Study On Correlativity Of TCM Syndromes In Stage â…£ Of Diabetic Nephropathy

Objective:Compare patients with stage Ⅲ and Ⅳ diabetic nephropathy in TCM syndrome elements distribution and the characteristics of TCM syndrome, and to explore the correlation of different quantitative urine proteins between syndrome of TCM and clinical indicators.Methods:Relying on the project "Common kidney disease mainly the quantitative diagnosis of syndromes of traditional Chinese medicine model", the research collected 297 patients of diabetic nephropathy patients with stage Ⅲ and Ⅳ from March,2014 to December 2015 visiting Guang’anmen hospital and other ten research units. Record of the general data and clinical data of Chinese and Western medicine, with each index of two groups of patients were retrospectively analyzed, compared in the general situation, distribution of TCM symptoms, the deficiency and the excessl distribution and laboratory examination differences.Results:1. GenerallyDN stage Ⅲ patients and stage Ⅳpatients in gender, age, WHR, BMI, smoking history and drinking history have no difference (P>0.05). DN Ⅲ patients have retinopathy complicaitions (25.55%) and nerve system complications (30.66%); DN stage Ⅳ patients have retinopathy complicaitions (46.25%)and nerve system complications (46.25%). Stage Ⅳ patients’ complication rate is higher; the difference has significant statistical difference (P <0.01). Compared with DN stage Ⅲ patients, DN stage Ⅳ patients with hypertension, hyperlipidemia, was increased, the proportion of the merger the proportion of coronary heart disease, including the differences of hyperlipidemia is significant statistically (P<0.01).2. TCM four diagnostic information distributionDN stage Ⅲ patients’ five of the most common symptoms are:languid (67.88%), dry pharynx and mouth (64.96%), less breath and lazy words (62.04%), feverish sensation over the five centers (52.55%), and spontaneous perspiration (49.64%); Three of the most common tongues are:fat indented tongue (49.64%), yellow greasy coating tongue (45.26%), satiny coating tongue (37.23%). Top three common pulse conditions are:feeble pulse (35.77%), smooth pulse (33.58%), heavy retard pulse (29.19%);DN stage Ⅳ patients’five of the most common symptoms are:languid (73.75%), edema (63.13%), itching (62.5%), heavy limbs (59.38%), and dry pharynx and mouth (58.75%). Three of the most common tongues are:fat indented tongue (48.75%), moss embellish tongue (37.5%), satiny coating tongue (36.25%). Top three common pulse conditions are:feeble pulse (45.63%), heavy late pulse (38.13%), count pulse (35%).3. The TCM syndrome elements distributionAbout the deficiency TCM syndrome element distribution, DN stage Ⅲ patients are:Qi deficiency syndrome of 89 cases (64.96%), blood deficiency syndrome of 68 cases (49.63%), Yin deficiency syndrome of 81 cases (59.12%), Yang deficiency syndrome of 79 cases (57.66%); DN stage Ⅳ patients are:Qi deficiency syndrome of 123 cases (76.88%), blood deficiency syndrome of 97 cases (60.63%), Yin deficiency syndrome of 113 cases (70.63%), Yang deficiency syndrome of 117 cases (73.13%). Stage Ⅳ patiens show deficiency syndrome by qi and Yin deficiency, stage Ⅳ patients are qi and Yang deficiency. The differences of qi and Yin deficiency syndrome was statistically significant (P<0.05), the differences of Yang deficiency syndrome have obvious statistical significance (P<0.01).Combination of the relative organ of the disease, among the top three syndromes of stage Ⅲ patients are kidney Qi deficiency syndrome of 85 cases (62.04%), kidney Yin deficiency syndrome of 81cases (59.12%) and spleen Yang deficiency syndrome of 77 cases (56.20%). The top three syndromes of stage Ⅳ patients are kidney Qi deficiency syndrome of 120 cases (75%), spleen Yang deficiency syndrome of 115 cases (71.88%%) and kidney Yin deficiency syndrome of 113 cases (70.63%). Of all nine syndromes, the cases of stage Ⅳ patients were higher than that of stage Ⅲ patients, in which the differences of the kidney Qi deficiency syndrome, liver Yin deficiency syndrome, spleen Yang deficiency syndrome are statistically significant (P<0.05), in liver Blood deficiency syndrome of