| Objective:The objective of this study was investigating the distribution of TCM syndrome type of Primary Membranous Nephropathy(PMN)through large sample cross-sectional,and the relationship between the different syndromes and patients’ general conditions,clinical symptoms,relevant laboratory.It is expected to provide ideas for syndrome differentiation and treatment of PMN,and provide the evidence for studying on objectification of traditional Chinese Medicine.Methods:The Survey Table of Patients with primary membrane nephropathy was formulated,and 191 PMN patients meeting the inclusion criteria were collected by using the clinical epidemiology cross-sectional survey method.Patients with PMN were classified according to syndrome differentiation,and the distribution law of TCM syndrome types of this disease is explored.The correlation between PMN syndrome types and patients’ age,gender,course of disease,The relationship between BMI,CKD stage,clinical symptoms,tongue and pulse,relevant laboratory indicators(24-hour urinary protein quantification,serum albumin,renal function,blood lipid,coagulation function),anti-PLA2 R antibody were processed and analyzed by SPSS26.0 software.Results:1.Analysis of general conditions:(1)Among 191 PMN patients,123 are males and 68 are females,the ratio of males and females is 1.8:1.The age distribution is mostly between 61 and 70 years old,accounting for 31.4%.(2)The largest number of PMN patients had disease course within 1 years,accounting for 53.4%.(3)More PMN patients were engaged in manual labor,accounting for 40.84%,and the number of patients engaged in mental work was 73,accounting for 38.2%.(4)The main factor of PMN were no obvious predisposing cause and fatigue,41.4% and29.8%,respectively.(5)The proportion of comorbidity:hypertension>diabetes>no co-morbidities>other diseases>coronary heart disease>Pulmonary diseases.The distribution of clinical sign,tongue and pulse condition:(1)Clinical signs:The clinical signs with more than 10% frequency are fatigue,frothy urine,edema of both legs,fecal failure,poor sleep,facial edema,lumbar spine pain,sticky mouth,bitter taste,limb heaviness,spontaneous sweat,gasteremphraxis,chest tightness,anorexia,dizziness or headache,dry,tinnitus,being flustered,sensation of cold,dry stool.(2)Tongue image:The tongue with more than 10% frequency were dark red,dark,and red;The tongue coatings with more than 10% frequency were white greasy,thin white,white and yellow greasy.(3)Pulse condition:The pulses with more than 10% frequency were heavyfine vein,sunken pulse,taut pulse and taut slipprry pulse.TCM syndrome types distribution:(1)The deficiency syndrome: spleen and kidney qi deficiency syndrome>spleen and kidney yang deficiency syndrome>lung and kidney qi deficiency syndrome>liver and kidney yin deficiency syndrome> qi and yin deficiency syndrome.(2)The excess syndrome:dampness turbid syndrome>dampness heat syndrome>blood stasis syndrome>wind and dampness turbid syndrome>dampness turbid and blood stasis syndrome.(3)Mixed syndrome: Spleen and kidney qi deficiency syndrome is mostly combined with dampness turbid syndrome and dampness heat syndrome.Liver and kidney yin deficiency syndrome are mostly combined with dampness heat syndrome.Spleen and kidney yang deficiency syndrome is mostly combined with dampness turbid syndrome.Patients without the deficiency syndrome is more common in dampness turbid syndrome.TCM syndrome types and general conditions:(1)There is no significant difference in the distribution of PMN syndrome types between different gender,age and course of disease(P>0.05).(2)There is no significant difference in the distribution of PMN syndrome types between the BMI(P>0.05).(3)There is no significant difference in the distribution of PMN syndrome types between CKD1 period.The number of patients with spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome in CKD2 period is relatively large(P<0.05).TCM syndrome types and laboratory indicators:(1)There were significant differences in serum albumin levels among the The deficiency syndrome and excess syndrome types(P<0.05).In the deficiency syndrome,the serum albumin levels of spleen and kidney yang deficiency syndrome was higher;In the excess syndrome,the serum albumin levels of dampness turbid and blood stasis syndrome and blood stasis syndrome were higher.(2)There were significant differences in 24-hour urinary protein levels among the The deficiency syndrome and excess syndrome types(P<0.05).In the deficiency syndrome,the 24-hour urinary protein levels of spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were higher;In the excess syndrome,the serum albumin levels of dampness turbid and blood stasis syndrome was higher.(3)In the deficiency syndrome,the serum creatinine,blood urea,e GFR levels of spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were higher(P<0.05);In the excess syndrome,the serum creatinine level of blood stasis syndrome was higher(P<0.05),there were no significant differences in blood urea and e GFR levels among the excess syndrome types(P<0.05).(4)In the deficiency syndrome,the total cholesterol levels of spleen and kidney yang deficiency syndrome was higher(P<0.05),the triglyceride levels of spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were higher(P<0.05);In the excess syndrome,the total cholesterol and triglyceride levels of dampness turbid syndrome were were higher(P<0.05),the triglyceride and low-density lipoprotein levels of dampness turbid and blood stasis syndrome were higher(P<0.05).(5)There were significant differences in D-dimer and fibrinogen levels among the The deficiency syndrome and excess syndrome types(P<0.05).In the deficiency syndrome,the D-dimer and fibrinogen levels of spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were higher(P<0.05);In the excess syndrome,the D-dimer and fibrinogen levels of dampness turbid syndrome and dampness turbid and blood stasis syndrome were were higher(P<0.05).(6)The PMN patients’ positive rate of anti-PLA2 R antibody is 67.5%.Conclusion:(1)The proportion of males in PMN patients is higher than that of females,the elderly are susceptible to PMN,and the proportion of patients mainly engaged in physical labor is relatively high.Most patients can develop PMN without obvious inducements,and the most common inducement is fatigue.(2)Observed the symptoms and tongue and pulse of PMN patients,clinical patients mostly showed deficiency of spleen and kidney,and dampness,heat and blood stasis were the most common pathological factors.(3)Most of the PMN deficiency syndrome was spleen and kidney qi deficiency,and most of the PMN excess syndromes was dampness turbid syndrome.Spleen and kidney qi deficiency syndrome is mostly combined with dampness turbid syndrome and dampness heat syndrome.Liver and kidney yin deficiency syndrome are mostly combined with dampness heat syndrome.Spleen and kidney yang deficiency syndrome is mostly combined with dampness turbid syndrome.Patients without the deficiency syndrome is more common in dampness turbid syndrome.(4)There were significant differences in serum albumin levels among the The deficiency syndrome,and the courses of the spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were usually longer.There is no significant difference in the distribution of PMN syndrome types between CKD1 period.There were significant differences in CKD2 periods among the the deficiency syndrome,the renal function of spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome were more obvious than other syndrome.(5)The levels of serum albumin were low on the patients’ with PMN whose syndrome were spleen and kidney yang deficiency syndrome,dampness turbid and blood stasis syndrome and blood stasis syndrome;The levels of24-hour urinary protein were high on spleen and kidney yang deficiency syndrome,qi and yin deficiency syndrome and dampness turbid and blood stasis syndrome.spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome had more significant renal impairment;spleen and kidney yang deficiency syndrome,qi and yin deficiency syndrome,dampness turbid syndrome and dampness turbid and blood stasis syndrome had high blood lipid levels;dampness turbid syndrome and dampness turbid and blood stasis syndrome were at high risk for blood clots;The levels of Anti-PLA2 R antibody were high on spleen and kidney yang deficiency syndrome and qi and yin deficiency syndrome. |
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