Long-term Study On The Correlation Between Clinical Features Of Autosomal Dominant Polycystic Kidney Disease Growth Rate And TCM Syndrome Types

ObjectivesWe aimed to explore the TCM syndromes distribution regulation and its clini cal characteristics of patients with Autosomal dominant polycystic kidney disease(ADPKD),the longest diameter growth rate of polycystic kidney and its cysts.We tried to found out correlation between ADPKD and clinical indicators such as hypertension,renal insufficiency,etc.The risk factors and progress rules of cystic kidney growth rate provided theoretical basis for evaluating the prognosis of different TCM syndrome types and dialectical treatment.Thus,the TCM dialectical treatment of ADPKD could be standardized and normalized,and demonstrated the advantage traditional Chinese medicine on ADPKD treatment.MethodsBased on retrospectively analysis,the clinical data of 281 adult patients with ADPKD were collected.Their clinical indicators were compared between patients wi th normal renal function and patients wi th decreased renal function.Follow-up observations were carried out with an average observation time of(4.1±2.1)years.The clinical indicators were compared between dialysis and non-dialysis patients,cysts with rapid growth and slow growth,and the risk factors affecting polycystic kidney growth rate were analyzed.Combined with the symptoms and tongue veins of the patients,TCM syndrome differentiation was performed to compare the clinical indexes and cyst change index differences between the syndromes,and the correlation between TCM syndrome types and the growth rate of polycystic kidney disease was analyzed.Results1.General situation and clinical characteristics results:A total of 281 autosomal dominant polycystic kidney disease cases that meet the inclusion criteria and complete data were collected in this study,of which 142 were male(50.5%);139 were female(49.5%),and the ratio of men to women was about 1.02:1;aged between 18-83 years,with an average age of 61.82±12.07 years;101 patients(35.9%)with decreased renal function;180 patients(60.0%)with normal renal function;188 patients with urinary calculi(66.9%);178 patients with hypertension(63.3%);144 patients with anemia(51.2%);138 patients with hyperuricemia(49.1%);73 patients with urinary tract infection(26.0%);67 cases(23.8%)with hypercholesterolemia;52 cases(18.5%)with hypertriglyceride syndrome;62 cases(22.1%)with nephritis or nephrotic syndrome;67 cases(23.8%)with simple hematuria);A total of 18 patients with diabetes(6.4%).2.Analysis of the correlation between autosomal dominant polycystic kidney disease and renal function:the blood creatinine,blood urea nitrogen,blood uric acid,total blood cholesterol level,anemia,hypertension,hyperuricemia,and urinary tract infection were all in the patients with decreased renal function It was higher than the normal renal function group(P<0.05);the proportion of patients with normal renal function group combined with simple hematuria was higher than that of the renal function decreased group(P<0.05).In adults with polycystic kidney disease,the maximum diameter of the cyst is positively correlated with age(P=0.000),and negatively correlated with eGFR(P=0.000).3.Analysis of risk factors for cyst growth in autosomal dominant polycystic kidney disease:follow-up observation of 184 adult patients with polycystic kidney disease,the average longest diameter of the kidney is 176.00 mm,and the median annual growth rate of the longest diameter of the kidney is 1.97(1.19,2.99)%.The maximum long-diameter baseline of renal cysts was(55.93±20.68)mm,with a median annual growth rate of 4.27%.A total of 39(21.2%)patients maintained dialysis due to end-stage renal disease.The average age of dialysis started was(58.84±10.62)years;there was no statistically significant difference in age and gender between the dialysis group and the non-dialysis group(P>0.05);The average longest diameter of the average renal cyst in the dialysis group was(58.54±13.72)mm higher than that in the non-dialysis group(55.23±22.17)mm,and the age,proportion of hyperuricemia,anemia,urinary tract infection,nephritis or nephrotic syndrome were also higher High in non-dialysis group(P<0.05).4.TCM