Clinical Study On Type 2 Diabetic Nephropathy Based On TCM Syndromes,Physicochemical Indexes And Complications

Background and objective: To explore the risk factors of increased chronic kidney disease(CKD)staging in patients with type 2 diabetes mellitus(T2DM)and the related factors of diabetic nephropathy(DN)and non-diabetic nephropathy(NDRD)from the perspective of integrated traditional Chinese and Western medicine.Methods: This study collected patients with T2 DM and CKD who were seen in five top three hospitals in Beijing and Tianjin from October 2017 to July 2019.Through the questionnaire survey of Chinese medicine and checking the patient's medical records,collect the Chinese medicine syndrome,physical and chemical indicators and comorbidities,and use Logistic regression to explore.The research content is divided into the following two parts:(1)related factors of different CKD stages in T2 DM patients;(2)related factors of DN and NDRD.Results:(1)A total of 551 patients were included in the first part of the study.Medical history data: with the increase of CKD stage,the proportion of males in T2 DM patients gradually increased,systolic blood pressure,serum creatinine,blood urea nitrogen and 24-hour urine protein quantity showed an upward trend;while hemoglobin,serum albumin,glycated hemoglobin,serum uric acid and the prevalence of fatty liver showed a downward trend.Distribution of TCM syndrome elements: yin deficiency syndrome mainly occurs in CKD1 stage,blood deficiency syndrome mainly occurs in CKD4 stage,yang deficiency syndrome,water-dampness syndrome and blood stasis syndrome mainly occur in CKD5 stage.Distribution of deficiency and excess of TCM syndrome elements: patients with CKD1 stage mainly showed simple deficiency syndrome,while patients with CKD5 stage mainly showed mixed syndrome of deficiency and excess.Ordered multivariate logistic regression: male sex(OR=1.868,P=0.001),duration of diabetes> 60 months(OR=1.925,P=0.004),systolic blood pressure 140-159mmHg(OR=1.898,P=0.010),Systolic blood pressure ?160mmHg(OR=2.855,P<0.001),anemia(OR=5.480,P<0.001),hyperuricemia(OR=3.309,P<0.001),large amount of proteinuria(OR=2.773,P<0.001),Yang deficiency syndrome(OR=1.634,P=0.004)are the related factors of CKD stage increase in T2 DM patients.(2)The second part included 166 patients.Medical history: Diabetes course,systolic blood pressure,glycated hemoglobin,blood creatinine,24-hour urine protein quantitation and the incidence of diabetic retinopathy in the DN group were significantly higher than those in the NDRD group(P<0.05),BMI,hemoglobin,triglycerides,eGFR,and the incidence of fatty liver was significantly higher than that in the DN group(P<0.05).Distribution of TCM syndromes: The incidence of blood deficiency syndrome in DN group was significantly higher than that in NDRD group(P<0.05).Binary logistic regression analysis: Diseased liver(OR=2.308,P=0.026)is the related factor of DN.Conclusion: Among patients with T2 DM and CKD,male gender,duration of diabetes >60 months,systolic blood pressure ?140 mmHg,anemia,hyperuricemia,a large amount of proteinuria,and yang deficiency syndrome are the related factors of CKD staging increase.In the study of differential diagnosis of DN and NDRD in traditional Chinese medicine,diseased liver is the related factor of DN.