Study On Distribution Of TCM Syndrome Types And Related Factors Of Heart Failure In Patients With Stage 3-4 Chronic Kidney Disease

Objective: To investigate the distribution characteristics and related risk factors of heart failure in CKD 3-4 stage patients,in order to slow down the progress,reduce the incidence of heart damage and prevent the occurrence of Cardiorenal Syndrome.Methods:1.A total of 296 patients with CKD3-4 were enrolled from September 2018 to August 2020 in the Nephrology Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese medicine.2.According to the 2018 China guidelines for the diagnosis and treatment of heart failure,all patients included in this study were divided into two groups: the non-heart Failure Group and the heart failure group.Clinical data were collected,including general condition of patients,etiological factors of chronic kidney disease,common risk factors of patients with combined heart failure,CKD stage,results of laboratory examination,information of traditional Chinese medicine,classification of heart function in patients with heart failure.3.The data were collected and a database was established.The general situation between the two groups was compared and analyzed using SPSS statistical software,etiology of chronic kidney disease,common risk factors,laboratory markers,CKD stages,distribution of TCM syndrome types in patients with chronic kidney disease 3-4 stages of heart failure were analyzed,to explore the distribution of TCM syndrome types of heart failure in patients with stage 3-4 chronic kidney disease.Results:1.In general analysis,there were statistical differences in age and gender between the non-HF group and the HF group in this study(P<0.05).The incidence of heart failure was higher in women than in men,and the age of patients in the HF group was higher than that in the nonHF group.In the etiological analysis,there were statistical differences in diabetic nephropathy and chronic glomerulonephritis between the non-heart failure group and the heart failure group(P<0.05).The proportion of diabetic nephropathy in the heart failure group was higher than that in the non-heart failure group,while the proportion of chronic glomerulonephritis was lower than that in the non-heart failure group.In the analysis of common risk factors for heart failure,coronary heart disease,diabetes,anemia and dyslipidemia in the non-heart failure group and the heart failure group were statistically significant(P<0.05).The proportion of the number of patients with coronary heart disease,diabetes and anemia in the heart failure group was higher than that in the non-heart failure group,and the proportion of the number of patients with dyslipidemia was lower than that in the non-heart failure group.Analysis of laboratory indicators: there were statistical differences in Cl,TP,Alb,TG and Ddimer between the two groups(P<0.05).The levels of total protein,albumin,blood chlorine and triglyceride in the heart failure group were lower than those in the non-heart failure group,while the level of D-dimer was higher than that in the non-heart failure group.2.Distribution of CKD stage: In the non-heart failure group,there were 146 CKD3 patients(61.3%),92 CKD4 patients(38.7%),and 30 CKD3 patients(51.7%)and 28 CKD4 patients(48.3%).There was no statistical significance between CKD stage and whether or not the two groups had heart failure(P>0.05).3.Analysis of influencing factors for CKD3-4 patients complicated with heart failure: Age and diabetic nephropathy were positively correlated with the occurrence of heart failure in patients with CKD stage 3-4,in which the incidence of heart failure increased by 1.047 times for each increase of age by 1 year,and the incidence of heart failure in patients with diabetic nephropathy was 6.641 times higher than that in patients without diabetic nephropathy,and2.231 times higher in patients with CKD3-4 than in patients without cad.4.Distribution of TCM Syndrome types of CKD3-4 patients complicated with heart failure:By statistical analysis,There was a statistical difference between the non-heart Failure Group and the heart failure group(P<0.05).In the heart failure group,Yang Deficiency Syndrome was the main syndrome,There were significant differences in the distribution of standardpositive syndrome types(P<0.05),In Heart Failure Group,Water-qi Syndrome was the main syndrome;In heart failure group,the relationship between main syndrome and sign was statistically significant(P<0.05),The main syndrome of Qi deficiency was blood stasis syndrome(54.5%),while the main syndrome of Yang deficiency was water-qi syndrome(63.2%).5.Relationship between classification of cardiac function and distribution of TCM syndrome types in patients with CKD3-4 complicated with heart failure: there was a statistical difference between heart function classification and the distribution of deficiency syndrome(P<0.05).There were 9(45.0%)patients with QI deficiency Syndrome in Grade II of heart function There were 12(63.2%)patients with Yang deficiency syndrome in Grade Ⅲ of cardiac function,and 6(31.6%)patients with qi-yin deficiency Syndrome in Grade Ⅳ of cardiac function.There was no significant difference in the relationship between the classification of cardiac function and the distribution of standard positive syndrome(P>0.05),the most of the patients with damp-heat Syndrome was 5 cases(25.0%),and the most of the patients with Water-qi Syndrome was 8 cases(42.1%)There were 6 cases(31.6%)in grade Ⅳ of cardiac function.Conclusions:1.The incidence of heart failure in patients with CKD3-4 is related to age,diabetic nephropathy and coronary heart disease.The incidence of heart failure in patients with CKD3-4 increases with age,and the incidence of heart failure in patients with diabetic nephropathy is higher than that in patients without diabetic nephropathy,the incidence of heart failure in CKD3-4 patients with chd was higher than that in non-chd patients.2.The distribution of TCM syndrome types in CKD3-4 stage patients with heart failure: the Primary Deficiency Syndrome is Yang Deficiency Syndrome,and the secondary syndrome is Water-qi Syndrome.3.Relationship between classification of cardiac function and distribution of TCM syndrome types in patients with CKD3-4 complicated with heart failure: the main syndrome of cardiac fuction grade Ⅱ is Qi deficiency syndrome,the main syndrome of heart function Grade Ⅲ is Yang Deficiency Syndrome,the main syndrome of Water-qi Syndrome,and the main syndrome of heart function grade Ⅳ is qi-yin Deficiency Syndrome,the water-gas Syndrome is the main sign.