Study On The Correlation Of Primary Nephrotic Syndrome And Its Tcm Syndrome Type With Air Pollution And Seasonal Solar Term In Tianjin Area

ObjectiveIn this study,the clinical data of 173 patients with primary nephrotic syndrome included in the study and the air quality index from January 2014 to February 2022 were analyzed,in order to initially explore primary nephrotic syndrome and its TCM syndrome types and the correlation between air pollution and seasonal solar terms,and to provide useful references for the sequential improvement of TCM macroscopic explanation and differentiation system of etiology and pathogenesis of primary nephrotic syndrome.MethodsThe clinical data of patients who met the diagnostic criteria in the Nephrology Department of Tianjin from September 1,2019 to August 30,2021 were collected,and the air quality data from January 2014 to February 2022 were obtained.Combined with the diagnostic criteria of western medicine and TCM syndrome type,based on the principles of the corresponding statistical methods,the corresponding statistical analysis was performed on different types of data using IBM SPSS Statistics 26.0 software.Results1 The elderly were mainly included in the study.The proportion of young,middle-aged and elderly patients who were men was higher than that of women,and the difference in the proportion of men and women was the largest among the young population.2 In Tianjin,the annual air quality changes have a certain rule,of which AQI with atmospheric pollutants PM_2.5,PM₁₀,SO₂,NO₂,CO distribution rule is basically the same,are the peak solar terms in the Winter Solstice solar terms,summer is a low level period,the general change rule is in summer～winter,slightly fluctuated in winter～spring,decreased in spring～summer.O₃is different from other atmospheric pollutants.Its peak solar term is in the awn solar term,and winter is at a low level.The general change rule is that it decreases in summer–winter and increases in winter–summer.3 For the cases of primary nephrotic syndrome included in the study,there were significant differences in AQI,PM_2.5,NO₂,O₃and index as well as the whole time average air quality index in the retrospective time before the onset;The difference between PM₁₀index and the whole period average air quality index has statistical significance.The differences between SO₂and CO indexes and the whole period average air quality index are not statistically significant.AQI,air quality level,and indexes of atmospheric pollutants PM_2.5,PM₁₀,NO₂,O₃,and CO were correlated with laboratory indexes Hb,RBC,TP,Alb,24-hour urine protein quantification,Cr,eGFR,BUN/Urea,and UA.Among them,there was a positive correlation between 24-hour urine protein quantification and PM_2.5,PM₁₀and CO index,a positive correlation between Alb and AQI,air quality grade,a significant negative correlation between Hb and CO index,a significant negative correlation between RBC and O₃index,a significant negative correlation between eGFR and PM_2.5and PM₁₀index,and a significant positive correlation between Cr and NO₂and CO index.4 The peak solar term of the primary nephrotic syndrome cases included in the study is theGrain Buds,and the onset peak interval is from Pure Brightness to Minor Heat solar term.Syndrome types in TCM present the characteristics of deficiency-excess in complexity.Among them,the peak solar terms of spleen and kidney qi deficiency syndrome and dampness turbidity syndrome are all small full solar terms.No statistical difference was found in the peak periods of other syndromes.5 There is statistical significance in the difference of HB in each type of deficiency of spleen and kidney,with the deficiency of both qi and yin as the highest and the deficiency of lung and kidney as the lowest.There was statistical significance in the differences of RBC in each type of deficiency syndrome,with liver and kidney yin deficiency syndrome as the highest and lung and kidney qi deficiency syndrome as the lowest.No statistical difference was found in other laboratory indexes.Conclusion1 The elderly are the main population with primary nephrotic syndrome.The proportion of males among the young,middle-aged and elderly patients was higher than that of females,and the difference in the proportion of males to females was the largest among the young males.This may be related to the insidious onset characteristics,the physiological characteristics of people of different sexes and ages,and many other factors.2 In Tianjin,the annual air quality has a certain rule,of which AQI with atmospheric pollutants PM_2.5,PM₁₀,SO₂,NO₂,CO distribution rule is basically the same,are the peak solar terms in the Winter Solstice,summer is a low level period,the general change rule is in summer～winter,in winter～spring a little fluctuation,in spring～summer.Different from other atmospheric pollutants,O₃had a peak solar term in Grain in Ear and a low level in winter,with the general changing law of decreasing in summer–winter and increasing in winter–summer.The cause of its fluctuation may be related to the source of atmospheric pollutants.3 AQI may be related to the pathogenesis of primary nephrotic syndrome.Atmospheric pollutants PM_2.5,NO₂,O₃and PM₁₀may be the key pathogenic factors.SO₂and CO may not be related to the pathogenesis or have little effect in the pathogenic process.These changes may be related to the mechanism of proteinuria in primary nephrotic syndrome.4 The peak solar term of the primary nephrotic syndrome cases included in the study is theGrain Buds,and the onset peak interval is from Pure Brightness to Minor Heat solar term.Syndrome types in TCM present the characteristics of deficiency-excess in complexity.The peak solar terms of the spleen and kidney qi deficiency syndrome and the wet turbidity syndrome are all the lesser solar terms.No peak period of the disease was observed for the rest of the syndromes.There are many related influencing factors,which are related to the geographical location,climatic factors and the characteristics of air pollution in Tianjin area,but the deep effect relationship needs to be further explored.5 The laboratory tests indexes of Hb and RBC with statistical significance in the differences among the five syndromes of deficiency of spleen and kidney were determined.Hb was the highest in the syndrome of qi-yin deficiency and the lowest in the syndrome of lung-kidney deficiency.RBC was the highest in the liver and kidney yin deficiency syndrome,and the lowest in the lung and kidney qi deficiency syndrome.The results were consistent with the characteristics of TCM syndromes.