Clinical Features And Distribution Of TCM Syndromes In Patients With Type 2 Diabetes And Kidney Disease

Objective: To study the clinical features of patients with type 2 diabetes mellitus(T2DM)and kidney disease in the Department of Nephrology of our hospital,and to explore the distribution of TCM syndromes of these patients,so as to provide effective integrated TCM and Western medicine diagnosis and treatment ideas for the early diagnosis and reasonable treatment of T2 DKD patients.Methods: Select T2 DM patients with renal disease from February 2019 to September 2020 in the Department of Nephrology of our hospital,and divide them into DKD group and NDKD group according to the diagnostic criteria of diabetic kidney disease(DKD).Collect basic patient information,medical history data,and biochemical physical indicators[ Blood pressure(BP),Body mass index(BMI),Hemoglobin(Hb),Glycosylated hemoglobin(GHb),Serum albumin(SAlb),Serum creatinine(SCr),Blood urea nitrogen(BUN),Serum uric acid(SUA),Estimated glomerular filtration rate(e GFR),Total cholesterol(TC),Triglycerides(TG),Low-density lipoprotein(LDL),Urine microalbumin(Um Alb)and 24-hour urine protein quantification(24 h UTP)] and TCM information.Also,separately divide the T2 DM with kidney disease with pathological data into groups of diabetic nephropathy(DN)and non-diabetic nephropathy(NDN),and calculate the above indicators.Finally obtain the clinical characteristics and TCM syndrome distribution in patients with T2 DM combined with kidney disease.Result:1 General clinical dataA total of 321 patients with T2 DM and kidney disease were included in this study,including 201 patients in the DKD group and 120 patients in the NDKD group.The prevalence of DKD was 62.6%.Among them,56 patients had a clear pathological diagnosis of kidney biopsy and 31 cases in the DN group,25 cases in the NDN group.The DN group included 2 cases of DN+NDN,namely DN plus membranous nephropathy and DN plus minimal change nephropathy and subacute tubulointerstitial injury;Ig A nephropathy(8,32.0 %)and membranous nephropathy(8,32.0%)are the most common pathological type in the NDN group,followed by mesangial proliferative glomerulonephritis(4,16.0%).The analysis of gender and age of 321 patients showed that:(1)125 males and 76 females in DKD group,male/female approximately 1.6:1;59 males and 61 females in NDKD group,male/female approximately 1:1.(2)The average age of the DKD group is 61.37±11.84,of which the average age of men is 60.26±11.67,the average age of women is 63.18±11.97;the average age of NDKD group is 61.12±12.11,of which the average age of men is 58.83±12.95,the average age of women 63.33±10.92.2 Clinical features2.1 Characteristics of medical history dataThere were significant differences in diabetic retinopathy(DR),diabetes duration,diabetic peripheral vascular disease(DPVD),diabetic macroangiopathy(DMA),diabetic peripheral neuropathy(DPN),atherosclerosis(AS)and fatty liver disease(FLD)in the DKD group and NDKD group(P<0.01).There are differences in diabetic foot(DF),blood pressure(BP)and coronary heart disease(CHD);the prevalence of DR,DPVD,DMA,DPN,AS,DF,CHD and BP is higher in the DKD group and the duration of diabetes is longer,but the prevalence of FLD is lower.2.2 Characteristics of biochemical physical indicatorsThe DKD group and the NDKD group had significant differences in systolic blood pressure(SBP),Hb,SAlb,SCr,BUN,SUA,e GFR,Um Alb and 24 h UTP(P<0.01).In the DKD group,SBP,SCr,BUN,SUA,Um Alb and 24 h UTP levels were higher,while Hb,SAlb and e GFR levels were lower.2.3 Clinical features of T2 DM patients with kidney disease with pathological data2.3.1 Medical history dataThere was a significant difference in DR between the DN group and the NDN group(P<0.01).Compared with DR in the NDKD group,the prevalence in the DN group was significantly higher.2.3.2 Biochemical and physical indicatorsThere were differences in Hb,SCr and e GFR between the DN group and the NDN group(P<0.05).The levels of Hb and e GFR in the DN group were significantly lower,while SCr levels were significantly higher.3.Distribution discipline of TCM syndromes3.1 DKD group