| ObjectiveTo study the TCM syndromes of maintenance hemodialysis(MHD)combined with hyperhomocysteinemia(HHcy)in stage 5 of chronic kidney disease,and analyze the correlation between TCM syndromes and age,dialysis age,protopathy and clinical indicators,so as to provide theoretical reference for TCM syndrome differentiation and treatment,so as to facilitate clinical intervention and give full play to the advantages of TCM treatment.Reduce the incidence of cardiovascular and cerebrovascular events and autogenous arteriovenous fistula thrombosis in MHD patients,thus improving the prognosis of MHD patients.MethodsThis study is a cross-sectional study.On the basis of consulting a large number of relevant literatures,the TCM Syndrome Type Questionnaire for Patients with hyperhomocysteinemia during maintenance hemodialysis was designed to investigate the patients with MHD and HHcy in the Blood Purification Center of Beijing University of Chinese Medicine East Hospital.General information,TCM four diagnosis information and laboratory tests of blood routine,renal function ions,blood albumin and blood lipid were collected.Excel software was used for data entry,database was established,and SPSS 26.0 software was imported for statistical analysis.Under the guidance of the theory of traditional Chinese medicine,the frequency analysis method is adopted to intuitively understand the information distribution of the four diagnoses of traditional Chinese medicine.Using the method of factor analysis,exploratory factor analysis was carried out on the information of four diagnoses of traditional Chinese medicine,and common factors were extracted,so as to conclude the syndrome elements of traditional Chinese medicine.The method of cluster analysis was adopted to conduct R-type cluster analysis on common factors and combine different syndrome elements,so as to conclude TCM syndrome types.The measurement data were represented by mean ± standard deviation,subject to normal distribution and equal variances;independent sample t test was applied for comparison between two groups;one-way analysis of variance was applied for comparison between multiple groups;non-parametric test was applied if the data did not follow normal distribution or had uneven variances.Count data were expressed as frequency or percentage,and chi-square test was used for comparison between multiple groups.P<0.05 was considered to be statistically significant.Results(1)General information:A total of 86 patients with MHD and HHcy were included in this clinical study,including 48 males(55.8%)and 38 females(44.2%).The oldest was 87 years old,the youngest was 27 years old,and the average age was 65.20±12.96 years old.The number of elderly patients over 60 years old was the largest,with 60 cases(69.7%).The longest dialysis age was 252 months,the shortest dialysis age was 3 months,and the average dialysis age was 78.85±60.09 months.The number of patients with 1-5 years of dialysis age was the largest,with 29 cases(33.7%).Among the primary diseases,there were 29 cases of diabetic nephropathy,14 cases of primary glomerulonephritis,13 cases of hypertensive nephropathy,8 cases of polycystic kidney disease,7 cases of immune disease,5 cases of drug-induced kidney damage,2 cases of other secondary glomerulonephritis,and 8 cases of unknown or unknown cause.(2)Frequency analysis results:There are 34 TCM symptoms and signs of MHD patients with HHcy,of which 11 have a frequency of more than 20%,from high to low,including fatigue and sluggishness,shortness of breath and lazy speech,dry mouth and throat,dry eyes,limb restlessness,dizziness and headache,sticky mouth,slow eating,brown complexion,sallow complexion,and body sleepiness.There were 10 tongue images in MHD patients with HHcy,among which 5 had frequencies of more than 20%.From high to low,they included:purple and dark ecchymosis of tongue,white and greasy coating,tongue cracks,light and fat tongue,little moss and lack of fluid.Among them,the frequency of purple and dark ecchymosis of tongue,white and greasy coating and tongue cracks were the highest,accounting for 52.3%,34.9%and 31.4%,respectively.Patients with MHD complicated with HHcy had a total of 8 items of pulse,among which 4 items had a frequency of more than 20%.From high to low,the items included:sinking pulse,thin pulse,weak pulse,and uncomfortable pulse.The frequency of sinking pulse,thin pulse and weak pulse was the highest,accounting for 69.7%,58.1%and 40.6%,respectively.(3)Factor analysis results:20 TCM symptoms and signs,tongue images and pulse images with a frequency of more than 20%in the frequency analysis results were included as variables in factor analysis entries,and 7 common factors F1,F2,F3,F4,F5,F6 and F7 were extracted by principal component analysis.The TCM symptoms and signs,tongue images and pulse images contained in each common factor were listed as follows:F1:dark complexion,astringent pulse,purple and dark ecchymosis of tongue,heavy pulse;F2:The limbs are heavy and the mouth is sticky.F3:pale complexion and weak pulse;F4:fatigue,shortness of breath,lazy speech,tongue cracks,thin pulse;F5:dizziness,headache,dry eyes,limb restlessness;F6:light fat tongue,white greasy moss,food less Na nerdy;F7:dry mouth,dry throat,little moss and lack of fluid.The TCM syndromes corresponding to common factors were summarized:the syndromes of disease location were kidney,spleen and liver,mainly kidney and spleen;The pathogenic syndromes include qi deficiency,Yin deficiency,Yang deficiency,dampness turbidity and blood stasis.