical and TCM syndrome characteristics of the 60 cases of the early diabetic nephropathy patients and compared with the symptoms, syndrome type and laboratory indexes of the 40 cases of the type 2 diabetes who do not complicated with early diabetic nephropathy, in order to explore the early clinical characteristic of diabetic nephropathy and the TCM syndrome patterns.[Methods] To collect and clear up100cases of patients with type2diabetes including concurrent60patients with early diabetic nephropathy in the ward of Chinese medicine in the Beijing hospital, from March2011to January2013, then design tables, records, statistics and analysis of the general situation, the part of the main symptoms, frequency of complications occur, the main syndrome, and card type distribution of early diabetic nephropathy; and the differences of TCM syndrome and symptoms distribution between the sugar kidney group and the non sugar kidney;the correlation between some laboratory indexes and early diabetic nephropathy.[Results](1) Mainly of the60cases of early diabetic nephropathy patients is elderly people (68.3%), and there is no obvious gender bias; The ones whoes process is above5years account for about more than70%; The ones whoes body mass index (BMI) is high for71.7%.(2)In the60patients with early diabetic nephropathy, the number of patients with early diabetic nephropathy merger the diabetic peripheral neuropathy (DPN) is as high as73.3%and the merger of the digital radiography (DR) is about51.7%.(3) In the60patients with early diabetic nephropathy, the merger of hypertension is81.7%, and the population with dyslipidemia accounts for71.7%, atherosclerosis widely exists in patients with early diabetic nephropathy, which is as high as85%, people who is with the coronary heart disease accounts for only20%, the population with cerebrovascular disease accounts for23.3%(4) In the analysis of60patients with early diabetic nephropathy in traditional Chinese medicine syndrome and symptoms distribution, the main distribution of gas and Yin deficiency has the highest proportion (70%), and the syndrome, blood stasis syndrome, is one of the main and the proportion accounted for45%, and the composite model stat isties also show that both qi and Yin deficiecy and blood stasis are the most common (48.3%); And distribution proportion in mere than30%of the patients is together wi th the symptoms, such as:fatigue, more drink urine. numbness and blurred vision; Pulse condition with heavy fine, thin string, string smoothing is the most usual, the three kinds of pulse condition accounts for43.3%of the study. For the tongue, tongue reddish greasy, less reddish tongue moss is the most common.(5)There is no difference between the patients with early diabetic nephropathy and the patients with type2diabetes on the TCM syndrome and symptoms distribution.(6) Through the record of the laboratory indicators of40cases of diabetic and60cases of diabetic nephropathy part, and correlation and comparison analysis, the single factor correlation study found that the the difference between the non-diabetic nephropathy group and diabetic nephropathy group in C-reactive protein (CRP), low density lipoprotein (LDL-C) was statistically significant (P0.001and0.009, respectively),;The CRP, LDL-C the diabetic nephropathy group is higher than that in the non-diabetic nephropathy group; as to the glycosylated hemoglobin (HbAlC), serum creatinine (Scr) and carotid intima-media thickness (IMT), there was no statistically significant difference about them (P=0.562>0.05); But in the end the five variables are put into the multi-factor logistic regression analysis, the result shows that CRP, LDL-C, HbA1C, SCR and carotid artery intima-media thickness can not entered the model (P>0.05).[Conclusion](1) As the growth of the age and the process of diabetes, the incidence of diabetic nephropathy are on the rise, and obesity is likely to be the one of risk factors of diabetic kidney disease, and gender may have little relevance to diabetic nephropathy.(2)The patients with early diabetic nephropathy tend to merge other diabetes complications, such as DR, DPN.(3) The number of the early diabetic nephropathy patients with hypertension, dyslipidemia, atherosclerosis is more, however the ones merge with coronary heart disease, cerebrovascular disease is less.(4)The deficiency of Qi and Yin with blood stasis may be the main pathogenesis of early diabetic nephropathy. So based on tonifying qi and yin, the early application of promoting blood circulation to remove blood stasis drugs, is of great significance for the prevention and treatment of early diabetic nephropathy.(5) The patients with early diabetic nephropathy often can not be found with specific symptoms, compared to the patients with type2diabetes symptoms who is not complicated with early diabetic nephropathy, the performance is the same of tongue and pulse and TCM syndrome study, which accords with clinical characteristics.(6) The analysis of single factor suggest that CRP, LDL-C may be the influence factors of early diabetic nephropathy, but multiple factors analysis, the non-diabetic nephropathy group and diabetic nephropathy group showed no obvious difference on the five factors of CRP, LDL-C, HbALC, Scr, IMT; that may contribute to the few number of cases, it remains to be further research.