Clinical Characteristics Of Chronic Kidney Disease With Atrial Fibrillation And Distribution Of TCM Syndromes

Objective: to investigate the clinical characteristics of patients with CKD and AF,analyze their primary diseases,combined diseases and influencing factors,and study the distribution of TCM syndromes in patients with CKD and AF,so as to provide an effective way for early diagnosis,prognosis judgment and rational treatment of patients with CKD and AF.Methods: to select the first affiliated hospital of tianjin medical university department of nephropathy between January 2017 and December 2019,merge AF patients with chronic kidney disease(CKD),collecting the clinical data in detail,and records of the patient’s basic situation,primary disease,merge disease,cardiac function classification,relevant laboratory index(routine blood,serum creatinine,blood urea nitrogen,serum potassium,calcium,phosphorus,serum albumin,high-density lipoprotein cholesterol(hdl-c),low density lipoprotein,triglyceride,cholesterol,etc.)and TCM four diagnostic information,patients in CKD stage can be divided into: Ckd1-5 stage was divided into paroxysmal AF group,persistent AF group,long-term persistent AF group and permanent AF group according to AF classification,and the distribution law of TCM syndromes was obtained by analyzing the four TCM diagnoses of patients.Result:1 Clinical characteristics and related influencing factors of CKD patients with AF:A total of 188 patients were included in this study,including 101 males(53.7%)and 87 females(46.3%),with an average age of 70.95 ± 10.59 years old.The middle-aged patients accounted for the highest proportion,with 91 patients accounting for 48.4% of the total.Enrolled patients were 14 cases(7.4%) in CKD1,29 cases(15.4%) in CKD2,43 cases(22.9%)in CKD3,45 cases(23.9%) in CKD4,and 57 cases(30.4%) in CKD5(non-dialysis).In each of the CKD1-4 groups,there were more male patients than women,and in stage 5,there were more female patients than male patients.The primary symptoms of the patients were chronic glomerulonephritis(67.0%) and diabetic nephropathy(29.8%).AF classification: 36 cases of paroxysmal AF(19.1%),55 cases of persistent AF(29.3%),55 cases of long-range persistent AF(29.3%),42 cases of permanent AF(22.3%).Persistent AF was predominant in patients with stage 1,4 and 5 of CKD,with 7(50.0%),14(31.1%) and 20(35.1%) cases respectively;permanent AF was used in patients with stage 2 of CKD Mainly,9 cases(31.0%);in CKD stage 3,long-range persistent AF was the main,22 cases(51.2%).There are 119 patients(63.4%) with cardiac insufficiency(above NYHA level II)in patients with CKD and AF.With the decline of CKD stage,the cardiac function of patients shows a downward trend;in patients with paroxysmal,persistent,and long-term persistent AF,cardiac function is not obvious There are many patients with abnormalities,and those with permanent AF are mostly NYHA Ⅲ patients with cardiac function.2 Analysis of risk factors for patients with persistent AF and strokeThere were 152 patients(80.9%) with persistent AF in this study.Gender,e GFR,right and left atrium diameter,aortic valve orifice blood flow velocity,pulmonary valve orifice blood flow velocity,hemoglobin,red blood cell distribution width,urea nitrogen,blood calcium,Serum albumin is closely related to the occurrence of persistent AF.Logistic analysis showed that gender,e GFR,and right atrium inner diameter were independent factors of persistent AF.In this study,the incidence of stroke in patients with CKD and AF was 28.7%,a total of 54 cases.After analyzing the history of hypertension,coronary heart disease and stroke in this study,the logistic analysis showed that the two were independent risk factors for stroke in patients with CKD and AF.3 Distribution pattern of TCM syndromes in patientsIn this study,188 patients were mainly due to spleen and kidney qi deficiency,accounting for 56.9%,followed by spleen and kidney yang deficiency syndrome 19.1%,liver and kidney yin deficiency syndrome 12.2%,qi and yin deficiency syndrome 8.1%,yin and yang deficiency syndrome 3.7%;the standard evidence is the wet and turbidity syndrome,accounting for 40.4%,followed by the blood stasis syndrome 27.6%,the dampness and heat syndrome 26.6%,the heat poison syndrome and the wind motion syndrome are the least,each accounted for 2.7%;Card-based.In each CKD stage and AF type,the deficiency syndrome is dominated by deficiency of spleen and kidney qi,and wet and turbid blood stasis runs through the disease.4 Analysis of patient laboratory indicatorsIn each CKD staging group,the differences among hemoglobin,blood creatinine,urea nitrogen,blood uric acid,blood potassium,blood magnesium,blood calcium,blood phosphorus,and albumin were statistically significant(P <0.05)and decreased with the CKD staging Nutritional indicators such as hemoglobin and serum albumin showed a downward trend;the levels of serum creatinine,urea nitrogen,blood uric acid,and blood potassium showed an upward trend;and blood magnesium levels in CKD stages 4 to 5 were also higher than those in other groups.The distribution of hemoglobin,blood creatinine,urea nitrogen,blood magnesium,blood calcium,and serum albumin was statistically significant among the AF subtypes(P <0.05);the blood magnesium of paroxysmal AF patients was lower than that of other AF subtypes,and the long-term Serum albumin levels in patients with persistent AF were significantly lower than those in patients with paroxysmal AF and long-range persistent AF(P <0.01).The distribution of hemoglobin,blood creatinine,blood uric acid,blood calcium,and blood phosphorus in patients with this deficiency syndrome was statistically different(P <0.05).Comparing the deficiency syndromes,the hemoglobin content was highest in the spleen and kidney qi deficiency syndrome,and the serum creatinine and urea nitrogen contents were the lowest.Disturbances in calcium and phosphorus metabolism were most obvious in the yin-yang deficiency syndrome.The distribution of blood sodium,blood chlorine,and cholesterol content in the standard evidence of patients was statistically different(P <0.05),but the blood chloride levels of patients in the dehumidification and turbidity syndrome group were significantly higher than those of the damp heat syndrome difference.In conclusion:1 There are many males with CKD and AF;the primary disease is mainly caused by chronic glomerulonephritis(67.0%)and diabetic nephropathy(29.8%);with the progress of CKD and the continuous development of AF paroxysmal,The patient’s heart function showed a downward trend.2 EGFR,gender,right atrial diameter and left and right atrial diameter are the influencing factors for the transition from paroxysmal AF to persistent AF.History of hypertension and history of coronary heart disease were independent risk factors for stroke in patients with CKD and AF.3 The syndrome differentiation of patients with CKD and AF is based on the syndrome of deficiency.The CKD stage and the type of AF are mainly based on the syndrome of spleen and kidney qi deficiency.4 Laboratory indicators such as hemoglobin,blood creatinine,urea nitrogen,blood calcium,and blood phosphorus are related to the CKD stage,AF classification,and the distribution of TCM syndromes.