(4)Cluster analysis results:The 7 common factors were taken as variables for R-type cluster analysis.Combined with expert advice and clinical practice,the cluster could be divided into 4 categories:the first category:containing F4 and F7,including fatigue and fatigue,shortness of breath and lazy speech,cracked tongue,thin pulse,dryness of mouth and throat,and deficiency of moss and fluid,which were summarized as deficiency of Qi and Yin.The second category includes F2,F3 and F6,including heavy body,sticky mouth,yellow complexion,weak pulse,pale and fat tongue,white and greasy moss,little food and dull,which are summarized as spleen deficiency and dampness and turbidity syndrome;The third category:including F1,including dark complexion,astringency,dark purple ecchymosis of the tongue and deep pulse,which are summarized as syndrome of kidney deficiency and blood stasis;The fourth category:containing F5,including headache,dizziness,astringent eyes and limb restlessness,summarized as liver and kidney Yin deficiency syndrome.According to the score of common factor of each patient,the highest score was the common factor to which the patient belonged,and the syndrome group in which the common factor belonged should be the syndrome group to which the patient belonged.Among the 86 patients,36 cases(41.9%)of the second type of spleen deficiency syndrome were the most,followed by 22 cases(25.6%)of the first type of Qi and Yin deficiency syndrome,20 cases(23.2%)of the third type of kidney deficiency and blood stasis syndrome,and 8 cases(9.3%)of the fourth type of liver and kidney Yin deficiency syndrome.Among the four TCM syndrome types,the deficiency syndrome accounted for 34.9%and the deficiency and solid mixed syndrome accounted for 65.1%.(5)The results showed that the dialysis age of liver and kidney Yin deficiency type was significantly higher than that of spleen deficiency and dampness turbidity type,and the dialysis age of qi and Yin deficiency type was significantly higher than that of spleen deficiency and dampness turbidity type.The creatinine level of spleen deficiency dampness turbidity syndrome is significantly higher than that of kidney deficiency blood stasis syndrome,while the creatinine level of kidney deficiency blood stasis syndrome is significantly higher than that of liver kidney yin deficiency syndrome.The level of homocysteine in spleen deficiency dampness turbidity syndrome is significantly higher than that in kidney deficiency blood stasis syndrome,and the level of homocysteine in kidney deficiency blood stasis syndrome is also significantly higher than that in qi yin deficiency syndrome.The potassium level of liver-kidney Yin deficiency type was significantly higher than that of Qi and Yin deficiency type.Conclusions(1)The pathogenic syndromes of MHD patients with HHcy include kidney,spleen and liver,mainly kidney and spleen,and the pathogenic syndromes include qi deficiency,Yin deficiency,Yang deficiency,dampness turbidity and blood stasis.TCM syndromes are spleen deficiency and dampness,qi and Yin deficiency,kidney deficiency and blood stasis,liver and kidney Yin deficiency.(2)In terms of dialysis age,the dialysis age of liver-kidney Yin deficiency type in MHD patients with HHcy is longer than that of spleen deficiency and dampness turbidity type,and the dialysis age of both qi and Yin deficiency is longer than that of spleen deficiency and dampness turbidity type.It can be seen that MHD patients with HHcy present with syndrome of deficiency and insufficiency at the beginning,mainly with syndrome of spleen deficiency and dampness turbidity;after a long time of disease development,mainly with deficiency syndrome,mainly with syndrome of qi and Yin deficiency,followed by syndrome of liver and kidney Yin deficiency.(3)In terms of clinical indicators,both homocysteine and creatinine are metabolites,which can be classified as solid evil of traditional Chinese medicine.Studies show that the creatinine level and homocysteine level of spleen deficiency and kidney deficiency and blood stasis are higher than that of deficiency syndrome,indicating that toxin accumulation and stagnation are more common in spleen deficiency and kidney deficiency and blood stasis syndrome.Potassium ions can maintain the normal stress of myocardia and muscle nerves.Studies show that the potassium level of liver-kidney Yin deficiency type is significantly higher than that of Qi-yin deficiency type,indicating that hyperkalemia may be related to liver-kidney Yin deficiency. |
PDF Full Text Request