| Objective:To study the correlation between TCM syndromes of diabetic kidney disease(DKD)and human body composition,and to explore the changes of human body composition in patients with DKD at stage ? and ? and different TCM syndromes,so as to supplement the basis of microcosmic syndrome differentiation.Methods:Through a prospective design,this study included patients of DKD ? and ? from the inpatient and outpatient departments of Dongzhimen Hospital from June 2017 to January 2019 to collect their general data.The human body composition of patients who met the requirements of this subject was measured by human component analyzer.The case report tables and human body composition data were collated and entered into Epidata 4.2 database.The software SPSS 24.0 was used for statistical analysis.Quantitative index data were expressed,classification index was described by frequency and composition ratio,and the comparison of composition ratio and ratio was tested by chi-square test.The influential factors of TCM syndromes were screened by two-classification and multi-classification logistic regression models,and the changes of body composition in patients with DKD of different syndromes and stages were explored.Finally,correlation analysis was used to explore the correlation between human body composition index and some laboratory indexes.Result:(1)General situation analysis:201 cases of DKD were included,112 cases in stage ?and 89 cases in stage ?;the oldest was 75 years old,the youngest was 30 years old,and the average age of onset was about 60 years old.Among them,56-65 years old is the highest incidence of DKD,followed by 66-75 years old and 45-55 years old.Among 201 DKD patients,hypertension,hyperlipidemia,coronary heart disease,fatty liver,cerebrovascular disease and hyperuricemia were 157(78.11%),119(59.20%),80(39.80%),61(30.35%),48(23.88%)and 28(13.93%)respectively.DKD IV patients complicated with hypertension were significantly more than DKD ? patients(P<0.05).Before the diagnosis of diabetic nephropathy,93 patients(46.27%)had no exercise,79 patients(39.30%)had low intensity exercise,29 patients(14.43%)had moderate and high intensity exercise,and there was a difference in exercise between ? and ? patients(P<0.05).(2)Distribution of TCM syndromes:Among 201 DKD patients,deficiency of both Qi and Yin(66.96%),deficiency of spleen and kidney(18.75%),deficiency of Yin and dryness-heat(12.50%)and deficiency of Yin and Yang(1.79%)were the most common syndromes in stage ?.In stage ?,deficiency of the spleen and kidney(40.45%),deficiency of both Qi and Yin(38.20%)and deficiency of both Yin and Yang(16.85%)were the most common,and deficiency of Yin and Kidney(4.49%)was the least.In DKD stage ?,blood stasis syndrome(39.29%),damp-heat syndrome(29.46%),phlegm-stasis syndrome(26.79%)and Water-dampness syndrome(4.46%)were the main syndrome,followed by damp-heat syndrome(30.34%)and blood stasis syndrome(24.72%)and phlegm-stasis syndrome(11.24%)were the least.(3)The correlation between different stages of DKD and human body composition:On the basis of partial regression coefficient(?)with statistical significance(P<0.05),the independent variables of ?>0 and ratio of Exp(?)>1 are extracellular water ratio,intracellular water(ICW),extracellular water(ECW)and basal metabolic rate,and the Exp(?)is 1.018,1.074,1.219,1.002,respectively.The values of extracellular water ratio,ICW,ECW and basal metabolic rate were higher in patients with stage IV than those patients of stage ?.The independent variables of ?<0 and Exp(?)<1 were systemic phase angle(PA),and the value of ? was-0.536 and value of Exp(?)was 0.585,which indicated that the systemic PA of patients with stage DKD IV was lower than that of patients with stage ?.(4)The correlation between TCM syndromes and body composition:On the basis of the statistical significance of partial regression coefficient(?),the variables of ?>0 and Exp(?)>1 are the Qi-Yin deficiency syndrome with PA,the Yin-Yang deficiency syndrome with extracellular water ratio,the Water-dampness syndrome with extracellular water ratio,the Phlegm-blood stasis syndrome with BMI,and the Exp(?)are 1.424,1.016,1.016 and 1.087 respectively.It can be concluded that the PA of patients with deficiency of both Qi and Yin is higher than that of non-deficiency of both Qi and Yin.The extracellular water ratio of patients with deficiency of both Yin and Yang is higher than that of non-deficiency of Yin and Yang.The extracellular water ratio of patients with Water-dampness syndrome is higher than that of non-dampness syndrome.The BMI of patients with phlegm-stasis syndrome are higher than those without phlegm-stasis syndrome.The variables of ?<0,Exp(?)