| Objective:Investigate the distribution characteristics and combination of TCM symptoms,syndrome elements and clinical data of patients with diabetic kidney disease complicated with coronary heart disease and without coronary heart disease,so as to explore the risk factors of disease,provide the basis of syndrome for the theory of simultaneous treatment of heart and kidney for diabetic kidney disease.Material and methods:Through epidemiological investigation,the clinical data and TCM four diagnostic information of 102 patients with diabetic kidney disease complicated with coronary heart disease and without coronary heart disease were collected and analyzed by statistical analysis.The distribution characteristics of TCM syndrome elements,TCM symptoms and clinical indexes were compared between the two groups.Results:1.GenerallyThere was no significant difference in gender,BMI,course of diabetes,course of DKD,history of smoking and drinking between patients with diabetic kidney disease complicated with coronary heart disease and without coronary heart disease.The average age of patients with diabetic kidney disease complicated with coronary heart disease was 63.48±9.78 years old,and that of patients with diabetic kidney disease was 58.92± 11.85 years old.There was significant difference between the two groups(P<0.05).2.TCM four diagnostic information distributionThe top five symptoms in diabetic kidney disease with coronary heart disease group were dark purple lips(92%),fatigue(84%),shortness of breath and lazy speech(78%),heavy physical fatigue(76%),and edema of the face and foot(76%).The top five symptoms in the diabetic kidney disease group were purple lips(76.92%),dry pharynx and mouth(73.08%),fatigue and tiredness(71.15%),heavy limbs(71.15%),and skin itching(63.46%).The tongue quality of the two groups was mainly dark red tongue,dull tongue and tooth mark tongue,and the tongue coating was mainly yellow,white and thin white,and the pulse was mainly string slippery pulse,string veinlets and deep veinlets,among which astringent pulse also appeared in the diabetic kidney disease complicated with coronary heart disease group.3.The TCM syndrome elements distributionAbout the deficiency TCM syndrome elements distribution,the patients with the diabetic kidney disease complicated with coronary heart disease group were Qi deficiency syndrome of 40 cases(80%),Yang deficiency syndrome of 34 cases(68%),Yin deficiency syndrome of 31 cases(62%)and blood deficiency syndrome of 24 cases(48%)respectively.The diabetic kidney disease group are:Yin deficiency syndrome of 39 cases(75%),Qi deficiency syndrome of 26 cases(50%),Yang deficiency syndrome of 23 cases(44.23%)and blood deficiency syndrome of 22 cases(42.31%).The deficiency of both Qi and Yang was mainly found in the diabetic kidney disease complicated with coronary heart disease group,and the deficiency of both Qi and Yin was more common in the diabetic kidney disease group.The difference of qi deficiency syndrome and Yang deficiency syndrome have obvious statistical significance(P<0.01).Combination of the relative organ of the disease,the three syndrome types with the highest frequency of deficiency in both groups were kidney Qi deficiency syndrome,liver blood deficiency syndrome and kidney Yang deficiency syndrome.In terms of the excess TCM syndrome elements distribution,the distribution of patients in diabetic kidney disease group complicated with coronary heart disease group was as follows:blood stasis syndrome of 48 cases(96%),damp-heat syndrome of 39 cases(78%),phlegm-turbid syndrome of 35 cases(70%),wet certificate syndrome of 15 cases(30%),qi stagnation syndrome of 10 cases(20%),heat syndrome of 9 cases(18%).The distribution of patients in the diabetic kidney disease group:damp-heat syndrome of 38 cases(73.08%),blood stasis syndrome of 32 cases(61.54%),phlegm syndrome of 30 cases(57.69%),heat syndrome of 10 cases(19.23%),wet certificate syndrome of 6 cases(11.54%),qi stagnation syndrome of 5 cases(9.62%).Most of the patients in the two groups showed blood stasis syndrome,damp-heat syndrome and phlegm-turbid syndrome.The difference of blood stasis syndrome and wet certificate syndrome have statistical significance(P<0.05).4.The laboratory physical and chemical indicators(1)Serum creatinine and estimated glomerular filtration rate:the serum creatinine of patients with the diabetic kidney disease complicated with coronary heart disease was 262±249.36μmol/L,and that of patients with diabetic kidney disease was 191±211.10μmol/L.The estimated glomerular filtration rate in diabetic kidney disease with coronary heart disease group and diabetic kidney disease group were 45.38±36,34mL/min/1.73m2,and 63.11±40.12mL/min/1.73m2.Compared with the diabetic kidney disease group,the serum creatinine increased and the estimated glomerular filtration rate decreased in the diabetic kidney disease complicated with coronary heart disease group,the difference had statistically significance(P<0.05).