Clinical Study Of Integrated Traditional Chinese And Western Medicine Study On The Value Of Diabetic Retinopathy In The Diagnosis Of Type 2 Diabetic Nephropathy

Background: Diabetic Nephropathy(DN)and Diabetic Retinopathy(DR)belong to diabetic microangiopathy,which is one of the important causes of end-stage renal disease and blindness in adults.This study was to analyze the characteristics of TCM syndromes in patients with type 2 DKD with and without DR,and the clinical and pathological correlation of DN with DR,which provided a theoretical basis for the prevention and treatment of type 2 DN.Methods: This study is divided into two parts.The first part is to collect the TCM questionnaires and clinical indicators of type 2 DKD patients admitted to the Department of Nephrology and Endocrinology of 4 hospitals in Beijing from August 2018 to January 2019.The characteristics of TCM syndromes of patients with type 2 DKD with and without DR were analyzed.The second part is to collect type 2 diabetes mellitus confirmed by renal biopsy in the Department of Nephrology,Chinese People's Liberation Army General Hospital from January 2016 to December 2018.According to the pathological results,they are divided into DN group and NDRD group.In the two groups,the differences of clinical features and DR distribution between the two groups were analyzed,and the diagnostic efficacy of DR on DN was explored.According to the severity of DR,it was divided into non-diabetic retinopathy group(NDR group)and non-proliferative retinopathy group(NPDR group)and the proliferative retinopathy group(PDR group),the pathological and clinical indicators of DN patients were analyzed in three groups,the correlation between DN pathological parameters and the severity of DR was studied.Results: The first part of the study included a total of 213 patients.The top ten symptoms of DKD patients with the highest frequency of TCM symptoms were: blurred vision,nocturia,forgetfulness,cyanosis of the lips,itchy skin,severe limbs,weak waist and knees,convulsions of hands and feet,edema,loose teeth,and dry throat.Dry mouth and dull complexion.The frequency of occurrence of DKD patients' syndromes from high to low is yang deficiency syndrome,qi deficiency syndrome,yin deficiency syndrome and blood deficiency syndrome.The main sites are liver,spleen and kidney.The DKD patients who do not have DR combined with TCM syndromes are mainly yang deficiency syndrome,qi deficiency syndrome and yin deficiency syndrome.The DKD syndrome of DKD combined with DR is mainly based on yang deficiency syndrome and qi deficiency syndrome.The syndromes and TCM syndromes of the two groups of patients with NDR and DR were compared.There was no statistical difference between the two groups in the deficiency syndrome.the heat syndrome and blood stasis of the DR group were significantly higher than those of the NDR group.Group differences were statistically different.The second study included a total of 217 patients.In the DN group,87.4% of the patients had a combined DR,and the proportion was significantly higher than that of the NDRD patients(19.8%).The severity of DR in the DN group was higher than that in the NDRD group.The sensitivity and specificity of DR prediction DN were 87.4% and 80.2%.PDR predicted DN specificity(100%),but its sensitivity was low.The age,glycosylated hemoglobin,hemoglobin,total cholesterol,GFR,24-hour proteinuria,DN glomerular classification,K-W nodules in the DN group were statistically different in the NDR group,NPDR group,and PDR group.Spearman correlation analysis found that DN glomerular class,K-W nodules were positively correlated with the severity of DR,and DN glomerular injury was aggravated with the severity of DR.Conclusion: 1.In this study,213 cases of DKD patients with the overall syndrome type of deficiency syndrome mainly spleen and kidney yang deficiency syndrome,the standard evidence is mainly qi stagnation syndrome,blood stasis syndrome,the disease is mainly liver,spleen and kidney.In the DKD patients who did not merge with the combined DR,there was no significant difference in the deficiency syndrome between the two groups,and the proportion of blood stasis syndrome and heat syndrome in the DKD patients with DR changes was higher than that without DR.DKD patients.2.DR is a good predictor of DN in patients with dominant proteinuria type 2 diabetes,and PDR has a high specificity.The DN glomerular typing was positively correlated with the severity of DR,and the glomerular damage was aggravated with the severity of DR.