| Objective:To study the incidence of vascular calcification in peritoneal dialysis patients in the peritoneal dialysis center of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,as well as the TCM syndrome characteristics of vascular calcification in peritoneal dialysis patients,and to explore the advantages of traditional Chinese medicine in treating peritoneal dialysis patients with vascular calcification.Method:This study is divided into two parts.Part one: A retrospective study was conducted on peritoneal dialysis patients with vascular calcification in the department of Nephrology,the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine(TCM)from January 1,2016 to December 31,2018.All 125 patients met the diagnostic criteria of chronic kidney disease stipulated in the K/DIGO clinical practice guidelines for the assessment and management of chronic kidney disease in 2012.The diagnosis of vascular calcification was recommended in accordance with the K/DIGO CKD-MBD guidelines in 2017.Abdominal aortic calcification was evaluated by lateral abdominal radiograph and cardiac valve calcification was evaluated by echocardiography.Exclude the following circumstances:(1)Patients who do not meet the inclusion criteria;(2)patients who had parathyroid gland resection,or the whole parathyroid hormone(i PTH)continued to decrease(i PTH<150ng/L);(3)Patients with acute,chronic liver disease,moderate and severe heart failure,malignant tumor and all related diseases that can cause calcium and phosphorus metabolism disorder except chronic renal insufficiency;(4)Kidney transplant patients and patients receiving hemodialysis at the same time.The above patients were classified by TCM syndrome differentiation according to the guiding principles of Clinical Research on New drugs of Traditional Chinese Medicine in the treatment of chronic renal failure.Part two:For the first part analyzed the center of the abdomen through merger of vascular calcification in patients with TCM syndrome characteristics,we collected patients who hadregular peritoneal dialysis more than 3 months with vascular calcification in our center from September 1,2016 to September 1,2019,and in conformity with the Chinese medicine dialectical to spleen and kidney yang deficiency syndrome,37 patients with peritoneal dialysis were selected as the study subjects.According to the scheme of vascular calcification,the patients were divided into traditional Chinese medicine group and control group.The control group was given general treatment and symptomatic treatment,while the Chinese medicine group was given TCM decoction with the main treatment method of warming kidney,invigorating spleen and dampening,on the basis of the control group,the blood calcium(Ca),blood phosphorus(P),product of calcium,phosphorus,parathyroid hormone(i PTH),serum albumin(propagated),hemoglobin(HGB),urea nitrogen(BUN),serum creatinine(Scr),potassium(K),alkaline phosphatase(ALP),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),total creatinine clearance(Ccr),total score urea clearance(Kt/V),TCM syndrome integral,Heart valve calcification score and SGA scorewere collected in the two groups before and 12 months after treatment.Result:The first part:1.The number of patients with new peritoneal dialysis catheters combined with vascular calcification was high in our center during the three-year period,with a total of 125 cases,accounting for 29.7% of the total number of patients with dialysis catheters.2.In 125 cases of peritoneal dialysis patients with new catheterization,vascular calcification and cardiac valve calcification were common,among which aortic valve calcification was common.3.Comparison of calcification scores: there was no statistically significant difference in heart valve calcification scores between the two groups before,after and within treatment(P>0.05).The integral composition ratio of cardiac valve calcification before and after treatment in the two groups was not statistically significant(P>0.05).By comparing the overall trend of calcification score value between the two groups,the number of patients with each score value in the TCM group fluctuated less than that in the control group before and after treatment,and the trend of calcification score growth was slow.In addition,1 patient with calcification score score of 0 was found in the TCM group after treatment.4.Age is a key factor affecting the TCM syndrome distribution of peritoneal dialysis patients with vascular calcification.5.The distribution pattern of this deficiency in our patients with central membrane dialysis combined with vascular calcification is as follows: spleen and kidney yang deficiency syndrome > qi and yin deficiency syndrome > spleen and kidney qi deficiency syndrome >liver and kidney yin deficiency syndrome > yin and yang deficiency syndrome;The distribution law of standard evidence was as follows: damp heat syndrome > wet turbid syndrome > blood stasis syndrome > water vapor syndrome > wind motion syndrome.The second part:1.A total of 37 patients were included in this study,including 20 in the TCM group and 17 in the control group.There were no significant differences between the two groups in gender,age,dialysis time(months),the number of cases associated with cardiovascular disease and diabetes,and the primary disease(P>0.05),indicating comparability.2.Comparison of TCM syndromes score and efficacy: after treatment,TCM syndromes score of the two groups decreased significantly compared with that before treatment,and the difference was statistically significant(P<0.05).Among them,the decrease was more significant in the TCM group,while the difference in TCM syndromes score of the two groups was not statistically significant after treatment(P>0.05).Compared with the control group,the effective rate of the TCM group after treatment was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).3.Electrolyte comparison: before and after treatment,there were no statistically significant differences in blood Ca,blood P,calcium and phosphorus product,blood K,and blood Mg levels between the two groups(P>0.05).Through inter-group comparison,blood Mg levels in the TCM group increased after treatment compared with before treatment,with statistically significant differences(P<0.05).4.Comparison of nutritional indexes: before treatment,there was no significant difference in HGB level,ALB level or SGA score between the two groups(P>0.05).With the passage of treatment time,ALB level in the TCM group increased significantly after treatment and before treatment,with statistically significant difference(P<0.05).The SGA score of the TCM group decreased significantly after treatment compared with that before treatment,and thedifference was statistically significant(P<0.05).5.Comparison of i PTH and ALP: there was no significant difference in the levels of i PTH and ALP between the two groups before,after and within the two groups(P>0.05).6.Renal function comparison: there were no statistically significant differences in BUN and CR levels between the two groups before,after and within the group(P>0.05).7.Comparison of lipid levels:there was no significant difference in the levels of TC,TG and LDL-C between the two groups before and after treatment(P>0.05),the comparison between the same group,as the treatment time,the two groups of TC levels after treatment than before treatment is reduced,but there was no statistically significant difference(P>0.05),the previous lower TG levels after TCM treatment group,but there was no statistically significant difference(P> 0.05),the control group after treatment increased TG level from the previous,but there was no statistically significant difference(P>0.05),Chinese medicine group after treatment of LDL-C level was significantly reduced,the difference was statistically significant(P<0.05).8.Comparison of dialysis adequacy level: there was no significant difference in total Ccr and Kt/V levels between the two groups before and after treatment and within the group(P>0.05).Conclusion:The incidence of vascular calcification in peritoneal dialysis patients in our center is relatively high,and the characteristics of TCM syndromes are as follows: the deficiency of spleen and kidney yang deficiency is the main symptom,and the dampness-heat syndrome is the main symptom.At the same time,age is a key factor affecting the TCM syndrome distribution of peritoneal dialysis patients with vascular calcification.On the basis of general treatment,TCM decoction,which is supplemented by tonifying kidney and strengthening spleen,benefiting dampness and clearing heat,is safe and effective in treatment,which can significantly improve the treatment efficiency and help to improve the nutritional status and lipid profile of patients. |
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