diagnosis and syndrome distribution:Among the 281 adult patients with polycystic kidney disease,the most diagnosed with chronic renal fai lure,a total of 80 cases(28.5%);followed by 78 cases(27.8%)diagnosed with low back pain,diagnosed as others A total of 68 cases(24.2%),27 cases(9.6%)were diagnosed with gonorrhea,6 cases(2.1%)of urine turbidity,and 5 cases(1.8%)of edema;116 cases of spleen and kidney qi deficiency syndrome in this deficiency syndrome Cases(41.3%),107 cases(38.1%)with qi and yin deficiency syndrome,32 cases(11.4%)with liver and kidney yin deficiency syndrome,26 cases(9.35%)with spleen and kidney yang deficiency syndrome;A total of 187 cases(66.5%)were damp-heat syndrome;52 cases(18.5%)and 42 cases(14.9%)were identified as damp-turbid syndrome and blood stasis syndrome,respectively.5.Correlation analysis of TCM syndromes and various clinical indicators:the course of di sease progresses in the spleen and kidney yang deficiency group,the degree of renal damage is the most serious,and the occurrence rate of various complications is the highest,followed by the spleen and kidney qi deficiency group,liver and kidney yin deficiency Syndrome group,Qi and Yin deficiency syndrome group.Among the standard evidences,the damp turbidity syndrome group had the most serious disease progression and renal damage,followed by the blood stasis syndrome group and the damp heat group.Blood stasis syndrome is more complicated with hyperuricemia,anemia,simple hematuria and other complications(P<0.05);damp heat syndrome is more complicated wi th hypercholesterolemia(P<0.05);damp turbidity syndrome is associated with nephritis or nephrotic syndrome,The proportion of chronic kidney disease in stage 3 is higher than that of the other two groups,but there is no statistical significance(P>0.05).6.Correlati on analysis of TCM syndrome types and renal cyst change indicators:follow-up observation of 184 adult patients with polycystic kidney disease,the spleen and kidney yang deficiency syndrome,the qi and yin deficiency syndrome,and the standard blood syndrome of blood stasis syndrome The annual growth rate of the longest diameter of cysts was the fastest,which were6.67%、6.17%、5.55%(P<0.05).In thi s deficiency syndrome,the cystic kidney-yang deficiency group has a maximum]ong-term annual growth of 4.33mm/year,which is higher than that of the other three groups(P<0.05);the maximum kidney length of each syndrome in this deficiency syndrome and standard empirical evidence There was no statistically significant difference in cyst change indexes such as diameter,maximum length of cyst,annual growth length of kidney,and annual growth rate of kidney.(P>0.05).ConclusionWith the development of age and kidney cysts,adult patients with polycystic kidney disease will eventually have a decline in kidney function and cause complications such as hypertension and urinary calculi.Among them,the incidence of complications in patients with decompensation is significantly higher than that in compensation patient.The length of kidney in adult patients with polycystic kidney disease generally increases,and the largest diameter of renal cysts is positively correlated with age and negatively correlated with eGFR.Adult patients with polycystic kidney disease who have entered dialysis often have hyperuricemia,chronic nephritis,or nephrotic syndrome,suggesting that hyperuric acid,hematuria,or proteinuria may aggravate the progress of renal function deterioration.In terms of traditional Chinese medicine,the spleen and kidney qi deficiency syndrome and the qi and yin deficiency syndrome are the most common in this syndrome,and the dampness and heat syndrome are the most distributed among the standard syndromes.Patients with spleen-kidney-yang deficiency syndrome and damp-turbidity syndrome have the most serious illness and the highest incidence of complications;patients with spleen-kidney-yang deficiency syndrome,qi-yin deficiency syndrome and blood stasis syndrome have the fastest growth rate of kidney cysts,suggesting positive qi deficiency and blood stasis Factors such as play an important role in the development of ADPKD,and clinical syndrome differentiation treatment needs to focus on treatment.