| BackgroundPolycystic kidney disease(PKD)is a single-gene hereditary kidney disease characterized by numerous bilateral renal cysts accompanied by progressive renal enlargement.As a rare disease,the incidence is relatively high among the hereditary kidney disease worldwide.According to the genetic pattern,it can be divided into autosomal recessive polycystic kidney disease and autosomal dominant polycystic kidney disease.Since the latter often dies in perinatal and infancy,this study focused on autosomal dominant polycystic kidney disease.Patients with polycystic kidney disease have a high incidence of chronic renal insufficiency and will easily be progressed to the end-stage renal disease.At present PKD has become the fourth largest cause of end-stage renal disease(ESRD).As for now,there is no targeted treatment,which for polycystic kidney disease,with the internationally recognized safety and effectiveness.So exploring potential new therapy has become the important subject in medical science.Traditional Chinese medicine has its unique advantage in the treatment of chronic kidney disease(CKD),combining traditional Chinese and western medicine treatment of polycystic kidney disease has become a new trend in our country.But due to few clinical patients,large clinical trail can not be organized.TCM syndrome differentiation system has not yet been set up for polycystic kidney disease.The diagnosis and treatment is more depends on the clinical doctor's own experience.Case reports and doctos'experience are the major components of the literature,few large clinical studies has been reported.Therefore,this study firstly conducted data mining on literature and experience prescriptions of tutors to sort out the current TCM differentiation and treatment rules of polycystic kidney disease and summarize the clinical medication experience of tutors,and then developed and issued questionnaires to investigate the TCM syndrome of patients with polycystic kidney disease,so as to summarize the distribution rules of TCM syndrome types.Finally,we summarized the curative effect of patients with polycystic kidney disease treated by our tutor to verify the effectiveness and safety of our tutor's empirical formula,in order to initially establish a more complete TCM treatment system and provide a research basis for clinical treatment of patients with polycystic kidney disease in the future.ObjectiveStudy 1:Through data mining of literature and experience prescriptions of tutors,the current TCM differentiation and treatment rules of patients with polycystic kidney disease and experience of tutors' medication were summarized from a systematic and holistic perspective.Study 2:A large number of questionnaires were used to determine the distribution of common TCM syndromes in patients with polycystic kidney disease.Study 3:The efficacy and safety of the tutor's self-designed experience prescription were verified by comparing and observing the efficacy of the two groups of patients with or without the tutor's experience prescription.MethodsStudy 1:Literature retrieval was conducted by CNKI full-text journals database,CSTJ and wanfang Database.Design form for data entry.From the literature about the syndrome differentiation and treatment of polycystic kidney disease,to establish a syndrome differentiation and treatment of traditional Chinese medicine of polycystic kidney disease database,which content of the emphasis on "drug","symptom","cause","syndrome type","prescription" information.And analyzing the data.At the same time,establishing tutor experience database.IBM SPSS Statistics 21.0 and Traditional Chinese Medicine Inheritance computing platform V 3.0 were used for data mining.Study 2:Questionnaire data were distributed and collected through a combination of partial interviews and most electronic questionnaires.Patients with different age,gender,genotype and kidney disease stage were classified and compared to analyze the distribution of different TCM syndromes,and explore the correlation between common complications and different syndromes.Study 3:Observation and comparative analysis of the clinical efficacy of patients with polycystic kidney disease before and after treatment in the two groups of patients who received the experience of the tutor and the support of Western medicine and those who only received the support of western medicine.The main observation nodes were 3,6,9,12,18,24,30 and 36 months.Serum creatinine,glomerular filtration rate,24 h urine protein quantitative and hemoglobin content as the main therapeutic indexes,blood urea nitrogen,uric acid,blood glucose,triglyceride,total cholesterol,total protein,albumin as secondary efficacy index.potassium and the incidence of adverse events as safety index,and combined with traditional Chinese medicine symptom integral changes before and after treatment to determine the clinical curative effect.ResultsStudy 