Relationship Between Fatigue And TCM Syndrome Types In MHD Patients And Analysis Of Influencing Factors

Objective To explore the relationship between fatigue degree and TCM syndrome type in patients with maintenance hemodialysis(MHD),and analyze the related factors to provide evidence for clinical relief of fatigue symptoms.Method 1.According to the inclusion and exclusion criteria,the patients with end-stage renal disease were selected from October2018 to December 2018 in the hemodialysis center of Wuhan NO.1Hospital,and the general situation and laboratory indexes of the patients were collected;2.According to the range interquartile of CFQ(14,17,22),the patients were divided into four groups: Q1(< 14),Q2(14-16),Q3(17-21),Q2(14-16),Q3(17-21),Q4(≥22);At the same time,the TCM Syndrome types of maintenance hemodialysis patients was carried out by professional TCM doctors,which was Divided into deficiency syndrome(the deficiency of spleen and kidney qi,the deficiency of spleen and kidney yang,the deficiency of liver and kidney yin,the deficiency of qi and yin,and the deficiency of yang and yang)and standard demonstration(dampness and turbid syndrome,damp-heat syndrome,blood stasis syndrome,heat toxin syndrome,wind movement syndrome,no concurrent syndrome);3.To observe the distribution characteristics of TCM syndromes in patients with MHD and to compare the difference of fatigue scores(CFQ)of patients with different syndromes;4.To compare the general conditions,laboratory indexes,complications and TCM syndromes of patients with different fatigue degrees,and analyze the related factors of fatigue in maintenance hemodialysis patients.Result 1.A total of 454 patients with MHD were included and completed the study.The average level of the patient’s fatigue score(CFQ)was 18.15±5.01,and more than half(53.7%)of the patients were in moderate and severe and severe fatigue(CFQ> 17);2.There was no significant difference in dialysis age,dialysis frequency,duration of dialysis,sex ratio and the proportion of common primary diseases among patients with different fatigue degree(Q1、 Q2、Q3、Q4)(P > 0.05).The average age(60.10 ±9.08years)of patients with severe fatigue(Q4)was higher,the median sp Kt/V(1.39)was small,the proportion of internal arteriovenous fistula(73%)was lower,and that of married patients was higher(P < 0.05).The proportion of patients living alone in moderate fatigue(Q2)was relatively high(13%)(P < 0.05),while The proportion of in-service patients with mild fatigue(Q1)(18.6%)was relatively higher,and The proportion of retired patients in severe fatigue(Q4)(68.3%)was relatively high(P < 0.05);3.There was no significant difference in systolic pressure(SBP),ferritin(SF),serum creatinine,(Scr),uric acid(UA),blood urea nitrogen(BUN),serum calcium(Ca),phosphorus(P),parathyroid hormone logarithmic(Log PTH)in different fatigue groups(P> 0.05).Diastolic blood pressure(DBP),)hemoglobin(HB)was relatively lower in Q3 、Q4 group(P < 0.05).The erythrocyte volume(HCT),plasma albumin(ALB)was lower in the group of severe fatigue(Q4)(P < 0.05);4.The proportion of common complications in different fatigue groups was different(P < 0.05).The proportion of patients with dry mouth symptoms in mild fatigue(Q1)group(39.5%)was lower(P <0.05),and The proportion of patients with pruritus in severe fatigue(Q4)group(63.5%)was higher.Patients with dry skin,difficulty falling asleep and restless leg syndrome accounted for a higher proportion in moderate and severe fatigue groups,namely Q3 group(59.7%、58.2%、23.9%),Q4 group(61.9%、69.8%、30.2%)(P<0.05)and the proportion of patients complicated with arthralgia was higher(37.3%)in moderate and severe fatigue(Q3)group(P <0.05);5.In TCM syndromes,The deficiency syndrome was mainly liver-kidney yin deficiency syndrome(29.1%),followed by spleen-kidney qi deficiency syndrome(22%),;The syndrome of damp turbid syndrome(41.9%)and blood stasis syndrome(23.8%)accounted for more.There was no significant difference in the proportion of damp-heat syndrome and wind-moving syndrome in each