Association Of Plasma 25-Hydroxyvitamin D₃Concentration, TCM Syndrome Distribution And Carotid Intima-media Thickness In Patients With Moderate And Advanced Stage Chronic Kidney Disease

ObjectiveTo investigate the relationship among serum 25-Hydroxyvitamin D3 Concentration, TCM syndrome distribution and Carotid intima-media thickness in patients with moderate and advanced stage chronic kidney disease, then to provide basis for moderate and advanced stage chronic kidney disease prevention and treatment.MethodsSelect 83 CKD patients in stage 3-5 from July 2015 to December 2015 in Guangdong Provincial Hospital of TCM. According to Carotid intima-media thickness, the patients were divide into normal group (＜lmm)and abnormal group(≥1mm). Collect the clinical data of the patients in the study, including age, gender, smoking history, past medical history, body mass index (BMI), serum creatinine (Scr), Albumin(ALB), uric acid (UA), total cholesterol (TC), Triglyceride (TG), Low-density lipoprotein (LDL-C), Hemoglobin (Hb), intact parathyroid hormone (iPTH), serum calcium (Ca), Serum Phosphate (P), High sensitivity C-reactionprotein (hs-CRP),25-hydroxy vitamin D3, (25(OH)D3). Investigate the relationship among serum 25-Hydroxyvitamin D3 Concentration and Other laboratory indexes with Carotid intima-media thickness in patients with moderate and advanced stage chronic kidney disease. Besides, all the patients were divided into deficiency and evil with Chinese medicine dialectics type of cent.The deficiency syndrome type included spleen kidney qi deficiency, spleen-kidney-yang deficiency, Liver-Kidney Yin deficiency, Qi and Yin deficiency, yin and yang deficiency. The evil empirical included wet muddy syndrome, blood stasis syndrome, damp-heat syndrome, evidence of water vapor, heat toxin syndrome. And then Observing the syndrome type of traditional Chinese medicine and carotid intima-media thickness distribution.ResultsIn this study carotid IMT thickening of 50 cases, accounting for 60.24%. The abnormal group of 25(OH)D3 (12.15(4.88,20.65))was slightly lower than normal group of 25(OH)D3 (15.3(9.1,21.23), P＞0.05). The abnormal group of BMI (24.48 ±3.42) significantly higher than the normal group of BMI(21.59± 3.59, P＜0.05). The abnormal group is older than the normal (64.08±13.48 VS 47.18±17.28, P＜0.05). Diabetes incidence(48%) in abnormal group is obviously higher than that of normal group (12.1%, P＜0.05). Incidence of hypertension (88%) in abnormal group is higher than normal group (60.6%, P＜0.05). The incidence of smoking (9.1%) in normal group is obviously lower than abnormal group (42%, P＜0.05). The age, hs-CRP, BMI with carotid IMT in the linear correlation analysis, are positively correlated, and are statistically significant, P＜0.05, but the correlation between 25(OH)D3is no statistical difference (P＞0.05). In logistic regression analysis showed that age (OR: 1.088,95%CI:1.035-1.144, P:0.001), gender (OR:8.288,95%CI:1.579-43.505, P:0.012), hypertension (OR:1.994,95%CI:1.390-38.790, P.0.019) are the risk factor for carotid IMT thickening. Carotid IMT abnormal and normal group of SCr, BUN, TC, TG, LDL, UA, Hb, Ca, P, PTH were no statistical difference (P＞0.05).In the deficiency syndrome type, the spleen kidney qi deficiency is the most common among the two groups, accounts for 57.6%,60%, respectively.In the normal group the spleen and kidney Yang deficiency, qi and Yin deficiency, liver and kidney Yin deficiency accounted for 18.2%,15.2%and 18.2% respectively.In the abnormal group of spleen and kidney Yang deficiency, qi and Yin deficiency, liver and kidney Yin deficiency accounted for 22%,10% and 22%respectively. Each TCM syndrome in two groups had no statistical difference (P＞0.05). In the evil empirical,the normal group with blood stasis syndrome (42.5%), damp heat syndrome (21.2%), the wet muddy syndrome (33.3%), toxic heat syndrome (3%). In the abnormal group Blood stasis syndrome (36%), damp heat syndrome (18%), the wet muddy syndrome (44%), toxic heat syndrome (2%). The two groups had no statistical difference in the evil empirical (P＞0.05).ConclusionAccording to this study the carotid artery-membrane thickening rate is very high in the CKD3-5 patients without dialysis. Including age, smoking, obesity, high blood pressure, diabetes, hs-CRP,gender may be a risk factor for CIMT thickening. But did not find 25(OH)D3and TCM syndrome types have direct relationship with the hardening of the arteries.