Research On TCM Syndrome Characteristics Of Kidney Essence Deficiency In Diabetic Nephropathy

Objective:With the advancement of living standard,the incidence of diabetes and its complications is increasing year by year,and DKD has become one of the important causes of kidney failure,bringing a great burden to the society and individuals.At present,there is still a lack of clear and effective methods for the treatment of DKD.After years of clinical practice and observation of the clinical characteristics of DKD,professor liu hongfang,combined with zhang jingyue's "kidney-Yin and essence theory",proposed that deficiency of kidney essence is an important reason for the occurrence and development of DKD and runs through the disease.At present,this syndrome rarely appears in the research of diabetes or kidney disease,and there is no research on the related etiology,pathogenesis and syndrome characteristics.Therefore,this study investigated the clinical characteristics,TCM syndrome characteristics and the relationship between DKD and renal function in patients with renal essence deficiency syndrome through the research of syndrome,so as to provide new thinking and methods for the prevention and treatment of DKD by the TCM diagnosis and treatment.Method:By cross-sectional study,the method of collection from Beijing university of Chinese medicine dongzhimen hospital of Beijing 14 participating units and the dongcheng district under the jurisdiction of the community health service centers in diabetic kidney disease diagnosis standard,478 cases of patients with DKD,fill in the early stage of the team after several rounds of expert consultation for TCM syndrome evaluation form,and then according to the proposed kidney essence deficiency syndrome diagnostic criteria of all patients were divided into kidney essence deficiency group 332 cases and the kidney essence deficiency group 146 cases,compared two groups of patients with general situation,distribution of symptoms and signs,and clip card and laboratory index differences,According to Mogensen staging standard kidney essence deficiency syndrome patients divided into III period 168 cases 164 cases,? period,compare two signs and symptoms of patients,and the distribution difference,etc.,summarizes diabetic kidney disease and kidney essence deficiency syndrome of TCM syndrome characteristics and related factors.After the data of all cases were checked and summarized,SPSS 25.0 statistical analysis software was used for data analysis.The measurement data those with Gaussian distribution were delineated by mean±standard deviation(X±S),those without Gaussian distribution were delineatted by median(quarter distance)(M(Q3-Q1),and the counting data were represented by frequency(N)or frequency(%).For comparison between two independent samples,the independent sample t test was used for those with normal distribution and homogeneous variances.Independent sample nonparametric test was used for those who did not follow normal distribution or have different variances.The counting data were tested by X2.Binary Logistic regression analysis was used to study the data correlation of dichotomies.Correlation between syndrome integral and laboratory indexes.After excluding multicollinearity,Pearson correlation coefficient and P value were taken for those with normal distribution,and Spearman correlation coefficient and P value were taken for those without normal distribution.Result:1.DKD kidney essence deficiency syndrome distribution and general situation:?478 DKD patients included in this study,a total of 332 patients with kidney essence deficiency syndrome,accounting for 69.5%of the total,? period,a total of 164 patients with kidney essence deficiency,IV period,a total of 168 patients with kidney essence deficiency,IV phase of the kidney essence deficiency card number more than ? period(P<0.01).?Among the 332 patients with kidney deficiency syndrome.the ratio of male to female was 1.29:1,and the number of patients aged from 60 to 70 years old was the largest,with an average age of 63.5(12)years old.The female patients were older than the male patients(P<0.01).2.The distribution characteristics of symptoms and signs of the patients with kidney deficiency syndrome:from high to low,the symptoms are waist and knee ache,fatigue,tinnitus and deafness,loss of libido,dry throat and mouth,loose teeth and hair loss,blurred vision,heavy body sleepiness,forgetfulness,and numbness of hands and feet.3.The relationship between kidney essence deficiency and gender,age,blood pressure and BMI:the average age of patients with kidney essence deficiency syndrome was higher than that of patients without kidney essence deficiency syndrome(P<0.01).the diastolic blood pressure was higher than that of patients without kidney essence deficiency syndrome(P<0.05),and there was no correlation between kidney essence deficiency and gender or BMI(P>0.05).4.Relationship between kidney essence deficiency and family history and previous medical history of diabetes:the proportion of previous hyperlipidemia,coronary heart disease and hyperuricemia in patients with essence deficiency was higher than that in patients without essence deficiency(P<0.05),and there was no significant