Analysis Of The Related Factors Of Chronic Kidney Disease With Hyperfibrinogenemia And Study On The Distribution Of TCM Syndrome Types

ObjectiveTo collect and analyze the basic situation of chronic kindey disease(CKD)patients and the distribution of TCM syndrome types,and to explore the correlation factors of CKD patients with hyperfibrinogenemia(HFIB)by analyzing the clinical data of chronic kidney disease patients.One of the aims of this paper is to find out the high incidence of HFIB in the stage of CKD and provide data support for preventing the occurrence of HFIB,CVD and thrombotic events in CKD.Another is to summarize the rules and characteristics of TCM Syndrome differentiation in this group of patients,and provide clinical data and reference for the accurate syndrome differentiation of CKD.MethodsFrom June 2018 to December 2018,a retrospective study was conducted to analyze the clinical data of patients with CKD diagnosed in Nephrology Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine.According to the level of FIB in patients’ plasma,patients were divided into two groups: the pre-concurrent group and the non-concurrent group.General information and relevant laboratory tests were collected,syndrome types were classified according to the four diagnostic information of TCM,and the data were summarized and sorted,the results were analyzed by SPSS software.Observation items: gender,age,body mass index(BMI),primary disease of CKD,stage of CKD,history of smoking,history of drinking,history of hypertension,history of diabetes,serum creatinine(Scr),blood urea nitrogen(Bun),serum sodium(Na),blood serum uric acid(BUA),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein(LDL-C),very low density lipoprotein lholesterolin(VLDL-C),albumin(ALB),24-hour urine protein quantification(24h-Upro),serum bilirubin:total bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),hemoglobin(HGB),serum phosphorus(P),serum calcium(Ca),plasma fibrinogen(FIB),serum homocysteine(Hcy),platelets(PLT)and D-dimer(D-D).Results1 General Data: A total of 215 patients were collected,including 136 males(63.3%),79females(36.7%),with an average age of 59.02 ± 15.40 years.There were 28 cases(13%)with CKD1,26 cases(12%)with CKD2,47 cases(22%)with CKD3,36 cases(17%)with CKD4,and 78 cases(36%)with CKD5.There was no significant difference in FIB among different stages of CKD patients(p=0.053>0.05).CKD was glomerulonephritis in 138 cases(64%),diabetic nephropathy in 53 cases(25%),hypertensive nephropathy in 2 cases(1%),immune-associated nephropathy in 9 cases(4%),including nephrotic syndrome in 51 cases(24%),membranous nephropathy in 25 cases(12%),and unknown etiology in 13 cases(6%).FIB in diabetic nephropathy group and other etiological groups was higher than that in chronic glomerulonephritis group,and FIB in NS group was higher than that in non-NS group(P<0.05).2 Distribution of TCM Syndrome types: among 215 CKD patients,28 cases(43%)of spleen-kidney deficiency syndrome were the highest,followed by 14 cases(21%)of spleen-kidney Yang deficiency syndrome,14 cases(21%)of qi-yin deficiency syndrome,8cases(12%)of liver-kidney yin deficiency syndrome and 2 cases(3%)of yin-yang deficiency syndrome.The proportion of syndrome of blood stasis was the highest in 54 cases(36%),followed by 52 cases(35%)of damp-heat syndrome,22 cases(15%)of damp-turbidity syndrome,21 cases(14%)of water-qi syndrome and 0 cases(0%)of wind-motion syndrome.The FIB level in the water-qi syndrome group was higher than that in the blood stasis syndrome group and the liver-kidney yin deficiency syndrome group(P<0.05),but the FIB level in the damp-heat syndrome group and the water-qi syndrome group was higher than that in the qi-yin deficiency syndrome group(P<0.05).There was no significant difference between FIB and deficiency syndrome(P >0.05).3 There was significant difference between the two groups in the history of Diabetes Mellitus(P<0.05),the difference in gender,age,BMI,history of smoking,history of drinking,history of hypertension was not statistically significant(P >0.05).4 The levels of NA,TP,ALB,CA,TBIl,DBIL,IBIl and HGB in the concurrent group were lower than those in the non-concurrent Group(P<0.05),P,TC,TG,LDL-C,24h-Upro,D-D,PLT were higher than those in the non-concurrent group(P<0.05).5 Comparison of TCM syndrome types between the concurrent group and the non-concurrent group: The difference between the two groups was statistically significant(P<0.01).There were more cases in the concurrent group than in the non-concurrent group,and fewer cases in the concurrent group than in the non-concurrent group.There was no significant difference between the two groups(p=0.093>0.05).There was significant difference between the concurrent group and the non-concurrent group in each syndrome type(P<0.001),the ratio of wet turbid syndrome and water-qi syndrome,wet-heat syndrome and water-qi syndrome,blood stasis syndrome and water-qi syndrome were significantly different between the two groups(P=0.001,P=0.009,P<0.001,All<0.0125).There were more water-qi syndrome and damp-heat syndrome in the concurrent group than in the non-concurrent group,and less damp-turbid syndrome and blood stasis syndrome in the concurrent group.6 FIB was negatively related with blood Na,Ca,TP,ALB,TBIL,IBIL,DBIL,HGB(r=-0.233,r=-0.416,r=-0.333,r=-0.518,r=-0.407,r=-0.404,r=-0.273,r=-0.193).It was positively related with P,TG,LDL-C,VLDL-C,24h-Upro,D-D,PLT(r=0.222,r=0.192,r=0.292,r=0.199,r=0.533,r=0.364,r=0.269).7 Binary logistics regression shows that by removing confounding factors,the independent risk factors of CKD patients complicated with HFIB were Na(OR=0.893),TP(OR=0.951),ALB(OR=0.884),TBIL(OR=0.707),LDL-C(OR=1.562),24h-Upro(OR=1.385),PLT(OR=1.005),hypercholesterolemia(OR=2.895),NS(OR=4.291).Conclusion1 This study shows that the history of diabetes,NA,CA,P,TP,ALB,TBIL,TG,LDL-C,IBIL,DBIL,VLDL-C,24h-Upro,D-D,HGB,PLT may be the influencing factors of HFIB complicated by CKD,Na,TP,ALB,TBIL,LDL-C,24h-Upro,PLT,NS and hypercholesterolemia may be independent risk factors.2 The syndrome types of CKD patients complicated with HFIB are mainly marked syndrome,water-qi syndrome and damp-heat syndrome are the common TCM syndrome types,which provides a theoretical basis for the treatment of Qi,water and dampness-heat in TCM.