| With the increasing number of chronic kidney disease in China,the number of patients entering end-stage renal disease is also increasing.Hemodialysis is a common treatment for end-stage renal disease,accounting for about 90%.However,there are many complications in hemodialysis patients,such as anemia,malnutrition,renal osteopathy,cardiac insufficiency,anxiety and depression,etc.The conventional treatment of Western medicine has its limitations.Traditional Chinese medicine not only participates in the prevention and treatment of complications,but also it has unique advantages.It can protect the residual renal function,prevent the further progress of chronic complications,and improve the quality of life of patients.Syndrome is the key of TCM diagnosis and treatment,and the research of TCM syndrome is also a hot issue in the field of hemodialysis.There is no TCM syndrome classification standard for hemodialysis till now patients.However,the TCM syndrome classification standard of chronic renal failure before hemodialysis is mostly used in the comprehensive literature reports on hemodialysis patients.In clinical diagnosis and treatment,most doctors refer to the clinical experience.However,the disorder of water metabolism and electrolyte function in patients with end-stage renal disease has been improved after hemodialysis At the same time,there are different complications.There have been many literature reports that the four diagnostic information of traditional Chinese medicine has changed after hemodialysis.If the traditional Chinese medicine syndrome classification standard of chronic renal failure before hemodialysis is still used,it is not in line with the TCM syndrome classification in hemodialysis patients.At present,there is a lack of TCM Syndrome Classification Research which is multi-center and large sample for hemodialysis patients.It is necessary to conduct a more standardized and objective TCM syndrome classification standard research for hemodialysis patients.Objective:1.Based on the information sharing system of clinical scientific research,to construct the structured electronic medical record of hemodialysis patients;2.Through use DS-01B tongue diagnosis information collection system,to Establish the tongue diagnosis database of hemodialysis patients,so as to realize the objective collection of tongue diagnosis information;3.Through analyze the clinical distribution characteristics and classification of TCM Syndromes in hemodialysis patients,to lay a foundation for further research on the diagnosis standard of TCM Syndromes in hemodialysis patients.Method:In this study,369 hemodialysis patients from three centers(based on literature,67 TCM clinical information collection points selected in the previous study of our research group,according to Kendall's principle of taking 5-10 times of the number of variables)were included in the multi center and cross-sectional survey.1.Design of information collection scheme of four diagnosis of traditional Chinese medicine for hemodialysis patientsBased on the research of TCM syndrome factors and syndromes of hemodialysis patients completed in the early stage,and the related literature research,referring to Professor Zhu Wenfeng's syndrome factors syndrome differentiation scale,the information collection table of TCM four diagnosis was designed,and the"brainstorming method" of clinical experts was used to develop the information collection scheme of TCM four diagnosis.2.Establishment of structured electronic medical record of hemodialysis patients and collection of tongue diagnosis informationBased on the information sharing system of clinical scientific research,according to the four diagnosis information collection scheme of traditional Chinese medicine,a structured electronic medical record template of hemodialysis patients is constructed,which includes the four diagnosis information of traditional Chinese medicine.The objective collection of the tongue diagnosis information of hemodialysis patients is carried out by using ds01-b tongue diagnosis information collection system(Shanghai Daosheng Medical Technology Co.,Ltd.