| OBJECTIVE: This article is divided into 2 parts.The first part summarized the understanding and treatment of chronic kidney disease by Chinese and Western medicine.The second part analyzed the distribution pattern of TCM syndrome type of chronic kidney disease in general hospital and its relationship with clinical stage,biochemical index and quality of life index to provide evidence for the standardized diagnosis and treatment of chronic kidney disease with integrated traditional Chinese and western medicine.METHODS: Using the multi-center cross-sectional field survey method,the population,TCM syndromes,laboratory examination data and quality of life index SF-36 of 804 patients with chronic kidney disease were collected in 7 tertiary general hospitals in Shanghai to explore the distribution of TCM syndrome types of chronic kidney disease and the relationship between TCM syndrome types and clinical biochemical indicators and quality of life index.Results: 1.A total of 804 patients were investigated,including 465 males(57.8%)and 339 females(42.2%).The male to female ratio was 1.37:1;the age was 18-80(55.4±13.7)years old.2.Causes of CKD patients: 428 cases of primary glomerular disease in 804 adult CKD patients,accounting for 53.2%;167 cases of hypertensive renal damage,accounting for 20.8%;101 cases of diabetic nephropathy,accounting for 12.6%;40 patients with connective tissue disease,accounting for 5.0%;30 patients with interstitial nephritis,accounting for 3.7%;8 patients with polycystic kidney disease,accounting for 1.0%;6 patients with obstructive nephropathy,accounting for 0.7%;24 other causes,accounting for 3.0%.Primary glomerular disease,hypertensive renal damage,obstructive nephropathyand polycystic kidney disease had no sex difference(P>0.05),and the proportion of male patients with diabetic nephropathy and interstitial nephritis was higher(P<0.05).The proportion of female patients with connective tissue disease-related nephropathy was higher(P<0.05).The average age of primary glomerular disease was(52.3±14.1)years;the average age of hypertensive renal damage was(59.9±12.4)years;the average age of diabetic nephropathy(61.8±9.0)years;the average age of connective tissue diseases(51.5± 17.5)years old;average age of interstitial nephritis(58.6±11.6)years;average age of polycystic kidney disease(55.6±13.8)years;average age of obstructive nephropathy(52.8±11.0)years old;all mainly distributed between 41 and 65 years old.3.Distribution of CKD stages in CKD patients: 256 cases of CKD stage,accounting for 31.8%;386 cases of CKD stage 3,accounting for 48.0%;162 cases of CKD stage 4,accounting for 20.1%.There were no statistically significant differences in gender composition between the different stages of CKD patients.The average age of patients with stage CKD 2 was(53.2±14.1)years;the average age of patients with stage CKD 3 was(56.2±13.4)years old,compared with CKD stage 2,P<0.01,the difference was statistically significant;the average age of patients with stage 4 CKD was(55.4±13.8)years old,compared with CKD stage 2,P<0.01,the difference was statistically significant;both were mainly distributed in the 41-65 age group.4.The distribution of TCM syndromes: The symptoms with high frequency were fatigue,chills,constipation,dry mouth and eyes,shortness of breath,dizziness,backache,insomnia,dreaminess,nocturia,abdominal fullness,etc.This study showed that spleen-kidney Qi deficiency syndrome was the most common in each age group.It accounts for a total of 428 cases(53.2%),followed by Yin and Yang deficiency syndrome and spleen-kidney Qi and Yin deficiency syndrome,respectively,136 cases(16.9%)and 123 cases(15.3%),68 cases(8.5%)of spleen-kidney Yang deficiency syndrome,49 cases(6.1%)of liver-kidney Yin deficiency syndrome.The TCM main syndrome had no significant difference in gender and age(P>0.05).The most common excessive syndrome was the damp-heat syndrome,,a total of 76 cases(9.5%),62 cases of noxious dampness syndrome(7.7%),41 cases of turbid dampness syndrome(5.1%),32 cases of blood stasis syndrome(4.0%),25 cases of blood stasis + damp-heat(3.1%),7 cases of blood stasis and noxious dampness syndrome(0.9%),and 5 cases(0.6%)of blood stasis + turbid dampness syndrome.There was no significant statistical difference in the