Study On TCM Syndromes Of Diabetic Nephropathy

Diabetic nephropathy (DN) is idiopathic systemic diabetic microangiopathy of the kidney. It is caused by diabetes and characterized by glomerular sclerosis.ObjectivesFinding the regular law of development of TCM syndrome types of diabetic nephropathies and the relationship between the syndrome types and the indexes.Try to provide the evidence in clinic diagnosis in TCM, and try to provide the evidence to find more effective methods to treat the disease of DN.MethodsThe differentiation of symptome types are standardized by《Guideline for TCM Diabetes Prevention and Treatment》published by Chinese Medical Association, Traditional Chinese Medicine Press of China Press, 168 DN cases that all up to the diagnosis-standards of DN were divided into the principal syndrome types, the subordinate syndrome types and altered syndrome types. The principal syndrome types include : qi-yin deficiency syndrome 45 cases; syndrome of liver and kidney yin deficiency 57 cases; asthenia of spleen and kidney yang syndrome 66 cases. The subordinate syndrome types include: water failing to nourish wood, liver yang hyperactivity syndrome 25 cases; blood stasis syndrome 34 cases. The altered syndrome types include damp turbidity invasiving stomach syndrome 30 cases; attack of the heart by retained fluid syndrome 29 cases. Syndrome of both qi and blood deficiency belonged to the principal syndrome types,bladder damp-heat syndrome belonged to the subordinate syndrome types,toxic dampness invading brain syndrome belonged to the altered syndrome types which weren't brought into the study because cases belonged to these syndromes weren't clected enough. Then, analyze the relationship between the syndrome types and FPG, UA, CRE, BUN, Ccr, TP, ALB, Hgb, AST, ALT, Hct, 24hUPRO, CHOL, TG, HDL-C, LDL-C of the DN cases, and discuss the regular law of development of the mechanism and syndrome of DN.DN's condition is complicated , and with many complications and combined diseases, so it is hard to decide the patients' syndrome types. Logistic regression method was used for effects which TCM symptoms acted on syndrome types.Eight laboratory indexes statistically significantly different among syndrome types were selected to discriminate different syndrome types. Coding the data and making the database file, entering and checking the data depend on the software Epidata3.1 and turning into the SPSS database file, analyzing statistically the datum in virtue of the software about SPSS13.0, STATA10. 0.ResultsThere are eight indexes different among three principal syndrome types: Hgb, Hct, HDL-C, BUN, Ccr, CRE, UA, 24hupro.There are seven indexes different among four subordinate syndromes: Hgb, Hct, HDL-C, BUN, Ccr, CRE, 24hupro.Eight laboratory indexes statistically significantly different among three principal syndrome types were selected to discriminate different syndrome types. They are Hgb, Hct, HDL-C, BUN, Ccr, CRE, UA, 24hupro. Then the discrimination equation was established. Accuracy ratio of the discrimination was more than 80%.The course of DN, pro, CRE, Ccr, age, Sbp, Dbp were independent variables, and dependent variable was the principal syndrome types, the stepwise mlogistic regression bring pro, course and CRE into the model, and the accuracy ratio of the discrimination was 62. 5%.The study of the relationship of the principal syndrome types and the subordinate syndrome types and altered syndrome types show that asthenia of spleen and kidney yang syndrome was easy to accompany with damp turbidity invasiving stomach syndrome and attack of the heart by retained fluid syndrome. asthenia of spleen and kidney yang syndrome equals to Mogensen IV,V, condition is serious,It is easy to accompany subordinate syndromes and altered syndromes.The study of the logistic regression show that for the qi-yin deficiency syndrome, mental Weariness and fatigue, dryness of throat and dry mouth, frequency of amnesia, thin tongue, red or light red tongue with thin and dry tongue coating, are important than other symptoms. For syndrome of liver and kidney yin deficiency, ache of waist and knee, dryness of the eyes, less of urine, red tongue with less tongue coating, rapid and wiry pulse were more important than other symptoms. For asthenia of spleen and kidney yang syndrome, mental Weariness and fear cold , edema of limbs, white and bright complexion, light and fat tongue with teeth print on tongue margin, sinking and late pulse with adynamia are important than other symptoms.ConclusionWith variation of the indexes, the principal syndrome types developed from the qi-yin deficiency syndrome to syndrome of liver and kidney yin deficiency and to asthenia of spleen and kidney yang syndrome. Among the four subordinate syndrome types and altered syndrome types, damp turbidity invasiving stomach syndrome and attack of the heart by retained fluid syndrome were worse than the others. The result of the stepwise logistic regression and discrimination analysis were proved again that variables mentioned above have the important value to syndrome differentiation of DN, discriminant functions established have higher efficacy, can be used in clinic.