<1 were Qi-Yin Deficiency Syndrome and extracellular water ratio,spleen-kidney Qi deficiency syndrome and body fat,yin-yang deficiency syndrome and PA,Water-dampness syndrome and PA,blood stasis syndrome and muscle mass,ICW,ECW,basal metabolic rate,Exp(?)were 0.992,0.997,0.444,0.416,0.963,0.932,0.875 and 0.998 respectively.The results showed that the extracellular water ratio of patients with deficiency of both qi and Yin was lower than that of patients without deficiency of both qi and yin.The body fat content of patients with deficiency of spleen and kidney was lower than that of patients without deficiency of both qi and kidney.The PA of patients with deficiency of both Yin and Yang was lower than that of patients without deficiency of both yin and yang.The PA of patients with Water-dampness syndrome was lower than that of patients without Water-dampness syndrome.And the muscle volume,ICW,ECW and basal metabolic rate of patients with blood stasis syndrome were lower than those without blood stasis syndrome.(5)Changes of body composition among different syndromes:? The law between the Four BenZheng:a.Compared with Yin deficiency and dryness-heat syndrome,the extracellular water ratio of Qi deficiency of spleen and kidney and Yin-yang deficiency syndrome is significantly higher than that of Yin deficiency and dryness-heat syndrome(the ? is 0.010,0.020,P<0.05),and the PA of Yin-yang deficiency syndrome is significantly lower(the ? is-1.123,P<0.05).b.Compared with Qi-Yin deficiency patients,the extracellular water ratio of spleen-kidney Qi deficiency and Yin-Yang deficiency was significantly higher(? was 0.008,0.01,P<0.05),while the systemic PA was significantly lower than that of Qi-Yin deficiency patients(? was-0.363,-0.938,P<0.05).c.Compared with the spleen-kidney Qi deficiency group,the extracellular water ratio of Yin-Yang deficiency group was higher(? was 0.010,P<0.05),and the PA was lower(? was-0.575,P<0.05).? The law among the four BiaoZheng:a.Compared with Damp-heat syndrome,extracellular water ratio in water-damp syndrome increased significantly(? was 0.016,P<0.05),and the PA decreased(? was-0.858,P<0.05);ICW and ECW in blood stasis syndrome were lower than those in damp-heat syndrome(? was-0.079,-0.150,P<0.05);and there was no significant difference in body composition between phlegm-stasis syndrome and damp-heat syndrome,b.Compared with Water-dampness syndrome,the muscle mass,extracellular water ratio,ECW and basal metabolic rate of patients with blood stasis syndrome were lower(? were-0.055,-0.017,-0.161,-0.002,P<0.05),and the PA was higher(?was 0.782,P<0.05).Extracellular water ratio of phlegm-stasis syndrome was lower than that of Water-dampness syndrome(beta value was-0.017,P<0.05),and systemic phase angle was higher than that of Water-dampness syndrome(beta value was 0.959,P<0.05).c.Compared with blood stasis syndrome,BMI of phlegm and blood stasis syndrome was higher(beta value was 0.119,P<0.05).(6)The correlation between human body composition and some laboratory indicators:in laboratory indices,body fat was negatively correlated with 24-hour urinary total protein(24hUTP),Extracellular water ratio was positively correlated with urea nitrogen(BUN),serum creatinine(SCr)and 24hUTP,negatively correlated with hemoglobin(HGB)and albumin(ALB).ICW was positively correlated with SCr,24hUTP and negatively correlated with ALB.ECW was positively correlated with BUN,SCr and 24hUTP,negatively correlated with HGB and ALB.The basal metabolic rate was positively correlated with BUN,SCr,24hUTP and negatively correlated with ALB.PA was positively correlated with HGB and ALB,negatively correlated with BUN,SCr and 24hUTP.Conclusion:(1)Distribution of human components is different in different stages of DKD.The intracellular and extracellular water content in stage ? patients is higher than that in stage ?patients,and the PA is lower.(2)The TCM syndromes of DKD are related to some indexes of human body composition.There are certain changes in body composition among different types of DKD.Among the four types of BenZheng,there is no significant difference in body composition between yin deficiency and dryness-heat syndrome and Qi-Yin Deficiency syndrome.When developing to Spleen-Kidney Deficiency Syndrome and yin-yang deficiency syndrome,extracellular water ratio increases significantly,systemic phase angle decreases significantly,and yin-yang deficiency syndrome is the most serious.Among the four types of BiaoZheng,the extracellular water ratio of patients with Water-dampness syndrome was significantly higher than that of other groups,and the PA was significantly lower than that of other groups.(3)There is a certain correlation between the human body composition index and some laboratory indexes.It is shown that BUN,SCr and 24hUTP increase,the extracellular water ratio,ECW and basic metabolic rate all increase,while the phase angle decreases.When HGB and ALB decreased,the extracellular water ratio increased,and the phase angle decreased.In conclusion,the syndrome of spleen-kidney Qi deficiency,yin-yang deficiency and the syndrome of Water-dampness marked by this syndrome are closely related to extracellular water ratio and phase angle,which can provide objective basis for clinical differentiation,and extracellular water ratio and phase angle are useful for evaluating the severity of DKD patients. |
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