distribution of TCM excessive syndromes among the main syndromes(P>0.05).The distribution of TCM syndromes in different CKD stages was significantly different(P<0.05).With the progress of CKD,Yin and Yang deficiency syndromes showed a gradual upward trend,and the spleen-kidney Yang deficiency and liver-kidney yin deficiency showed a downward trend.There was no significant difference in the distribution of TCM excessive syndromes in patients with different CKD stages(P>0.05).There was a statistically significant difference in the distribution of TCM syndromes among patients with different causes of CKD(P<0.05).Yin and Yang deficiency syndrome accounted for a relatively high proportion of diabetic nephropathy,a total of 31 cases(30.7%),and spleen-kidney Qi deficiency syndrome accounted for a relatively high proportion of hypertensive renal damage,a total of 109 cases(65.3%).There was no significant difference in the distribution of TCM excessive syndromes between patients with different causes of CKD(P>0.05).5.Relationship between TCM syndromes and clinical indicators: The hemoglobin level of spleen-kidney Qi deficiency syndrome was significantly lower than that of liver-kidney Yin deficiency syndrome,the difference was statistically significant(P<0.05),and the hemoglobin level of Yin and Yang deficiency syndrome was significantly lower than that of spleen-kidney Qi deficiency,spleen-kidney Yang deficiency,spleen-kidney Qi and Yin deficiency,liver-kidney Yin deficiency,the differences were statistically significant(P<0.05,P<0.01,P<0.01,P<0.01,respectively);the serum creatinine level of Yin and Yang deficiency was significantly higher than that of spleen-kidney Qi deficiency syndrome,spleen-kidney Yang deficiency syndrome,spleen-kidney Qi and Yin deficiency syndrome,liver-kidney Yin deficiency syndrome,the difference was statistically significant(P<0.01,P<0.05,P<0.05,P<0.01,respectively);the eGFR-EPI value of Yin and Yang deficiency syndrome was significantly lower than that of spleen-kidney Qi deficiency syndrome,spleen-kidney Yang deficiency syndrome,spleen-kidney Qi and Yin deficiency syndrome,liver-kidney Yin deficiency syndrome,the difference was statistically significant.(P<0.01,P<0.01,P<0.05,P<0.01,respectively);the systolic blood pressure level of spleen-kidney Qi deficiency syndrome was significantly lower than that of Yin and Yang deficiency syndrome,the difference was statistically significant(P<0.05);there was no significant difference in blood uric acid,24-hour total urine protein,diastolic blood pressure,serum albumin,total cholesterol,triglycerides,low-density lipoprotein and high-density lipoprotein among the TCM main syndromes(P> 0.05).6.Relationship between TCM syndrome and quality of life index: The total score of quality of life index of patients with spleen-kidney Qi deficiency is significantly lower than that of spleen-kidney Yang deficiency,spleen-kidney Qi and Yin deficiency and liver-kidney Yin deficiency syndrome,the difference was statistically significant.(P<0.01);the total score of quality of life index of patients with Yin and Yang deficiency syndrome was significantly lower than that of spleen-kidney Qi and Yin deficiency,liver-kidney Yin deficiency syndrome,the difference was statistically significant(both P<0.01).The total score of quality of life index of patients with liver-kidney Yin deficiency syndrome was significantly higher than that of spleen-kidney Qi deficiency,spleen-kidney Yang deficiency,and Yin and Yang deficiency syndrome,the difference was statistically significant(P<0.01,P<0.05,P<0.01,respectively).Conclusion: The multi-center cross-sectional field investigation showed that the main syndrome of CKD 2-4 patients were more common with spleen-kidney Qi deficiency syndrome,and the most common excessive syndrome was damp-heat syndrome.With the progress of CKD,the Yin and Yang deficiency syndrome was gradually increasing.At the same time,patients with spleen-kidney Qi deficiency syndrome and Yin and Yang deficiency syndrome were more prone to anemia and decreased quality of life,which may be related to the progress of CKD.The treatment should be based on treatment of deficiency syndrome,taking into account the excessive syndrome. |
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