Study On TCM Syndrome Types And Related Factors In Elderly Patients With Chronic Kidney Disease Complicated With Proteinuria

Objective : To explore the distribution of TCM syndromes and its relationship with related factors in elderly patients with stage 1-3 chronic kidney disease and proteinuria,in order to provide theoretical basis for early intervention of TCM in elderly chronic kidney disease.Methods:From January 2021 to January 2022,325 patients diagnosed with chronic kidney disease,aged ≥ 60 years and meeting the inclusion and exclusion criteria in the clinical study were selected.Clinical data were collected,and statistical analysis of the data was carried out with SPSS 26.0software.The main syndrome groups were divided by cluster analysis,the main and secondary symptoms were determined by principal component analysis,and then syndrome type was determined.The statistical analysis of the relationship between syndrome type and related factors was based on different data types to select the corresponding statistical methods,so as to explore the factors affecting syndrome type.Results:1.325 patients,CKD1 stage accounted for 27.69%,CKD2 stage accounted for 34.46%,CKD3 a stage accounted for 19.38%,CKD3 b stage accounted for 18.46%.With the increase of CKD stage,the number of risk factors increased.There was no significant difference in the prevalence of hypertension and dyslipidemia among different stages of CKD(P > 0.05),and the incidence of diabetes and hyperuricemia was different or not completely the same among different stages of CKD(P < 0.05).2.The frequency of symptoms,tongue and pulse symptoms in the statistical results is more than 50%,in descending order:limb edema,fatigue,lumbago,deep pulse,inappetence,white tongue fur,dark tongue or ecchymosis,lusterless complexion,greasy fur,abdominal distension,and fine pulse.According to cluster analysis and principal component analysis,there are three syndrome types:liver and kidney Yin deficiency with dampness-heat blood stasis syndrome,qi deficiency with blood stasis and water dampness syndrome,deficiency of spleen and kidney with damp-turbidity syndrome.3.The distribution of the three syndromes were as follows: deficiency of spleen and kidney with damp-turbidity syndrome(42.15%)> qi deficiency with blood stasis and water dampness syndrome(31.08%)> liver and kidney Yin deficiency with dampness-heat blood stasis syndrome(26.77%).4.The difference of general data between different syndrome types: 1)There was statistical significance in age among the three groups of syndrome type(P < 0.05).The mean age of deficiency of spleen and kidney with damp-turbidity syndrome group was higher than that of liver and kidney Yin deficiency with dampness-heat blood stasis syndrome group.2)There was difference in BMI index among the three groups of syndrome type(P < 0.05).Pairwise comparison between the two groups suggested that the BMI of deficiency of spleen and kidney with damp-turbidity syndrome group was lower than that of the other two groups.3)There was no statistically significant difference in the distribution of hypertension,dyslipidemia and hyperuricemia among different syndrome types(P > 0.05),but there was statistically significant difference in the distribution of diabetes among different syndrome types(P< 0.001).4)The distribution of different syndrome types in CKD1-3B stage was different or not identical(P < 0.05).With the increase of CKD stage,the proportion of deficiency of spleen and kidney with damp-turbidity syndrome increased.5.Differences of clinical indicators among different syndrome types:there were statistically significant differences in ALB,24H-UTP,SCr and PLT levels among different syndrome types(P < 0.05).The decrease of ALB level was most significant in qi deficiency with blood stasis and water dampness syndrome.The 24h-UTP and DD levels in qi deficiency with blood stasis and water dampness syndrome group were higher than those in the other two groups.Pairwise comparison of SCr level between groups showed that all P values were greater than 0.05,and the difference was not statistically significant.The PLT level of deficiency of spleen and kidney with damp-turbidity syndrome was lower than that of qi deficiency with blood stasis and water dampness syndrome group.There were significant differences in TC,LDL-C and HDL-C levels among syndrome types(P < 0.05).The TC and LDL levels in qi deficiency with blood stasis and water dampness syndrome group were higher than those in the other two groups,and HDL-C levels in liver and kidney Yin deficiency with dampness-heat blood stasis syndrome group were lower than those in the other two groups.Conclusion:1.In this study,the basic pathogenesis of elderly patients with CKD was based on the asthenia in origin sthenia in superficiality.The asthenia syndrome mainly involves deficiency of qi,Yin and Yang.The sthenis syndrome was blood stasis,dampness-heat,dampness-turbidity,and water dampness.The disease location mainly involves kidney,spleen liver and other organs.2.The main TCM syndromes of senile CKD include deficiency of spleen and kidney with damp-turbidity syndrome,qi deficiency with blood stasis and water dampness syndrome,liver and kidney Yin deficiency with dampness-heat blood stasis syndrome.3.In CKD1-3b stages,with the increase of stage,the cases of deficiency of spleen and kidney with damp-turbidity syndrome gradually increased,while the cases of qi deficiency with blood stasis and water dampness syndrome showed a decreasing trend.With the progress of CKD,the deficiency of spleen and kidney further deepened.4.The ALB level of qi deficiency with blood stasis and water dampness syndrome decreased most significantly,followed by deficiency of spleen and kidney with damp-turbidity syndrome,and finally liver and kidney Yin deficiency with dampness-heat blood stasis syndrome.The 24h-UTP,DD,TC and LDL-C levels of qi deficiency with blood stasis and water dampness syndrome were higher than those of other groups.The level of HDL-C in liver and kidney Yin deficiency with dampness-heat blood stasis syndrome was lower than that in other groups.