(2)Cardiac troponin,ejection fraction and left ventricular mass index:the cardiac troponin in diabetic kidney disease with coronary heart disease group was 0.077±0.237ug/L,and that in the diabetic kidney disease group was 0.018±0.037ug/L.Compared with the diabetic kidney disease group,the troponin in the diabetic kidney disease complicated with coronary heart disease group increased,and the difference had obvious statistically significance(P<0.01).The ejection fraction of patients with diabetic kidney disease complicated with coronary heart disease was 56.12±8.35%,and that of patients with diabetic kidney disease was 60.32±5.58%.The left ventricular mass index of patients with diabetic kidney disease complicated with coronary heart disease was 97.03±23.33g/m2,and that of patients with diabetic kidney disease was 88.54±20.81 g/m2.Compared with the diabetic kidney disease group,the ejection fraction in diabetic kidney disease with coronary heart disease group decreased,the difference had obvious statistically significance(P<0.01),and the left ventricular mass index increased,the difference had statistically significance(P<0.05).(3)Platelet and D-dimer:the platelet of diabetic kidney disease with coronary heart disease group was 224±62.70 10^9/L,and that of diabetic kidney disease group was 254±62.62 10^9/L.The D-dimer was 0.64±0.45mg/L in patients with diabetic kidney disease complicated with coronary heart disease and 0.53±0.48mg/L in patients with diabetic kidney disease.Compared with the diabetic kidney disease group,the platelet decreased significantly and the D-dimer increased significantly in diabetic kidney disease with coronary heart disease group,and the difference had statistically significance(P<0.05).(4)Serum albumin:the serum albumin of patients of diabetic kidney disease with coronary heart disease was 34.98±6.83g/L,and that of patients with diabetic kidney disease was 38.81 ± 10.47g/L.Compared with the diabetic kidney disease group,the serum albumin in the diabetic kidney disease complicated with coronary heart disease group was lower,and the difference had statistically significance(P<0.05).(5)Serum calcium and whole segment parathyroid hormone:The serum calcium of patients with diabetic kidney disease complicated with coronary heart disease was 2.18±0.20mmol/L,and that of patients with diabetic kidney disease was 2.22±0.31 mmol/L.The whole segment parathyroid hormone was 136.6±124.30pg/ml in patients with diabetic kidney disease complicated with coronary heart disease and 77.9±89.94pg/ml in patients with diabetic kidney disease.Compared with the diabetic kidney disease group,the serum calcium in diabetic kidney disease with coronary heart disease group decreased,the difference had statistically significance(P<0.05),and the parathyroid hormone increased,the difference had obvious statistically significance(P<0.01).(6)The proportion of cerebral infarction in diabetic kidney disease with coronary heart disease group was 60%,and that in diabetic kidney disease group was 40.40%,the difference between the two groups has staticstical difference(P<0.05).Conclusion:1.The Serum creatinine,troponin and left ventricular mass index of patients with diabetic kidney disease complicated with coronary heart disease were higher,estimated glomerular filtration rate and left ventricular ejection fraction were lower,and renal function and cardiac function were relatively poor.Coronary heart disease may be one of the risk factors of diabetic kidney disease.2.In diabetic kidney disease patients complicated with coronary heart disease,the degree of deficiency syndrome is deeper in Qi-deficiency syndrome and Yang-deficiency syndrome,and syndrome is deeper in blood stasis syndrome and wet certificate syndrome. |
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