Real World Based Study On Risk Factors And Prescription Rules Of Diabetic Kidney Disease

Objective:1.To investigate the correlation between neutrophil/lymphocyte ratio(NLR)and renal function in patients with type 2 diabetic renal disease(DKD)in the real world based on the general data and laboratory indicators of patients previously diagnosed with DKD.2.Through the ancient and modern medical case cloud platform(V2.3.7)to analyze the relationship between the rules of clinical prescriptions and their admission symptoms in the real world,and to provide theoretical basis and optimization of diagnosis and treatment plan for TCM treatment of DKD through modern data mining means;The distribution of clinical drugs in Shenxiao patients was summarized to lay the foundation for clinical drug compatibility.Methods:1.Through the retrospective collection of hubei province hospital between January 2018 and February 2019 hospitalized cases of diabetic kidney disease in two years are collected,and according to include and exclude standards,selected conform to research the data of 177 cases patients with collecting the related clinical data,using spss23.0 analysis software,according to the estimated glomerular filtration rate< 90ml·min-1·1.73m-2 forrenal damage will occur to group 177 patients,The correlations were analyzed by binary regression with gender,age,duration of diaetes,body mass index,thyroid function,Hb A1 c,neutrophils/lymphocytes ratio,total bilirubin,blood lipid indexes,urinary microalbumin,and thickness of cervical artery media.Then,multivariate regression analysis was performed between the above indexes and the estimated glomerula filtration rate to determine the independent risk factors for diabetic renal disease.The truncated values of independent risk factors were determined by receiver operating characteristic curve(ROC curve),and divided into two groups according to their truncated values.The correlation between them as clinical indicators and renal function indicators was analyzed,and the renal function injury in patients with DKD was predicted by their levels.2.Through screening the data of patients who met the require ments of Study 1,and whose first TCM diagnosis was Shenxiao disease,with complete information of TCM four diagnoses and prescriptions,127 patients with complete syndrome differentiation prescriptions who met the requirements of Study 2 were finally obtained.The ancient and modern medical case cloud platform(V2.3.7)was used to conduct statistical analysis on the frequency,four qi,five taste,meridian return,efficacy,symptoms,tongue pulse,syndrome type and syndrome elements of the drugs clinically prescribed for 127 patients.And use association analysis,drug-drug,symptom-symptom,symptom-drug association mining;Through the hierarchical clustering method,the top 20 drugs with drug frequency were cluster analyzed to summarize the prescription rules and clinical distribution rules of Shenxiao patients,laying a foundation for clinical compatibility of clinical drugs.Results:1.177 patients with diabetic renal disease,univariate renal injury analysis showed that age,course of type2 diabetes,FT3,FT4,NLR,STB,Hcy and carotid artery thickness were risk factors for renal function injury of DKD(P< 0.05).Age,duration of type 2 diabetes,NLR,Hcy,and thickness of cervical artery media were negatively correlated with e GFR,while FT3,FT4,STB were positively correlated with e GFR.There was no statistically significant difference between age and renal injury.Multivariate analysis of renal injury showed that age and NLR were independent risk factors for renal function injury in DKD patients(P<0.05).NLR=2.65 can be used as the cut-off value of renal function impairment in patients with DKD,which is correlated with renal function indexes e GFR,Cyc,Scr,Ua,C1 q are all positively correlated with NLR.2.127 patients with renal disease elimination,prescription drugs main frequency > 35 times in astragalus membranaceus and salvia miltiorrhiza 123 times,Chinese yam,Gordon euryale seed,Cherokee rose,rhizoma anemarrhenae,cornus,fenugreek,poria cocos,eucommia bark,zizyphus