correlation with family history of diabetes,hypertension,fatty liver,and history of cerebral infarction(P>0.05).5.The relationship between kidney essence deficiency and double clamping syndrome:Yin deficiency syndrome(59.3%)was the most common deficiency syndrome in patients with essence deficiency,followed by qi deficiency(52.1%),Yang deficiency(35.5%)and blood deficiency(24.7%).In the empirical evidence,the largest number of people were dampness-heat syndrome(54.2%),followed by blood stasis(45.8%),phlegm turbidity(35.2%),heat sheng(22.6%),qi stagnation(16.9%),and water dampness(6.0%).The proportions of qi asethenia,Yang asthenia,qi depression,damp and hot,blood stasis and phlegm turbid in patients with fine deficiency were significantly higher than those without fine deficiency(P<0.01),and the differences between blood deficiency syndrome and Yin deficiency syndrome were statistically significant(P<0.05).The proportion of kidney Yin deficiency and kidney Yang deficiency in patients with fine deficit was higher than that of patients without fine deficit(P<0.05).The scores of deficiency syndrome and evidence-based evidence were higher in patients with fine deficit than those without fine deficit(P<0.01).There were 69 cases(20.78%)of pure deficiency syndrome and 263 cases(79.22%)of deficiency and real deficiency.There were 23 patients(6.93%)with deficiency of qi,blood,Yin and Yang,and more than three cases(29.22%).6.The relationship between renal sperm deficiency and laboratory indexes:the levels of HbA1c,FPG and eGFR in patients with sperm deficiency were lower than those without sperm deficiency,and the levels of BUN.SCr,24hUTP,TP,ALB and K+were higher than those without sperm deficiency,with statistically significant differences(P<0.05).Based on binary Logistic regression,the study on the relevant factors of DKD syndrome of kidney essence deficiency concluded that among DKD patients,the syndrome of qi deficiency,phlegm turbidity,age and 24hUTP were the most correlated with the syndrome of kidney essence deficiency,and all of them were positively correlated with the syndrome of kidney essence deficiency.The syndrome score was positively correlated with 24hUTP(r=0.419,P<0.001),negatively correlated with eGFR(r=-0.312,P<0.001),and positively correlated with SCr(r=0.333,P<0.001).There was no linear correlation with UA(r=0.085.P>0.05).7.Kidney essence deficiency syndrome in patients with different stages of syndromes learning features:IV phase of the kidney essence deficiency syndrome score higher than ?period(P<0.01).IV period and Yang deficiency syndrome,wet,patients with blood stasis ratio higher than ? period(P<0.01).? period blood deficiency,Yang deficiency,water wet,damp and hot,blood stasis and phlegm turbidity syndrome factor score higher than ? period(P<0.01).The empirical,? period in patients with hot and humid card number,total ?period in patients with blood stasis.In kidney deficiency and clip,? kidney Yin deficiency syndrome in 87 cases(53%),94 cases of kidney Yang deficiency(57.3%),? phase of 110 cases of deficiency of kidney-yin(65.5%),120 cases of deficiency of kidney-yang(71.4%).IV period in patients with kidney Yin deficiency,kidney Yang deficiency syndrome scale are relatively high ? period(P<0.05).? period in patients with kidney Yin deficiency,kidney Yang deficiency is also higher than ? period(P<0.01).164 patients with kidney essence deficiency ? period,pure deficiency syndrome 45 cases,accounting for 27.44%,factors of 119 cases,accounting for 72.56%.IV period patients,24 cases of pure deficiency syndrome,accounted for 14.28%,factors of 144 cases,accounting for 85.72%.IV period the number of pure deficiency syndrome in patients with relatively less ? period,factors proportion is relatively high ? period(P<0.01).Conclusion:1.Deficiency of kidney essence is prevalent in patients with DKD,accounting for 69.5%of the total DKD population in this study.With disease progression,IV period ? percentage kidney essence deficiency syndrome of the period,kidney essence is deficient degree also grown.2.DKD kidney essence deficiency syndrome patients are mainly the elderly,and age is positively correlated with kidney essence deficiency.The main symptoms are waist and knee ache,fatigue,tinnitus and deafness,loss of libido,dry throat,loose teeth,hair loss,blurred vision and forgetfulness.3.TCM syndromes are characterized by the inclusion of deficiency and consolidation:?compared with patients without deficiency of kidney essence,the proportion of simple deficiency syndrome in patients with deficiency of kidney essence is lower,and the proportion of deficiency and consolidation is higher.Qi asthenia,Yang asthenia,kidney Yin asthenia and kidney Yang asthenia were more common,and qi depression,damp and hot,blood stasis and phlegm turbidity were more common.?With the progress of the disease,the degree of deficiency of kidney essence aggravates,Yang deficiency,kidney Yin deficiency,kidney Yang deficiency syndrome increases,the degree of deficiency increases,the proportion of water,blood stasis syndrome increases,the degree is also more.4.The degree of kidney essence deficiency was positively correlated with SCr,BUN and 24hUTP,and negatively correlated with eGFR.