| Objectives:In this study,the distribution patterns of TCM syndrome types,clinical characteristics and influencing factors of peritoneal dialysis-related gastrointestinal dysfunction were investigated by analyzing the four diagnostic data and clinical indicators of peritoneal dialysis-related gastrointestinal dysfunction.The aim was to provide reference for the clinical diagnosis and treatment of peritoneal dialysis-related gastrointestinal dysfunction by combining Chinese and Western medicine,and to improve the survival quality of patients with peritoneal dialysis-related gastrointestinal dysfunction.Methods:A retrospective study was conducted.After evaluating the general conditions,TCM four-diagnosis data and clinical symptoms of peritoneal dialysis patients hospitalized in the Department of Nephrology,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,from 2019.9.1 to 2021.9.1,the patients were divided into the group with gastrointestinal dysfunction and the group without gastrointestinal dysfunction.Information on age,gender,duration of peritoneal dialysis,primary illness,complications and laboratory findings was collected from both groups.The clinical data were statistically analyzed using SPSS 23.0 software,and the characteristics of peritoneal dialysis-related gastrointestinal dysfunction were summarized and analyzed;the distribution pattern of Chinese medical evidence of peritoneal dialysis-related gastrointestinal dysfunction was investigated by summarizing the data from the four Chinese medical consultations of patients;and the factors associated with peritoneal dialysis-related gastrointestinal dysfunction were studied using binary logistic regression analysis.Results:1.A total of 304 peritoneal dialysis patients were included,of which 189 were in the combined gastrointestinal dysfunction group and 115 were in the no gastrointestinal dysfunction group.The incidence of peritoneal dialysis-related gastrointestinal dysfunction was 62%.The minimum age of the included cases was 28 years and the maximum age was 88 years.The average age of the patients in the combined gastrointestinal dysfunction group included in this study was(59.51 ± 12.56)years,and the group without gastrointestinal dysfunction was(54.27 ± 13.45)years.The age of the combined gastrointestinal disorders group was mainly distributed in the group of ≥ 60 years,while the group without gastrointestinal disorders was relatively concentrated in the age group of < 60 years,and there was a statistical discrepancy in age between the two groups(p<0.05).The shortest duration of abdominal dialysis in the included patients was 3 months and the longest was 132 months;the mean duration of abdominal dialysis was(34.03 ± 28.99)months in the group with gastrointestinal dysfunction and(31.00±26.11)months in the group without gastrointestinal dysfunction.There was a statistical discrepancy in terms of combined hypertension and coronary artery disease between the both groups(p<0.05).In the gastrointestinal dysfunction group,the most common symptom was poor appetite(40%),followed by constipation(24%)and nausea and vomiting(20%).2.In the combined gastrointestinal dysfunction group: spleen-kidney qi deficiency(92cases,48.68%)> spleen-kidney yang deficiency(61 cases,32.28%)> yin and yang deficiency(17 cases,8.99%)> qi and yin deficiency(12 cases,6.35%)> liver-kidney yin deficiency(7 cases,3.70%);and in standard syndrome type distribution: the symptoms of dampness and turbidity(87 cases,46.03%)> the symptoms of damp-heat(48 cases,25.40%)> the symptoms of blood stasis(45 cases,23.81%)> the symptoms of heat toxicity(6 cases,3.17%)> the symptoms of wind movement(3 cases,1.59%).All the evidence types were mixed with deficiency and reality.The most frequent evidence types were spleen-kidney qi deficiency combined with dampness and turbidity,spleen-kidney yang deficiency combined with blood stasis,yin-yang deficiency combined with dampness and turbidity.On the other handand,the most frequent evidence types were dampness and turbidity combined