jujube kernel,radix puerariae,radix paeoniae rubra,mulberry parasitism,radix rehmanniae,alis,angelica,twotooth achyranthes root,radix scrophulariae,duckweed mainly;The most sexual taste was sweet,followed by bitter and pungent taste.Most drugs went to the kidney meridian,followed by liver meridian and lung meridian.The clinical symptoms> for 35 times were dry mouth,fatigue,foamy urine,polydipsia,blurred vision,numbness,poor sleep,weight loss,dizziness,polyuria,chest tightness,lower limb edema,palpitation,pruritus,cough and dry stool.Dark red tongue was the most common tongue,followed by light red tongue and toothed tongue.The tongue coating was mostly yellow and greasy,followed by yellow and little coating.The pulse pattern was mostly heavy and late veins,followed by fine and smooth veins.The syndrome types were mostly deficiency of Qi and Yin,followed by deficiency of spleen and kidney Yang and de-ficiency of liver and kidney Yin.The syndrome types were mostly kidney,followed by deficiency of spleen and liver.Yin deficiency was the largest,followed by Qi deficiency and Yang deficiency.The top 10 Chinese materia medica-Chinese medicine association in the order of confidence degree were:Euryale euryale-Rosa auriculata,Alisma alissima-Salvia miltiorrhiza,Fenugrel-Yam,Radix Paeon-iae Radix-Salvia miltiorrhiza,Anemarhizae Rhizoma-Astragalusmembranaceus,Tuckai ng-Astragalus mem-branaceus,Eucommiau-lmo Salvia miltiorrhiza,Fenugrel-Salvia miltiorrhiza,Radix Puerariae Radix;Alisma alisma-Astragalus membranaceus;The top 10symptomatic-symptom associations,in order of confidence,were polydipsia-polyuria,polydipsia-dry mouth,weight loss-dry mouth,poor sleep-foamy urine,weight loss-foamy urine,blurred vision-dry mouth,polydipsia-foamy urine,dipsia-dry mouth,weight loss fatigue,poor sleep-dry mouth;The top 10 symptom-drug associations in order of confidence were lower limb edema-duckweed,poor sleep-jujube seed,frothy urine-cherry cherry,frothy urine-Euryale seed,dizziness-yam,polyur-iaastragalus,blurred vision-yam,dry mouth-yam,polydipsia-yam,weight loss-yam;It can be divided into 6groups: the Chinese medicine frequency ≥30 times can be obtained by cluster analysis of 6 groups,the first group: cherry,Gordon euryale;Group 2: Yam,Astragalus,Salvia miltiorrhiza;The third group:jujube seed,dogwood,rehmannia glutinosa,fenugreek,alisma alisma,duckweed;Group 4: Poria cocos,Radix Puerariae;Group 5:Anemarrhenae anemarrhenae,Radix Sophorae;The sixth group: red peony,mulberry parasitic,eucommia,angelica,Achyr-anthes knee.Conclusions:1.The age,type 2 diabetes mellitus patients with diabetic kidney disease progression,NLR,Hcy,neck artery in the film thickness and e GFR is negative correlation,that is the protection factor in e GFR,FT3,FT4,STB and e GFR is positive correlation,a long time exposure to these risk factors,and not timely intervention to correct the damage,easy to cause diabetes complications.Age and NLR are independent risk factors in the process of DKD,and NLR is negatively correlated with e GFR.Therefore,clinical attention should be paid to its diagnostic value,and early prediction of its effect on renal function is of great significance for the prevention of DKD.2.Kidney-elimination disease is a disease of deficiency,deficiency and solid,with typical symptoms such as dry mouth,fatigue,foam urine and polydipsia.Drug laws in kidney and spleen,solid reduction,on the basis of urine with astragalus root,Chinese yam,Cherokee rose,Gordon euryale seed,cornus,fenugreek,eucommia bark,such as drug is given priority to,complementary with ziyin clear heat,rhizoma anemarrhenae,radix paeoniae rubra,phlegm moisture penetration,Dan,tuckahoe,alisma,promoting bloo-d circulation to remove blood stasis drugs such as ginseng,radix paeoniae rubra,drug was associated with more land and water elixir,add and subtract liuwei dihuang pill treatment,associated with more symptoms-drugs,fructus rosae laevigatae bubble urine Gordon euryale seed,lower extremity edema-duckweed,poor sleep-zizyphus jujube kernel,such as drug for the treatment of Chinese medicine kidney provides a certain reference significance.