1:1.Literature data mining included 185 prescriptions,including 279 drugs,and the top 10 drugs in use frequency were:Poria cohoe,Astragalus membranaceus,Atractylodes,Glycyrrhiza,Yam,Radix paeoniae.Rhubarb,Cortex danpi,Peach kernel,and Radix danggui.2.The frequency analysis of the drug efficacy of literature classification,four properties and five tastes:these drugs include 21 classes,the top 10 of drug use frequency,according to the frequency,in arrangement of high and low order for tonic drugs,blood-activating and stasis-elimination drugs,water-disinhibiting damp-percolating drugs,heat-clearing drugs,styptic,qi-regulating drugs,drugs for relieving Exterior Disorder,qi,asthmatics.interior-warming drugs,drugs for calming liver wind;The main properties of drug is cold,warm and mild;The main tastes of drug is sweet,bitter and acrid.Channel tropism is in spleen meridian mainly.3.The combination of drug combination analysis of the association rules and produced 13 rule,get seven commonly used two drugs combined association rules,six commonly used three kinds of drug combination association rules,the two drugs combination is mainly made up by tonic drugs,drugs for clearing damp and drugs for invigorating blood circulation and eliminating stasis.The three types of drug combinations is mainly made up by kidney-reinforcing drugs and drugs for clearing damp.The rule is in accordance with clinical characteristics.4.Six types of core prescriptions were obtained through cluster analysis,among which tuckahoe,Astragalus membranaceus,Atractylodes,Achyranthes bidentata,Cornus meat,Chinese yam,tangerine peel and salvia miltiorrhiza were the most commonly used.5.Frequency analysis of clinical symptoms,involving a total of 65 symptoms,including abdominal distension or tingling pain.fatigue,dull abdominal distension;A total of 29 tongue images were involved.The main tongue images were "thin white moss,white and greasy moss,yellow and greasy moss" and "dark purple tongue with ecchymosis,dark red tongue,pale white tongue and light red tongue".There are 37 kinds of pulse symptoms involved in the study,among which the main ones are fine sinking pulse,fine chord pulse and smooth chord pulse.6.According to the analysis of etiology frequency,the top three common etiology of pathogenic syndrome were blood stasis,damp-heat and drowning poison,and the top three common etiology of positive deficiency syndrome were qi deficiency.Yin deficiency and Yang deficiency.7.According to the syndrome differentiation analysis of TCM,the top 10 syndrome types in terms of frequency are spleen and kidney qi deficiency,spleen and kidney Yang deficiency,excessive dampness and heat obstruction,liver and kidney Yin deficiency,dampness and heat stasis obstruction,blood stasis obstruction,water stasis interaction,Qi stagnation and blood stasis,qi and Yin deficiency and phlegm stasis interaction.8.According to the frequency analysis of TCM prescriptions,the commonly used prescriptions are tonifying kidney prescription and promoting blood circulation and removing stasis prescription.9.Data mining supervisor's medication experience,whose core prescriptions are Astragalus membranaceus,leech,Achyranthes,Bupleurum,and Woodlouse.10.The pathogenesis of polycystic kidney disease is vacuity and marked solid.In the cyst stage,phlegm,stasis and retained fluid are intertwined,and in the renal failure stage,phlegm,stasis and retained fluid are accumulated for a long time as stagnancy.11.The characteristics of tutor's medication are:nourishing spleen and kidney,treating phlegm,retained fluid,stasis and stagnancy,and dispersing and eliminating.Study 21.A total of 146 questionnaires were distributed,and 143 valid questionnaires were recovered.2.Female patients are easy to fear cold limbs cold,yellow face,chest and flank pain,lumbago swelling,male easy fatigue,face swarthy,tinnitus,deafness and urinary symptoms.The incidence of vision loss was higher in the younger group,the older group was more prone to dull abdominal distension than the younger group,and the middle-aged group was more prone to facial edema and fever.In the elderly group easy face lip purple dark,purple tongue dark.The occurrence frequency of thin white moss decreased with age.while yellow greasy moss increased.3.The syndrome of deficiency of spleen and kidney Yang is the most common in females,and the syndrome of deficiency of qi and Yin is more common in males.From the perspective of age.the most common syndrome type is deficiency of spleen and kidney Yang in youth group and middle-aged group,while the syndrome of deficiency of qi and Yin is the most common syndrome type in elderly group.Blood stasis blocking collaterals is the basic syndrome type of this disease.4.The incidence of deficiency syndrome of polycystic kidney disease 2(PKD2)gene mutation is significantly higher than that of PKD1(polycystic kidney disease 1)mutation,and