Study On The Relationship Between TCM Syndromes Of Hypertesion With Type 2 Diabetes Mellitus And Urinary Albumin

ObjectiveTo explore the relationship between urinary albumin abnormalities and target organ da-mage in patients with hypertension and type 2 diabetes mellitus and TCM syndromes,blood pressure grading and disease course,and to provide certain reference basis for the diagnosis and treatment of hypertension with type 2 diabetes mellitus in TCM and western medicine.Methods1.TCM syndrome differentiation was performed on 484 patients with hypertension and type 2 diabetes,and UACR and/or 24-hour urine protein were detected in patients wi-th positive MAU screening.2.Indicators such as IMT and LVMI were measured in 197 patients with UACR abnor mality with hypertension and type 2 diabetes,and the relationship between TCM synd romes and UACR,IMT and LVMI was analyzed.Results1.Distribution of TCM syndromes of 1.484 cases of hypertension with type 2 diabetes:242cases(50.00%)of phlegm-blood stasis interaction syndrome,102 cases(21.07%)of phlegm-dampness accumulation syndrome,73 cases(15.08%)of Yin deficiency and Yang hyperactivity syndrome,and 67 cases(13.84%)of kidney qi deficiency syndrome.There were197 patients with hypertension and type 2 diabetes mellitus with abnormal UACR,among which 103(52.28%)had phlegm-stasis syndrome,42(21.32%)had Yin deficiency and Yang hyperactivity syndrome,33(16.75%)had phlegm-dampness accumulation syndrome,and 19(9.65%)had kidney qi deficiency syndrome.Distribution of TCM syndromes of hypertension with type 2 diabetes mellitus with a large amount of proteinuria:Yin deficiency and Yang hyperactivity syndrome in 11 cases(39.29%),phlegm and blood stasis syndrome in 9 cases(32.14%),kidney qi deficiency syndrome in 6 cases(21.43%),and phlegm dampness accumulation syndrome in 2 cases(7.14%).The abnormal positive rate of UACR in each syndrome type:Yin deficiency and Yang hyperactivity syndrome(60.00%),phlegm stasis interaction syndrome(42.04%),phlegm-dampness accumulation excess syndrome(32.35%),and kidney qi deficiency syndrome(28.36%),P=0.000,with statistical difference.There were statistically significant differences between the Yin deficiency and Yang hyperactivity syndrome,excessive accumulation of phlegm and dampness,mutual accumulation of phlegm and blood stasis,and deficiency of kidney qi(P<0.0083).2.Analysis results of 197 cases of hypertension with type 2 diabetes mellitus with abnormal UACR:Differences in UACR levels among different syndromes:UACR level increased with the evolution of excess accumulation of phlegm-dampness syndrome phlegm-stasis interaction syndrome kidney qi deficiency syndrome Yin deficiency and Yang hyperactivity syndrome(P<0.05),and the UACR level of Yin deficiency and Yang hyperactivity syndrome was higher.The thickening distribution of IMT of each syndrome type:Yin asthenia and Yang hyperactivity(78.57%),phlegm and blood stasis syndrome(65.05%),phlegm and dampness accumulation syndrome(45.45%),kidney qi deficiency syndrome(36.84%),P=0.004,with statistical difference.Increased distribution of LVMI in all syndromes:Yin deficiency and Yang excess syndrome(47.62%),phlegm-stasis accumulation syndrome(25.24%),phlegm-dampness accumulation syndrome(15.15%),kidney qi deficiency syndrome(10.53%),P=0.003,with statistical difference,among which Yin deficiency and Yang excess syndrome and phlegm-stasis accumulation syndrome account for a higher proportion.Comparison of the course of diseases between different syndromes:the course of Yin deficiency and Yang hyperactivity and kidney qi deficiency was greater than the excess accumulation of phlegm-dampness and the mutual accumulation of phlegm-dampness(P<0.01),and the course of phlegm-dampness accumulation was greater than the excess accumulation of phlegm-dampness(P<0.01).There was no statistical difference between Yin deficiency and Yang hyperactivity and kidney qi deficiency(P>0.05).The difference between the course of disease and the levels of UACR,IMT and LVMI:with the extension of the course of disease,UACR,IMT and LVMI gradually increased,P<0.01,which was statistically significant.The difference between blood pressure grading and UACR,IMT and LVMI levels:UACR,IMT and LVMI gradually increased with the increase of blood pressure level,P<0.01,which was statistically significant.Correlation analysis of UACR with IMT and LVMI:UACR was positively correlated with IMT(r_s=0.410,P=0.000<0.01)and LVMI(r_s=0.425,P=0.000<0.01).Conclusion1.There are differences in the proportion of MAU in TCM syndromes in patients with hypertension and type 2 diabetes,and phlegm and blood stasis syndrome and Yin deficiency and Yang hyperactivity syndrome are the most common.2.With the increase of UACR level and the change in the course of disease,the disease changed from solid to deficiency and mixed with deficiency and solid.3.The incidence of target organ damage such as UACR abnormality,IMT thickening and left ventricular hypertrophy is relatively high in patients with hypertension with type 2 diabetes mellitus with phlegm and blood stasis syndrome,Yin deficiency and Yang hyperactivity syndrome.4.UACR level in patients with hypertension and type 2 diabetes gradually increaseswith the increase of blood pressure and prolongation of disease course,and is positively correlated with IMT and LVMI.