Analysis Of Related Factors Of Depressive Symptoms In Patients With DKD Stage Ⅲ-Ⅳ And Study On The Correlation Of TCM Syndrome Type

Objective:To research the depressive symptoms,influencing factors and the distribution of TCM syndrome types of depressive symptoms in patients with diabetic kidney disease at stage Ⅲand Ⅳ,in order to provide a new intervention target for the prevention and treatment of patients with depressive symptoms in stage Ⅲ-Ⅳ of DKD.Methods:Patients with diabetic kidney disease at stage Ⅲ and Ⅳ in Dongzhimen Hospital and Fangshan Hospital of Beijing University of traditional Chinese Medicine from December 2021 to December 2022 were included.The psychological status of patients was estimated by self-rating depression scale,self-rating anxiety scale and 90 symptom list.The patients were divided into depression group and non-depression group according to the results of SDS scale.The basic information and clinical physicochemical indexes of patients were collected.The TCM syndrome types were counted,and the related factors,psychological status and TCM syndrome distribution of patients with depressive symptoms in stage Ⅲ-Ⅳ of DKD were analyzed.Results:(1)Among the 152 patients,96 were in the non-depression group and 56 in the depression group,including 46(82.2%)with mild depression,10(17.8%)with moderate depression and 0(0%)with severe depression.(2)There were 56 patients in the depression group,including 55 patients with anxiety symptoms.Depressive symptoms were often accompanied by anxiety symptoms.(3)There were significant differences in age,sex,smoking,drinking,income level,ALB,HGB,family history of diabetes,number of chronic diseases,number of DKD complications between the depression group and the non-depression group(P<0.05).There were no significant differences in education,marriage,BMI,exercise,diabetes course.DKD course,diabetic retinopathy,peripheral neuropathy,RBC,SCr,GFR,24hUTP,FBG,2hBG.K+(P>0.05).(4)The results of univariate Logistic regression analysis showed that there were differences in sex,age,income,smoking,drinking,family history of diabetes,number of chronic diseases,number of DKD complications,ALB,HGB were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that number of complications in DKD was statistically significant(P<0.05).(5)There were significant differences in the total score of SCL-90 and the scores of somatization,obsessive-compulsive,depression,anxiety,hostility and phobia in DKD patients with depressive symptoms(P<0.05).The score of depression group was higher than that of non-depression group.There were no significant differences in the scores of interpersonal sensitivity and paranoia(P>0.05).(6)The distribution of syndrome types of DKD Ⅲ-Ⅳ,deficiency of both qi and yin syndrome>spleen and kidney qi deficiency syndrome>liver and kidney yin deficiency syndrome>spleen and kidney yang deficiency syndrome>qi and blood deficiency syndrome>yin and yang deficiency syndrome;standard demonstration:blood stasis syndrome>water-dampness syndrome>phlegm-turbid syndrome>damp-heat syndrome.Primary deficiency syndrome in depression group,deficiency of both qi and yin syndrome>spleen and kidney qi deficiency syndrome>spleen and kidney yang deficiency syndrome>liver and kidney yin deficiency syndrome>qi and blood deficiency syndrome>yin and yang deficiency syndrome;standard demonstration:blood stasis syndrome>water-dampness syndrome>dampness-heat syndrome>phlegm-turbid syndrome.Among them,the distribution of qi-yin deficiency syndrome and liver-kidney yin deficiency syndrome was different between the two groups(P<0.05),but there was no difference in other syndrome types between the two groups(P>0.05).Conclusion:(1)The prevalence rate of depressive symptoms in patients with stage Ⅲ-Ⅳ of DKD selected in this study was 36.8%,of which mild depression was dominant.(2)Female,older,non-smoking,non-drinking,low income,no family history of diabetes,more chronic diseases,more DKD complications,low HGB and low ALB were more likely to have depressive symptoms in stage Ⅲ and Ⅳ of DKD.(3)There were significant differences in the total score of SCL-90.somatization and depression between DKD Ⅲ-Ⅳ depression group and non-depression group.(4)Distribution of TCM syndrome types:the main syndrome types of this deficiency syndrome are qi-yin deficiency syndrome,spleen-kidney qi deficiency syndrome,blood stasis syndrome and water-dampness syndrome.The proportion of liver and kidney yin deficiency syndrome in depression group was higher than that in non-depression group,while the qi-yin deficiency syndrome in depression group was lower,which was statistically significant.There was no statistical significance in the distribution of standard evidence between the two groups.