the non-truncated mutation of PKD1 and PKD2 mutation have higher incidence of dampness and heat accumulation syndrome.The incidence of asthenia-syndrome in PKD1 non-truncated mutation and PKD2 mutation was much higher than that in sthenia-syndrome while the incidence of asthenia-syndrome and sthenia-syndrome in PKD1 truncated mutation was nearly average.5.The occurrence of hypertension is related to spleen and kidney Yang deficiency syndrome,qi and Yin deficiency syndrome.The occurrence of Polycystic liver disease is related to liver and kidney Yin deficiency syndrome and qi and Yin deficiency syndrome.The occurrence of hematuria is related to all types of syndrome.The occurrence of urinary tract infection has connection with all other types of syndrome except qi and blood deficiency syndrome.The occurrence of urinary calculi is related to spleen and kidney Yang deficiency syndrome,qi and Yin deficiency syndrome and syndrome of superficies attacked by wind heat.There was no significant correlation between heart disease and qi and blood deficiency syndrome and phlegm-dampness block syndrome.6.The proportion of asthenia syndrome in the early stage of chronic kidney disease was higher,and the proportion of sthenia syndrome increased with the development of the disease.Study 3101 cases were collected,17 cases were detached,and 84 cases were included,including 42 cases in the empirical prescription group and 42 cases in the symptomatic treatment.In the empirical prescription group,serum creatinine decreased significantly and the glomerular filtration rate increased significantly in the first 3 months,and remained stable in the later period.In the symptomatic treatment group,there was no significant difference before and after the early treatment,but the serum creatinine continued to increase and the glomerular filtration rate continued to decrease.The serum uric acid level decreased obviously in empirical prescription group.There was no significant difference in other indexes between and within groups.The total clinical effective rate of empirical prescription group was 64.3%,much higher than that of symptomatic treatment group.Different CKD stage renal function in patients with symptomatic treatment group were continued to decline,at the 12 months decline significantly accelerated,10 patients has to be on dialysis.empirical prescription group in each stage has a obvious upward trend in the early stage of the kidney,especially CKD3-5 late period treatment kidney can still keep smooth,no obvious drop,CKD3 stage increased during the whole observation period.Conclusions1.Polycystic kidney disease results from asthenia of healthy qi and sthenia of pathogenic factors."Waist and abdomen pain,fatigue,anorexia and abdominal distention,hematuria,lumbar debility,abdominal mass "as the primary symptoma,syndrome types as main asthenia pattern are spleen and kidney deficiency syndrome,spleen kidney Yang deficiency and liver and kidney Yin deficiency,syndrome types as main sthenia pattern are syndrome of excessive dampness and heat obstruction,dampness and heat stasis obstruction and blood stasis obstruction.the commonly used prescriptions are tonifying kidney prescription and promoting blood circulation and removing stasis prescription.The mainly used drugs are tonic drugs,drugs for invigorating blood circulation and eliminating stasis and drugs for clearing damp.The four properties and five tastes of common drugs are mainly "cold,warm and mild","sweet,bitter and acrid".The characteristics of tutor's medication are:nourishing spleen and kidney,treating phlegm,retained fluid,stasis and stagnancy,and dispersing and eliminating.The main medicines used by the tutor were rhizome sparganii,curcuma zedoary,leech,woodlouse which can promote blood circulation to remove blood stasis and use lots of astragalus membranaceus to strengthen the body resistance but not keep the evil.2.The main asthenia pattern of TCM syndrome types of polycystic kidney disease is spleen and kidney Yang deficiency syndrome and Qi and Yin deficiency syndrome,the main sthenia pattern is syndrome of blood stasis blocking collaterals and hyperactivity of liver-Yang.For female,spleen and kidney Yang deficiency syndrome is more common and for male,qi and Yin deficiency syndrome is more common.Males can be sicker than females.Along with the age level increases,the spleen and kidney Yang deficiency syndrome gradually to qi and Yin deficiency syndrome,so the disease's progression is companied with the transformation of syndromes.In the early stage of the disease,asthenia pattern in more proportion and in the later stage,sthenia pattern in more proportion.3.tutor's experience prescription probably can delay the decline of renal function for a long time,reduce blood creatinine and blood uric acid,and may improve the clinical symptoms of patients. |
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