syndrome(P >0.05).The proportion of dampness and turbid syndrome in spleen and kidney qi deficiency syndrome was relatively high(64%),and that of blood stasis syndrome was more(50%)in both yin and yang deficiency syndrome.Heat and toxin syndrome accounted for more(10.6%)in liver and kidney yin deficiency syndrome,and non-syndromes accounted for the least proportion in yin and yang deficiency syndrome(0%)(P < 0.05);6.The comparison of fatigue scores of patients with different syndromes showed that there was a relatively lower degree of fatigue(P <0.05)in syndrome of yin deficiency of liver and kidney and non-syndromes.The proportion of the patients with mild and moderate fatigue(Q1,Q2)was relatively higher in syndrome of yin deficiency of liver and kidney and non-syndromes(P <0.05),and the fatigue level of the patients with syndrome of deficiency of yin and yang and blood stasis was relatively high(P <0.05).The proportion of deficiency of yin and yang syndrome and blood stasis syndrome in severe fatigue(Q4 group)is relatively higher(P < 0.05);7.The results of multivariate linear regression model showed that the fatigue level of MHD patients was positively correlated with age(B=0.156)and negatively correlated with HB(B=0.045),HCT(B=0.093)(P < 0.05).Univariate Logistic regression analysis: age,hypertensive nephropathy,weekly dialysis frequency,married,living alone,working state,itching,dry skin,difficulty falling asleep,restless legs,joint pain,HB,HCT,ALB were the influencing factors of high level(CFQ >17)fatigue degree(P <0.05).The results of Multivariate Logstic regression model showed that sleep difficulty(OR=2.943),restless leg(OR=2.619),joint pain(OR=2.048),Blood stasis syndrome(OR=3.853)were the independent risk factors of high level of fatigue(CFQ > 17).The primary diseases were hypertensive nephropathy(OR=0.416),weekly dialysis frequency(OR=0.330),solitary living(OR=0.248),diastolic blood pressure(OR=0.974),Ca(OR=0.08),and deficiency of spleen and kidney(relative to yin and yang deficiency).OR = 0.18,the deficiency of the spleen and kidney(OR = 0.146),the deficiency of the liver and the kidney(OR = 0.41),the deficiency of the Qi and yin(OR = 0.135)were the independent protective factors of the level of fatigue(P <0.05).Conclusion 1.More than half of the patients(57.3%)were in a high level of fatigue(CFQ > 17),and there were many factors influencing the fatigue degree of the patients.The results of this study showed that age,HB,HCT had a significant effect on the fatigue score of the patients.The older the age,the lower the level of HB and HCT,the higher the(CFQ)score.Patients with difficulty falling asleep restless legs and joint pain had a higher risk of fatigue(CFQ >17).The patients who were with hypertension nephropathy,higher frequency of weekly dialysis,higher diastolic blood pressure(DBP),and higher level of ca with a relatively low risk of high level of fatigue(CFQ >17).In clinic,the fatigue state of patients can be alleviated by improving sleeping difficulty,restless legs,arthralgia and other accompanying symptoms,correcting anemia,hypoproteinemia,hypotension,hypocalcemia,and increasing dialysis frequency;2.The TCM syndromes of MHD patients are characterized by "asthenia in origin and asthenia in superficiality ",The deficiency syndrome is mainly liver-kidney yin deficiency syndrome,and the standard syndrome is damp-turbid syndrome.The deficiency of both yin and yang and blood stasis syndrome are more likely to appear more serious fatigue state,the fatigue degree of liver-kidney yin deficiency syndrome and non-syndrome is relatively mild.On the basis of western medicine treatment,according to the etiology,pathogenesis and syndrome differentiation of mhd patients,we can give the treatment of yin-yang double tonifying,nourishing the liver and kidney,and according to its combination of syndrome,activating blood circulation to remove blood stasis,removing dampness and removing turbidity,to realize the individual treatment of integrated traditional Chinese and western medicine.