| ObjectivesWe aimed to know the clinical features, the distribution of TCM syndromes and the correlation between them of patients with autosomal dominant polycystic kidney disease (ADPKD). To explore the correlative factors of ADPKD complicated with renal impairment, hypertension or hyperuricemia and the distribution rule of TCM syndromes in ADPKD. In order to provide theoretical basis for the prevention and treatment of ADPKD, and then play the advantages of traditional Chinese medicine in the treatment of the disease.MethodsAnalyze the clinical data of 200 patients with ADPKD by the method of retrospective study. To compare the clinical parameters of the patients with normal renal function and renal function decreased, the clinical parameters of the patients with hypertension and without hypertension, the clinical parameters of the patients with hyperuricemia and without hyperuricemia. Analyze the risk factors of ADPKD patients complicated with renal function decreased, hypertension, or hyperuricemia by using logistic regression analysis. Discriminate the TCM syndromes of the collected cases by referring the standards of TCM syndromes of chronic glomerulonephritis and considering our clinical experience, patients’symptoms, pulse examination and tongue examination. Analyze the TCM syndromes’distribution of ADPKD and its correlation with clinical parameters. As the control group, the clinical parameters of the patients with simple renal cysts were compared to the patients with ADPKD.Results1. General information and clinical characteristics results:200 cases were included totally, with an average age in 46.69±13.60 years old. Patients between 30y and 60y were accounted for 75.0%. There was no statistical difference between men and women in average age, and their age compositions are consistent. The cases complicated with decreased renal function were 109(54.5%) and CKD3-5 patients were 78(39.0%). There were 126 cases (63.0%) complicated with hypertension. There were 135 cases(67.5%) complicated with urinary calculi,95 cases(47.5%) complicated with hyperuricemia,94 cases(47.0%) complicated with anemia,35 cases(17.5%) complicated with chronic glomerulonephritis, and 12 cases(6.0%) complicated with simple hematuria.2. The TCM diagnosis and the distribution of syndrome:In The TCM diagnosis, the most common was backache in 71 cases(35.5%). The second respectively were chronic renal failure in 45 cases(22.5%), others(such as product cerficate ect) in 41 cases(20.5%), stranguria in 19(9.5%), hematuria in 14 cases(7.0%), Turbid urine in 6 cases (3.0%), edema in 4 cases(2.0%). In dialectical classification,200 cases were all for the syndrome of deficiency-excess complication. The syndrome of deficiency of qi and yin, damp heat and blood stasis was the most common. In the deficiency syndrome, the most common was the syndrome of deficiency of qi and yin in 109 cases (54.5%). The second respectively were the syndrome of qi deficiency of spleen and kidney in 51 cases (25.5%), the syndrome of yin deficiency of liver and kidney in 24 cases(12.0%), the syndrome of yang deficiency of spleen and kidney in 16 cases (8.0%), In standard empirical, the most common was the damp heat and blood stasis syndrome in 158 ceases(79.0%). The second respectively were blood stasis syndrome in 20 cases(10.0%), dampness and blood stasis syndrome in 20 ceases(10.0%).3. The correlation analysis results:(1)Correlation between renal function and clinical parameters:Compared with the normal renal function group, patients with decreased renal function were older, having higher level of systolic blood pressure, serum urea nitrogen level, serum uric acid, triglyceride, lower level of hemoglobin, larger cysts, and higher incidence of chronic glomerulonephritis or nephrotic syndrome. And the logistic regression analysis revealed that the risk factors for ADPKD patients complicated with renal function decreased included age>30y, large cysts, hyperuricemia and hypertension.(2) Correlation between hypertension and clinical parameters:Compared with the ADPKD patients who weren’t complicated with hypertension, those complicated with hypertension were older, and had higher serum uric acid level, lower hemoglobin level and larger cysts, in which renal function was worse. And the logistic regression analysis revealed that the risk factor for ADPKD patients complicated with hypertension was renal function decreased.(3) Correlation between hyperuricemia and clinical parameters:Compared with the ADPKD patients who weren’t complicated with hyperuricemia, those complicated with hyperuricemia were older, having higher level of blood pressure, triglyceride, lower hemoglobin level, in which renal function was worse. And the logistic regression analysis revealed that renal function decreased was the risk factor for ADPKD patients complicated with hyperuricemia.(4) Correlation between distribution of TCM syndrome and clinical parameters:In the deficiency syndrome groups, patients with yang deficiency of spleen and kidney syndrome were oldest, with worst renal function, highest serum uric acid level and lowest hemoglobin level. In addition, patients with deficiency of qi and yin syndrome were youngest, with lowest serum uric acid level. Besides, the renal function of patients with syndrome of yin deficiency of liver and kidney were the best. In the incidence of chronic glomerulonephritis, patients with syndrome of yang deficiency of spleen and kidney were highest, and in the incidence of hypertension, patients with syndrome of qi deficiency of spleen and kidney were highest. Moreover, in standard empirical groups, patients with syndrome of dampness and blood stasis, who were oldest, had the worst renal function and lowest hemoglobin level, when patients with syndrome of damp heat and blood stasis, who were youngest, had the best renal function. In the incidence of chronic glomerulonephritis, patients with syndrome of dampness and blood stasis were highest.4.Comparison of ADPKD with simple renal cysts:Compared with the simple renal cyst group, ADPKD group were of younger age, less proportion of male patients, larger cysts, higher serum creatinine and serum urea nitrogen level, lower blood lipid and hemoglobin level, higher incidence of hypertension and urinary calculi.ConclusionADPKD possesses diversity and complexity of manifestation. The risk factors for ADPKD patients complicated with renal function decreased included age>30y, large cysts, hyperuricemia and hypertension. The occurrence of hypertension and hyperuricemia were related to renal function decreased. The syndrome of deficiency of qi and yin, damp heat and blood stasis was the most common. Age, renal function, serum uric acid level and hemoglobin level had a certain effect on the distribution of TCM syndromes. There were significant differences between ADPKD and simple renal cysts in the gender composition, total cholesterol level, serum creatinine level, serum urea nitrogen level, hemoglobin level, and incidence of hypertension and urinary calculi. |
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