-hxzz 0152270430).369 patients were collected in the blood purification center of Wangjing hospital,Guang'anmen Hospitaland Xiyuan Hospital of the Chinese Academy of traditional Chinese medicine respectively.The four diagnosis information of traditional Chinese medicine was collected and the database was established by using structured electronic medical record.3.TCM syndrome analysis and TCM syndrome classification of hemodialysis patients 3.1 analyze the four diagnosis information of hemodialysis patients by disease nature+disease location and syndrome element,refer to the simplified measurement method of syndrome element in syndrome element syndrome differentiation by Professor Zhu Wenfeng,find out the simplified measurement weight of relevant syndrome element corresponding to each symptom and physical sign of patients,and respectively carry out weighted sum(including minus value)to calculate the total weight of each syndrome element,so as to make judgment on syndrome element.The threshold value of syndrome element is 20,that is,when the sum of the contributions of symptoms and signs to each syndrome element(total weight)reaches or exceeds 20,it can be diagnosed as the syndrome element,that is,if the total weight is less than 20,the diagnosis of the syndrome element is not tenable;if the total weight is more than 20,the diagnosis of the syndrome element is tenable3.2 calculate the distribution frequency(percentage)of each syndrome element=the sum of the quantitative components of each syndrome element/sample size*100%,take TCM syndrome elements with the distribution frequency higher than or equal to 5%.use SPSS22.0 software,summarize the characteristics of TCM syndrome elements by frequency method,cluster analysis method to cluster TCM syndrome elements,through expert demonstration,according to the classification and code of TCM diseases and syndromes(GB/T15657-1995),Chinese Medicine The classification and description of TCM syndromes are formed by the terms of basic theory of Medicine(GB/T20348-2006)and the diagnostic efficacy standard of TCM syndromes(ZY/T001.1.94);the complex network relationship among the four diagnostic information of TCM is constructed by using the Bayesian network model,the Bayesian network diagram of each TCM Syndrome type is formed,and the syndrome syndrome correspondence table is constructed,and the TCM syndrome types obtained by the two methods are compared According to the clinical practice,the TCM syndrome classification results of hemodialysis patients were obtained3.3 aiming at the two most common syndrome types of the basic deficiency syndrome and the standard empirical syndrome,we use the binomial logistic regression method to estimate the weight of the reference standardized estimation of the basic deficiency syndrome and the standard empirical syndrome,get the weight value of each four diagnostic information of the basic deficiency syndrome and the standard empirical TCM,use the ROC curve to determine the diagnostic threshold,and establish the common basic deficiency syndrome and the standard empirical TCM syndrome of hemodialysis patients Diagnostic simple scale.Result:1.General clinical data results:This study included 370 hemodialysis patients,139 cases from Wangling hospital,Chinese Academy of traditional Chinese medicine,144 cases from Guang'anmen Hospital,Chinese Academy of traditional Chinese medicine,and 87 cases from Xiyuan Hospital,Chinese Academy of traditional Chinese medicine-accounting for 37.6%,38.9%and 23.5%respectively.Among the 370 patients,208 were male,accounting for 56.2%,162 were female,accounting for 43.8%;the age span was 27-90 years old.the average age was 60.8±13.1 years old,of which 46 were young(<45 years old),accounting for 12.2%;109 were middle-aged(? 45 years old and<60 years old),accounting for 29.5%;215 were old(? 60 years old),accounting for 58.3%Among them,103 cases were chronic glomerulonephritis,accounting for 27.8%,followed by 99 cases of diabetic nephropathy and 43 cases of hypertensive nephropathy,accounting for 26.8%and 11.6%respectively.The shortest dialysis age is 3 months,the longest is 264 months,the average dialysis age is 63.3 months,among which the number of dialysis age 25-60 months is the most,up to 130 cases,accounting for 35%of the total number,and the number of dialysis age 181-264 months is the least,up to 12 cases,accounting for 3.2%of the total number.2.Characteristics of four diagnostic information of traditional Chinese medicine in hemodialysis patients:the occurrence rate of 370 hemodialysis patients is more than 10%.There are 87 items of four diagnostic information of traditional Chinese medicine,among which the top ten items with the