kidney Yang deficiency syndrome differentiation has significant statistical differences (P<0.01). According to the symptom integral, in patients with stage Ⅳ kidney Qi deficiency syndrome, liver Blood deficiency syndrome, liver Yin deficiency, spleen Yang deficiency syndrome and kidney Yang deficiency symptoms in these five syndromes are heavier, with kidney Qi deficiency syndrome and kidney Yang deficiency syndrome has statistical difference (P< 0.05), with liver Yin deficiency syndrome and spleen Yang deficiency syndrome has significant statistical difference (P<0.01).About the excess TCM syndrome element distribution, distribution of DN patients with stage Ⅲ syndrome factors are:damp heat syndrome of 83 cases (60.59%), phlegm turbidity syndrome of 83 cases (60.59%), heat syndrome of 66 cases (48.17%), qi stagnation syndrome of 60 cases (43.96%) and, blood stasis syndrome of 59 patients (43.07%), wet certificate syndrome of 39 cases (28.47%). DN patients with stage IV the element distributions are: damp heat syndrome of 118 cases (73.75%), blood stasis syndrome of 103 cases (464.38%), phlegm turbidity syndrome of 99 cases (61.88%), qi stagnation syndrome of 91 cases (56.88%), heat syndrome of 53 cases (33.13%), wet certificate syndrome of 47 cases (29.38%). The difference of qi stagnation syndrome and damp heat syndrome are statistically significant (P<0.05), the differences of heat syndrome and blood stasis syndrome have obvious statistical significance (P<0.01).4. The laboratory physical and chemical indicators(1)Albuminuria Quantitative:the urine protein urine trace albumin of DN patients with stage Ⅲ was 129.79±123.07 mg,24 hours urinary protein quantitative was 240.06±130.24 mg; DN patients with stage Ⅳ urine trace albumin was 626.54±792.34 mg,24 hours urinary protein quantitative was 2569.56±1948.88 mg. Stage Ⅳ patients’ urine trace albumin levels and 24 hours’ urinary protein quantitative level increased significantly, and the differences are obvious statistical significance (P<0.01).(2) the kidney function:DN Ⅳ patients represented with more renal pathology progress. Stage Ⅲ and Ⅳ patients’ serum creatinine were 71.78±30.84 umol/l, and 113.32± 74.83umol/l, urea nitrogen were 6.49±2.76mmol/l and 7.20±3.04 mmol/l, estimated glomerular filtration rate were 85.29±27.32 ml/min/1.73 m2 and 65.01±27.92 ml/min/1.73 m2, the difference had statistical significance (P<0.01).(3) blood pressure:the average systolic blood pressure for DN patients with stage Ⅲ was 133±14.25 mmHg, average diastolic blood pressure was 77.38±8.64 mmHg; DN patients with stage Ⅲ’s systolic blood pressure was 137±17.01 mmHg, average diastolic blood pressure was 80.39±7.80 mmHg. Stage Ⅳ patients with high blood pressure, in which systolic blood pressure difference was statistically significant (P<0.05),diastolic blood pressure differences have significant statistical significance (P<0.01).(4) other indicators:The blood sugar and glycated hemoglobin levels of DN stage Ⅲ patients were lower than the DN patients with stage Ⅳ, the difference was statistically significant (P<0.05). DN patients with stage Ⅳ patients’level of uric acid have increased significantly, patients with stage Ⅲ and IV patients were 326.73±90.79 umol/1, and 364.38 ±110.17 umol/1;Stage Ⅳ’s albumin and total protein levels were higher than in patients with stage Ⅲ, and the differences are obvious statistical significance (P<0.01).Conclusion:1. Diabetic nephropathy patients with stage Ⅲ represent the deficiency syndrome by qi and Yin deficiency, in patients with stage Ⅳ is qi and Yang deficiency, both of which mainly concerned with kidney and spleen.2. Diabetic nephropathy patients with stage Ⅲ represent the excess syndrome by damp hot syndrome and phlegm turbidity syndrome, patients with stage Ⅳ by damp heat syndrome and blood stasis syndrome.3. Compared with stage Ⅲ patients, stage Ⅳ patients’ serum creatinine, blood urea nitrogen, uric acid, blood pressure levels increased significantly, albumin, estimated glomerular filtration rate level is decreased obviously.4. Compared with stage Ⅲ patients, stage Ⅳ patients’complications with retinopathy, neuropathy and hyperlipidemia ratio is higher.