Association Between TCM Syndrom And Left Ventricular Hypertrophy And Effects On Prognosis Of Kidney In Chronic Kidney Disease Stages 3-4

Objectives:To understand the distribution of Traditional Chinese Medicine(TCM) syndrome type and LVH in patients with CKD stages 3-4, and explore the impact factors of on renal function progression.Methods:We collected the baseline data(including gender, age, blood pressure, BMI, renal function, echocardiography and TCM syndrome type and so on) of 61 patients with CKD stages 3-4 who followed up in Nephrology outpatient of Hubei Provincial Hospital Of TCM from February 1, 2012 to February 1, 2016. To understand the distribution of TCM Syndrome and LVH in patients with CKD stages 3-4. By following up regularly, we recorded outcome events(including the Scr double, e GFR <15 ml/min/1.73m~2 or 50% reduction of e GFR, maintain hemodialysis or death). We considered the censored data as did not appear the outcome events in the end of the study.And we divided 61 cases into renal function progression group and non-progression group, compared the two groups' data, and used COX risk regression model to analysis risk factors of patients with CKD stages 3-4.Results:1.61 patients include 42 cases in CKD stage 3 and 19 cases in CKD stage 4. The average follow-up time was 34.70±9.54 months. One case dropped out. 22 cases entered outcome events,including 12 cases occurred Scr doubles / 50% reduction of e GFR or <15 ml / min / 1.73m~2, 8 cases occurred maintain hemodialysis and two deaths(one died of cerebral hemorrhage, one died of ruptured abdominal aortic aneurysm).2.In the distribution of TCM Syndrome type of 61 patients, spleen and kidney qi deficiency,spleen and kidney Yang deficiency and deficiency of both qi and yin respectively accounted for 50.82%, 31.15% and 18.03%. The spleen and kidney qi deficiency was the most in the deficiency syndrome type. In real evil signs, the wet muddy?the damp heat and the blood stasis respectively accounted for 40.98%,24.59%,34.43%, and the wet muddy was the most.3.In this study,the prevelence of left ventricular dilatation, LVH and left ventricular diastolic dysfunction in CKD stages 3-4 was 22.95%, 37.70%, 60.66% respectively, 23.81%?30.95%?61.90% in CKD stage 3,and 21.05%?52.63%?57.89% in CKD stage 4 respectively.4.In LVH groupe, spleen and kidney qi deficiency,spleen and kidney Yang deficiency and deficiency of both qi and yin respectively accounted for 21.74%(5/23), 39.13%(9/23), 39.13%(9/23). The spleen and kidney qi deficiency and spleen and kidney Yang deficiency were more in the deficiency syndrome type. The wet muddy ? the damp heat and the blood stasis respectively accounted for 34.78%(8/23), 26.09%(6/23),39.13%(9/23), and the blood stasis was the most in real evil signs. And difference of the deficiency syndrome type between LVH group and NLVH group was significant(?~2=16.013,P<0.05).5.The rate of outcome events in LVH group(65.22%;15/23) was significant higher than that in NLVH group(18.42%;7/38).6.In renal function progression group, spleen and kidney qi deficiency, spleen and kidney Yang deficiency and deficiency of both qi and yin respectively accounted for 27.27%(6/22), 40.91%(9/22), 31.82%(7/22),and the spleen and kidney Yang deficiency was the most. The wet muddy?the damp heat and the blood stasis respectively accounted for 31.82%(7/22), 27.27%(6/22), 40.91%(9/22), and the blood stasis was the most.7.The difference of systolic blood pressure, Scr, e GFR, interventricular septum thickness(IVST), left ventricular end-diastolic diameter(LVEDd), left ventricular ejection fraction,LVM, LVMI, the deficiency syndrome type and rate of left ventricular enlargement and LVH between renal function progression group and non-progression group was significant(P<0.05).8.COX single factor regression analysis showed that systolic blood pressure(P=0.013), LVM(P=0.003), LVMI(P=0.001), left ventricular enlargement(P<0.001), LVH(P=0.009)and the deficiency syndrome type(P=0.015)could endanger the patients of CKD stages 3-4 into the end point events. Multivariate COX proportional hazards regression analysis(enter method) showed risk factors associated with renal function progression in patients of CKD stages 3-4 were systolic blood pressure(b=1.075,HR=2.931,P=0.025), LVH(b=1.319,HR=3.740,P=0.048), spleen and kidney Yang deficiency(b=-1.604,HR=0.201,P=0.030).The risk of systolic blood pressure?140mm Hg into the endpoint was 2.931 times than that of systolic blood pressure <140mm Hg. The risk of LVH into the endpoint was 3.740 times than that of NLVH. And the spleen qi and Yin deficiency was the protest factor, the risk of which was 79.9% decreased than that of spleen and kidney Yang deficiency.Conclusions:1.In the distribution of TCM syndrome type of patients with CKD stages 3-4, spleen and kidney qi deficiency was the most in the deficiency syndrome type,and the blood stasis was the most in real evil signs. With the renal function decreasing, spleen and kidney Yang deficiency syndrome, deficiency of both qi and yin syndrome and the blood stasis syndrome became more and more. The wet muddy syndrome and the blood stasis syndrome were main evil signs in patients with CKD stages 3-4.2.LVH was common observed in patients with CKD stages 3-4. With the renal function decreasing,the rate of LVH became higher. The spleen and kidney Yang deficiency syndrome, deficiency of both qi and yin syndrome may play a role in the formation of LVH.3.Left ventricular enlargement had an impact on the progress of renal function in patients with CKD stages 3-4. Elevated systolic blood pressure and LVH were the independent risk factors for the prognosis of kidney. Early paying attentions to cardiac ultrasound, and timely interventing and controlling blood pressure and structural abnormality of left ventricular are necessary.4.The deficiency syndrome type was an important factor for the progress of renal function in patients with CKD stages 3-4, and the risk of spleen and kidney Yang deficiency to endanger the patients of CKD stages 3-4 into the end point events was higher than that of spleen and kidney qi deficiency.