highest frequency are:little urine,dry skin,greasy tongue coating,itchy skin,tiredness and fatigue,purple lips,dry mouth,thirst,sore waist and knees,twitching limbs and forgetfulness.The frequency of oliguria was the highest,85.9%3.Characteristics of TCM syndrome elements in hemodialysis patients:370 hemodialysis patients involved 24 disease syndrome elements and 17 disease location syndrome elements,of which the top four disease syndrome elements were Yang deficiency,blood deficiency,Qi deficiency and yin deficiency,the top three disease location syndrome elements were kidney,liver and spleen,the highest frequency of deficiency syndrome elements was Yang deficiency syndrome elements,up to 95.68%,and the frequency of solid syndrome elements was 95.68%The highest is hygroscopic syndrome element(89.46%).There were 355 cases(95.95%)with the combination of deficiency and solid syndrome elements.There are 11 kinds of combination forms of deficiency syndrome elements,of which the most cases are Yang deficiency+blood deficiency+Qi deficiency+Yin deficiency,which is 312 cases,accounting for 84.32%;there are 8 kinds of combination forms of solid syndrome elements,of which the most are three combinations of real syndrome elements,which is 140 cases,accounting for 37.84%;there are 23 kinds of combination forms of deficiency+real syndrome elements,of which the most combination forms are 4 deficiency+3 real syndrome,which is 127 cases,accounting for 34.32%.4.Results of TCM Syndrome Classification:370 hemodialysis patients' TCM syndrome elements were clustered by Q-cluster method,and divided by Euclidean distance of 10.The syndrome types were:deficiency of Qi and blood,deficiency of liver and kidney yin,deficiency of spleen and kidney yang,deficiency of kidney essence and deficiency of body fluid;standard evidence:blood stasis,qi stagnation,damp heat,dampness and turbidity,wind movement,water stop Card.According to the Bayesian network model,the results of TCM syndrome classification are as follows:deficiency of Qi and blood,deficiency of Qi and Yin,deficiency of yin and Yang,deficiency of spleen and kidney yang,deficiency of kidney essence,deficiency of body fluid,deficiency of spleen and kidney qi;standard evidence:Qi Stagnation,blood stasis,damp heat,dampness and turbidity,wind movement and water stagnation.According to the experts' discussion and clinical practice,14 types of TCM syndromes are finally obtained,including 8 types of deficiency syndrome and 6 types of standard empirical syndrome:deficiency syndrome of Qi and blood,deficiency syndrome of Qi and Yin,deficiency syndrome of liver and kidney yin,deficiency syndrome of yin and Yang,deficiency syndrome of spleen and kidney yang,deficiency syndrome of kidney essence,deficiency syndrome of Jin,deficiency syndrome of spleen and kidney qi;standard empirical syndrome:Qi stagnation syndrome,blood stasis syndrome,damp heat syndrome,damp turbid syndrome,wind movement syndrome and water stop syndrome.5.The results of diagnosis scale of blood stasis syndrome and Qi Yin deficiency syndrome:Based on two logistic regression analysis,the scale of TCM syndrome diagnosis of blood stasis syndrome and Qi Yin deficiency syndrome was established The total score of the scale was 50 points,and the diagnostic threshold was 29 points The sensitivity of the scale was 95.7%and 91.6%,the characteristic degree was 89.7%and 94.1%,and the yoden index was 85.4%and 85.7%.respectivelyConclusion:1.The characteristics of TCM syndrome elements in hemodialysis patients are as follows:basic deficiency and standard excess,deficiency syndrome elements are mostly deficiency of both qi and blood,yin and Yang,and solid syndrome elements are mostly dampness.2.The TCM syndrome types of hemodialysis patients can be divided into the following types:this deficiency type:deficiency of Qi and blood,deficiency of Qi and Yin,deficiency of liver and kidney yin,deficiency of yin and Yang,deficiency of spleen and kidney yang,deficiency of kidney essence,deficiency of Jin,deficiency of spleen and kidney qi;standard evidence:Qi stagnation,blood stasis,damp heat,dampness and turbidity,wind movement and water stop3.The syndrome diagnosis scale of blood stasis syndrome and deficiency of Qi and Yin Syndrome in hemodialysis patients has certain diagnostic performance,and its diagnostic value needs further study. |
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