Study On Abdominal Fat Distribution And Its Correlation With TCM Syndrome In Patients With Diabetic Nephropathy Based On QC

[Objective]The purpose of this study is to explore the TCM syndrome characteristics of type 2 diabetes kidney disease(DKD)patients,and provide a reference basis for TCM syndrome differentiation treatment.Quantitative CT(QCT)was used to measure abdominal fat and bone mineral density in type 2 diabetes(T2DM)and DKD patients Total abdominal fat(TAT)and bone mineral density(BMD)of the lumbar spine,in order to understand the characteristics of abdominal fat distribution in DKD patients,provide reference and useful information for early prevention and comprehensive management of DKD patients,and summarize the influencing factors of DKD occurrence.Analyze the correlation between QCT parameters and laboratory indicators,as well as the correlation with traditional Chinese medicine syndromes,in order to rationalize the differentiation and treatment of traditional Chinese medicine Objectification lays the foundation.[Methods]In this study,150 patients with type 2 diabetes were selected from the inpatients in the Department of Endocrinology,Dongfang Hospital,Beijing University of Traditional Chinese Medicine.According to the level of urinary albumin,the subjects were divided into 75 patients with diabetes non kidney disease(T2DM-N group)and 75 patients with early diabetes kidney disease(DKD group)according to the admission and excretion criteria;Collect the general information and laboratory indicators of patients,fill out a case questionnaire,and perform chest CT scans on all patients.Transfer the data to the QCT workstation to measure the mean values of VAT,SAT,TAT,and BMD at the middle level of the lumbar 2 vertebral body,as well as at the thoracic 12,lumbar 1,and lumbar 2 vertebral bodies.Perform two measurements at each site to obtain the average value.At the same time,collect the four diagnostic information of traditional Chinese medicine for patients in the DKD group,and determine the TCM syndrome.Finally,input the collected information and data into Epidate to establish a database,and use SPSS 25.0 to conduct statistical analysis on the collected data,[Result]1.General situation:The number of patients in DKD group was significantly higher than that in T2DM-N group in terms of age,BMI,systolic blood pressure,and the number of patients with diabetes retinopathy and peripheral neuropathy.The course of disease in DKD group was significantly longer than that in T2DM-N group.There was no significant difference between the two groups in terms of gender,diastolic blood pressure,gender,diabetes foot,diabetes peripheral vascular disease,hypertension,coronary heart disease,hyperlipidemia,smoking and drinking history.2.Laboratory examination and influencing factors:DKD group PBG,HbAlc,TG,UACR,Scr,BUN,UA,CsyC,urine NAG,urine β The levels of 2-MG were significantly higher than those in the T2DM-N group,while the P1NP levels in the DKD group were significantly lower than those in the T2DM-N group.In FBG,TC,LDL,HDL,25-(OH)D3,BGP β-There was no significant difference in CTX between the two groups.Multivariate logistic regression analysis suggests that disease course,TG,Hb1Ac,and UA are risk factors for DKD in T2DM.3.QCT parameter measurement:①VAT and TAT in the DKD group were significantly higher than those in the T2DM-N group,while SAT in the DKD group was significantly lower than those in the T2DM-N group.There was no significant difference in wall fat ratio(VSR)and BMD between the two groups;②Group D showed a positive correlation between VAT and PBG,TG,LDL,UACR,Scr,while SAT showed no significant correlation with various clinical indicators.Group DKD showed a positive correlation between BMD and P1NP,but a negative correlation with Scr and UACR Single factor logistic regression analysis:VAT,SAT and DKD are correlated,while multivariate logistic regression analysis:VAT and DKD are independently correlated;④The area under the ROC curve of the four abdominal fat parameters VAT,SAT,TAT,and VSR is all>0.54.Traditional Chinese Medicine Syndromes:Traditional Chinese medicine syndromes in DKD patients are characterized by deficiency in both qi and yin,spleen and kidney yang deficiency,followed by liver and kidney yin deficiency and yin yang deficiency;The main types of standard syndrome are phlegm turbidity syndrome and blood stasis syndrome,followed by dampness heat syndrome and qi stagnation syndrome;The syndrome of deficiency of both qi and yin is mainly characterized by two types of combined syndrome and one type of combined syndrome.The syndrome of deficiency of spleen and kidney yang is mainly characterized by two types of combined syndrome,the syndrome of deficiency of liver and kidney yin is mainly characterized by one combined syndrome,and the syndrome of deficiency of yin and yang is mainly characterized by two types of combined syndrome.There is statistical significance in the number of cases of combined syndrome between each deficiency syndrome;VAT is related to the occurrence of Qi Yin deficiency syndrome and spleen kidney Yang deficiency syndrome;VAT is related to the occurrence of phlegm stasis syndrome(i.e.phlegm turbidity syndrome+blood stasis syndrome);BMD is related to the occurrence of phlegm turbidity syndrome.[Conclusion]1.DKD patients are mainly characterized by deficiency and excess,with a mixture of deficiency and excess.The deficiency is mainly characterized by deficiency of both qi and yin,spleen and kidney yang deficiency,and multiple responsibilities of excess and excess,such as phlegm turbidity or phlegm stasis;The more obvious the accumulation of abdominal visceral fat,the higher the risk of developing spleen kidney yang deficiency syndrome and phlegm stasis syndrome,while the risk of developing qi yin deficiency syndrome is lower;The higher the bone density value of the lumbar spine,the lower the risk of developing phlegm turbidity syndrome.2.Abdominal fat distribution in DKD patients is mainly due to visceral fat accumulation.Among them,visceral fat accumulation is an independent risk factor for T2DM to develop DKD,while subcutaneous fat accumulation is a non independent protective factor for T2DM to develop DKD;Compared with subcutaneous adipose tissue in the abdomen,the more visceral adipose tissue there is,the more obvious the disorder of glucose and lipid metabolism and renal function damage in DKD patients;VAT may provide a reference basis for early diagnosis of DKD.