Diabetic Nephropathy In Chinese Medicine Syndrome

ObjectiveTo discuss the TCM syndrome pattern of diabetic nephropathy, and the relativity ofdifferent TCM syndrome with sex, age and laboratory indices, so as to explore the characterofTCMsyndrome.MethodsThis research is part of program 973 grant (No.2005CB23503)from the Ministry ofScience and Technology to P.L—the systematic biology research of clinic methodology inpreventingandtreatingchronicrenalfailurebyTCM.This research is composed of prospective study, retrospective study and specialistquestionnaire, of which the most principal is the prospective study. The results of theretrospective study and the specialist questionnaire, together with literature consultation andspecialist opinion, are the basic of the questionnaire and the TCM syndrome study.Theresearch proceeds with the questionnaire of diabetic nephropathy established according to taskgroup. The included DN patients were all from Dongzhimen Hospital affiliated to Beijinguniversityof Chinese Medicine and three other units of the study. The general conditions, fourdiagnostic information of TCM and relative laboratory indices of patients with completeinformationwerecollected.Themethodsofclusteringanalysis,principalcomponentanalysisandfactoranalysiswereadopted to analyse and sum up the distribution of TCM syndrome. The canonical correlationanalysis was adopted to analyse the relativity of the laboratory indices with different TCMsyndromes, so as toestablish agenerallyaccepted, scientificlaboratoryindices relatedtoTCMsyndrome.The retrospective study was conducted in Dongzhimen Hospital affiliated to Beijinguniversity of Chinese Medicine. The general conditions, four diagnostic information of TCMof enrolled patients with complete data were collected to analyse and sum up the TCMsyndrome and explore the general law of the distribution of symptomes and syndromes of DN.The questionnaires were filled up by twenty-seven well-known Chinese specialists in person.The results were collected to serve as a compensatory material for the retrospective study andtoprovideinformationfortheconstructionofthequestionaire.ResultsThe main syndromes of the patients in stage III (Mogenson ) DN are deficiency of Yinand deficiency of Qi, the syndromes of patients with stage IV DN are deficiency of and Qideficiencyof Yin; while for the stage V syndromes are mainlydeficiencyof and Qi deficiencyof Yang. Phlegm and dampness, stagnation of blood stasis are evenly distributed in the threestages of DN. The tendency of progressing from deficiency of Yin to deficiency of Qi andfinallydificiencyofyangisthemainprocedureofDN.This research also disclosed that there are rarely pure deficiency syndrome or pureexcessivesyndrome.Thereare66cases(86.4%)inthethirdstageDNwithcombinedsyndromeofdeficiencyandexcessiveness,and102cases (93.6%)instage IVand55cases(100%)instage Vrespectively,mostofwhicharethecombinationofmorethanthreesyndromes.The results of clustering analysis, principal component analysis and factor analysis areapproximately inaccordencewiththe7groupsofTCMsyndromeinquestionary,andprovedthat deficiency of Qi, deficiency of Xue, deficiency of Yin, deficiency of Yang, phlegm anddampness,dampnessandturbid,stagnationofbloodstasisarebasicTCMsyndromeelementindiabetic nephropathy. The results of canonical correlation analysis displayed that there arepertinencebetweenthedeficiencyofQiandScr,deficiencyofYinandScr.Conclusion1.The main TCM syndrome of DN patients in the early stage are deficiency of Qi,deficiency of Yin, and in the forth and the fifth stage of diabetic nephropathy are mainlydeficiencyofYang.TheTCMsyndromeofphlegmanddampness, stagnationofbloodstasisare in the whole procedure of DN, in accordence with the traditional TCM pathogenesis. Andthe pathogenesis of this disease is complicated, deficiencysyndrome accompanied with excesssyndrome.Theresultsprovedprofessorlv'sciencestandpoint.2.The results of clustering analysis, principal component analysis and factor analysis alsomanifested the several well-known experts'clinical experience, and hint us that according tothe clinical Epidemiology principle methods, proceeding the strictly designation of the TCMsyndrome research,then theexpert experiencebywayofthe goldstandard that checkedbytheclinicalverificationisviable.3.Theresults ofcanonical correlationanalysis indicatethat standpoint ofdeficiencyoftheprimary and excessive of the secondary, that standpoint of deficiency causing excessive;alsoindicatethatprofessorLv'sstandpointthatpathologicaldevelopmenttrendis"XuShun,Lao,Shuai"inDN.4. The results of clustering analysis, canonical correlation analysis, principal componentsanalysisandfactoranalysishavedefinitesignificationinTCMsyndromeresearch.5.Theresultofprospective study is consistent with the resultof retrospective study and thespecialist questionnaire, showingthat retrospectivestudyandthespecialist questionnaireis thebasisforgainingrightresult,andisabsolutelyanecessarypartofTCMsyndromestudy.