and NDKD groupThe origin-deficiency syndrome of both groups is mostly spleen-kidney Qi deficiency syndrome,followed by Qi-Yin deficiency syndrome,Yin-Yang deficiency syndrome and Yin deficiency-Dry heat syndrome.There are no statistical difference between these two groups.Compared with the NDKD group,the DKD group has a higher percentage of Yin-Yang deficiency syndrome,and a lower percentage of Qi-Yin deficiency syndrome.The evil-excess syndrome of both DKD group and NDKD group is mainly damp-heat syndrome,followed by phlegm-stasis syndrome,water-dampness syndrome and stasis syndrome.The proportion of phlegm-stasis syndrome in the DKD group was higher than that in the NDKD group,while the proportion of damp-heat syndrome was lower than that in the NDKD group.In the DKD group,the most evil-excess syndromes of Yin deficiency-Dry heat syndrome,Qi-Yin deficiency syndrome,spleen-kidney Qi deficiency syndrome and Yin-Yang deficiency syndrome were water-dampness syndrome,damp-heat syndrome,phlegm-stasis syndrome and damp-heat syndrome.In the NDKD group,the most evil-excess syndromes of the above-mentioned origin-deficiency syndrome were damp-heat syndrome and phlegm-stasis syndrome,damp-heat syndrome,damp-heat syndrome and phlegm-stasis syndrome.3.2 DN group and NDN groupThe origin-deficiency syndrome of both groups are in the order of spleen-kidney Qi deficiency syndrome,Qi-Yin deficiency syndrome,Yin-Yang deficiency syndrome and Yin deficiency-Dry heat syndrome.There are no statistical difference between these two groups.Compared with the NDN group,the DN group had a higher proportion of spleen-kidney Qi deficiency syndrome,a lower proportion of Qi-Yin deficiency syndrome and Yin-Yang deficiency syndrome.According to the percentage,the DN group has phlegm-stasis syndrome,damp-heat syndrome,water-dampness syndrome and stasis syndrome in order from high to low,while damp-heat syndrome,water-dampness syndrome,phlegm-stasis syndrome and stasis syndrome in the NDN groups.There is no statistical difference between them.In the DN group,the most evil-excess syndromes of Yin deficiency-Dry heat syndrome,Qi-Yin deficiency syndrome,spleen-kidney Qi deficiency syndrome and Yin-Yang deficiency syndrome were water-dampness syndrome,damp-heat syndrome,phlegm-stasis syndrome,damp-heat syndrome and stasis syndrome.In the DKD group,the most evil-excess syndromes of Qi-Yin deficiency syndrome,spleen-kidney Qi deficiency syndrome and Yin-Yang deficiency syndrome were damp-heat syndrome,damp-heat syndrome,phlegm-stasis syndrome.Conclusion1 The prevalence of DKD in T2 DM combined with renal disease in our hospital’s nephrology department was 62.6%.Ig A nephropathy and membranous nephropathy are the most common pathological types in the NDN group.2 The prevalence of DR,DPVD,DMA,DPN,AS,DF,CHD and BP in DKD patients is higher than that in NDKD patients,and diabetes lasts longer;DKD patients have high levels in SBP,SCr,BUN,SUA,Um Alb and 24 h UTP indicators,while low levels in Hb,SAlb and e GFR indicators.3 DR prevalence in DN patients is relatively high;Compared with NDN group’s patients,Hb and e GFR are significantly lower,while SCr is significantly higher.DR,Hb,e GFR and SCr are more valuable indicators to distinguish between kidney disease caused by diabetes mellitus and kidney disease caused by non-diabetes mellitus.4 In patients with DKD and NDKD,the origin-deficiency syndrome is mainly spleen-kidney Qi deficiency syndrome,and then Qi-Yin deficiency syndrome,Yin-Yang deficiency syndrome,Yin deficiency-Dry heat syndrome.Damp-heat syndrome is the mainly evil-excess syndrome,and then phlegm-stasis syndrome,water-dampness syndrome,stasis syndrome.5 In patients with DN and NDN,the primary origin-deficiency syndrome is spleen-kidney Qi deficiency syndrome,and then Qi-Yin deficiency syndrome,Yin-Yang deficiency syndrome,Yin deficiency-Dry heat syndrome.Phlegm-stasis syndrome is the mainly evil-excess syndrome in DN group,and then damp-heat syndrome,water dampness,stasis syndrome;while damp-heat syndrome is the primary evil-excess syndrome in NDN group,and then water dampness,phlegm-stasis syndrome,stasis syndrome.