with spleen-kidney qi deficiency;damp-heat combined with spleen-kidney qi deficiency;blood stasis combined with spleen-kidney yang deficiency.3.The comparison of clinical indicators between the two groups: the differences in blood glucose,creatine kinase,blood calcium,glycosylated hemoglobin,c-reactive protein,residual renal Kt/V,calcitoninogen,peritoneal Kt/V,total CCr,cholesterol,triglyceride,bilirubin,blood urea nitrogen,residual renal CCr,and total CCr standardization were statistically distinct(P<0.05).4.Univariate logistic regression analysis showed that glycosylated hemoglobin,blood calcium,peritoneal Kt/V value,blood urea nitrogen,residual renal Kt/V value,total CCr value,residual renal CCr value,total CCr standardization,hypertension,male,age,diabetic nephropathy and coronary heart disease were statistically valid as influencing factors for peritoneal dialysis-related gastrointestinal dysfunction(P<0.05).Glycosylated hemoglobin(OR=1.328,95%CI=1.091-1.618),blood calcium(OR=3.520,95%CI=1.179-10.513),peritoneal Kt/V value(OR=2.185,95%CI=1.222-3.908),hypertension(OR=9.120,95%CI=1.183-70.309),male(OR=1.698,95%CI=1.050-2.745),age(OR=1.032,95%CI=1.013-1.051),and diabetic nephropathy(OR=5.726,95%CI=1.053-31.131)were positively associated with peritoneal dialysis-related gastrointestinal dysfunction.Blood urea nitrogen(OR=0.952,95%CI=0.914-0.992),residual kidney Kt/V value(OR=0.439,95%CI=0.251-0.767),total CCr value(OR=0.979,95%CI=0.968-0.991),residual renal CCr value(OR=0.980,95%CI=0.969-0.990),total CCr standardization(OR=0.979,95%CI=0.966-0.992),and coronary heart disease(OR=0.577,95%CI=0.361-0.922)were negatively associated with peritoneal dialysis-related gastrointestinal dysfunction.5.The results of multifactorial binary logistic regression analysis showed that glycosylated hemoglobin,diabetic nephropathy and residual kidney CCr were independent influences on peritoneal dialysis-related gastrointestinal dysfunction(P<0.05).Further,glycosylated hemoglobin and diabetic nephropathy were danger factors for peritoneal dialysis-associated gastrointestinal dysfunction,while residual kidney CCr was the protective factor for peritoneal dialysis-associated gastrointestinal dysfunction.Conclusion:1.The incidence of peritoneal dialysis-related gastrointestinal dysfunction was relatively high,with a clinical prevalence in the elderly.The most frequent symptom in the combined gastrointestinal dysfunction group was poor appetite,followed by constipation,nausea and vomiting.2.Peritoneal dialysis-related gastrointestinal dysfunction was dominated by spleen-kidney qi deficiency and spleen-kidney yang deficiency,and in standard syndrome type distribution,the most frequent symptoms were dampness and turbidity,damp-heat,and blood stasis.In the combined gastrointestinal dysfunction group,all the evidence types were mixed with deficiency and reality.The most frequent evidence types were spleen-kidney qi deficiency combined with dampness and turbidity,spleen-kidney yang deficiency combined with blood stasis.And the most frequent evidence types were dampness and turbidity combined with spleen-kidney qi deficiency,damp-heat combined with spleen-kidney qi deficiency,blood stasis combined with spleen-kidney yang deficiency.3.Glycosylated hemoglobin,blood calcium,peritoneal Kt/V value,blood urea nitrogen,residual renal Kt/V value,total CCr value,residual renal CCr value,total CCr standardization,hypertension,male,age,diabetic nephropathy and coronary heart disease were influencing factors for peritoneal dialysis-related gastrointestinal dysfunction.4.Glycosylated hemoglobin,diabetic nephropathy and residual kidney CCr were independent influences on peritoneal dialysis-related gastrointestinal dysfunction.Further,glycosylated hemoglobin and diabetic nephropathy were danger factors for peritoneal dialysis-associated gastrointestinal dysfunction,while residual kidney CCr was the protective factor for peritoneal dialysis-associated gastrointestinal dysfunction. |
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