Distribution Of TCM Syndrome Types And Related Influencing Factors In Patients With Chronic Kidney Disease Complicated With Left Ventricular Hypertrophy

PurposeThis study analyzed the clinical data of patients with Chronic Kidney Disease(CKD)to understand the general situation of CKD patients and the distribution of TCM syndrome types.By analyzing the clinical data of patients with CKD and Left Ventricular Hypertrophy(LVH),explore the distribution of TCM syndromes in patients with CKD and LVH,and provide clinical data support and reference for the accurate differentiation of patients with CKD and LVH.To investigate the influencing factors of the patient's illness and provide a theoretical reference for preventing LVH in CKD patients.MethodThis study is a retrospective cross-sectional study,through the analysis of the clinical data of the inpatients diagnosed as CKD non dialysis in nephrology department of the First Affiliated Hospital of Tianjin University of traditional Chinese medicine from June 1,2017 to June 30,2019 with complete clinical data.1.To understand the general situation of CKD patients and explore the distribution of TCM Syndrome Types in CKD patients.2.According to the level of Left ventricular mass index(LVMI),patients were divided into LVH group and NLVH group.The general situation,clinical data and TCM syndrome types of the two groups were compared.To explore the distribution of TCM syndromes,understand the prevalence of CKD patients with LVH and analyze the influencing factors,using multivariate logistic regression to analyze the risk factors.Result(1)General situation of CKD patients: A total of 254 patients were included,151 males(59.4%),103 females(40.6%),and average age 57.86±15.59 years.The primary disease was chronic glomerulonephritis in 179 cases(70.47%),diabetic nephropathy in 45 cases(17.72%),immune-related nephropathy in 7 cases(2.76%),hypertensive nephropathy in 3 cases(1.18%),and the other 20 cases(7.87%).The LVMI of the hypertensive nephropathy group was significantly higher than that of the chronic glomerulonephritis group,diabetic nephropathy group and immune-related nephropathy group(P <0.05).There were 14 cases(5.51%)ofCKD stage 1-2,51 cases(20.08%)of stage CKD 3,66 cases(25.98%)of stage CKD 4 and123 cases(48.43%)of stage 5.The LVMI level in patients with CKD5 stage was higher than that in patients with CKD3 stage(P <0.05).(2)The distribution of TCM Syndrome Types in CKD patients: 109 cases(42.91%)of this deficiency syndrome are mainly spleen kidney qi deficiency syndrome,followed by 56cases(22.05%)of spleen kidney yang deficiency syndrome,52 cases(20.47%)of liver kidney yin deficiency syndrome,24 cases(9.45%)of Qi Yin deficiency syndrome and 13 cases(5.12%)of yin yang deficiency syndrome.In the standard demonstration,77 cases(30.31%)were damp-heat syndrome,followed by 72 cases(28.35%)of damp-turbidity syndrome,46cases(18.11%)of blood stasis syndrome,40 cases(15.75%)of water-gas syndrome and 19cases(7.48%)of wind-movement syndrome.LVMI level in patients with spleen kidney yang deficiency syndrome was significantly higher than that in patients with deficiency of liver kidney yin deficiency(P < 0.05).There was no statistically significant difference in LVMI between standard demonstration groups of CKD patients(P> 0.05).(3)Comparison of general situation between LVH group and NLVH group:143 patients(56.30%)in the LVH group,111 patients(43.70%)in the NLVH group,LVH group has more women,diabetes history and age than NLVH group(P <0.05).In the LVH group,6 cases of CKD stage 1-2,22 cases of CKD stage 3,39 cases of CKD stage 4,76 cases of CKD stage 5,and CKD 1 to 2 stage in NLVH group.8 cases,29 cases in CKD3,27 cases in CKD4,and 47 cases in CKD5.The difference between these two groups was not statistically significant(P>0.05).(4)Comparison of TCM syndrome types between LVH group and NLVH group: In the LVH group,the spleen kidney qi deficiency syndrome(40.56%)accounted for the largest number,followed by spleen kidney yang deficiency syndrome(26.57%),and liver kidney yin deficiency syndrome(18.18%),qi yin deficiency syndrome(10.49%),yin yang deficiency syndrome(4.20%).The majority of the standard demonstrations are damp-heat syndrome(30.07%),damp-turbidity syndrome(30.07%),followed by water-gas syndrome(20.28%),blood stasis syndrome(15.38%),and wind-movement syndrome(4.20%).There was no significant difference between the LVH group and the NLVH group in deficiency syndrome type(P> 0.05).There were more patients with water-air syndrome in the LVH group than inthe NLVH group,and fewer patients in the wind-induced syndrome than in the NLVH group(P <0.05).(5)Comparison of laboratory indicators between LVH and NLVH group: The differences between LVH and NLVH groups in systolic blood pressure,blood urea nitrogen,fibrinogen,D-dimer quantification,blood phosphorus,carbon dioxide binding capacity,hemoglobin,and e GFR were statistically significant(P <0.05).The LVH group was higher than the NLVH group in systolic blood pressure,blood urea nitrogen,fibrinogen,D-dimer quantification,and blood phosphorus,and lower than the NLVH group in carbon dioxide binding capacity,hemoglobin,and e GFR.(6)The correlation analysis between LVMI level and indicators showed that LVMI was positively correlated with systolic blood pressure,blood urea nitrogen,D-dimer quantification,and blood phosphorus(r = 0.179,r = 0.273,r = 0.208,r = 0.292);It was negatively correlated with hemoglobin,carbon dioxide binding force and e GFR(r =-0.282,r =-0.192,r =-2.31).(7)Multivariate Logistitic regression showed that Female(OR=2.490,95%CI=1.429?4.338,P=0.001),high systolic blood pressure(OR=2.447,95%CI=1.290?4.643,P=0.006),low hemoglobin(OR=2.525,95%CI=1.473 ? 4.327,P=0.001)were independent risk factors for CKD patients complicated with LVH.Conclusion(1)The results of this study indicate that the deficiency syndromes in CKD patients are mainly spleen and kidney qi deficiency syndromes,and the standard demonstrations are mainly damp-heat syndromes;Among the TCM syndromes of the patients complicated with LVH,spleen and kidney qi deficiency is the main syndrome of this deficiency,and damp-heat and damp-turbidity are the main syndromes,providing theoretical reference for clinical TCM treatment of CKD patients complicated with LVH by strengthening spleen and kidney and clearing damp-heat.(2)According to this study,the prevalence of LVH in CKD patients is 56.30%.For patients with stage CKD3-5,the prevalence of LVH is high.Special attention should be paid to cardiac function.Early intervention is expected to improve the quality of life of patients.(3)This study shows that women,history of diabetes,age,systolic blood pressure,blood urea nitrogen,fibrinogen,D-dimer quantification,blood phosphorus,carbon dioxide bindingcapacity,hemoglobin,e GFR may be influencing factors for patients with CKD and LVH,among them women,high systolic blood pressure,and low hemoglobin may be independent risk factors.