Study On Characteristics Of Syndrome Elements And Relationship Between Spleen And Dampness In Different Clinical Stages Of Chronic Kidney Disease

Objective:Based on the principle of syndrome differentiation,the basic information,symptoms,signs and related physical and chemical indicators of 240 patients with chronic kidney disease（CKD2⁵ stage）were statistically analyzed to explore: 1.The distribution characteristics of syndrome elements in chronic kidney disease;2.The relationship between syndrome elements and disease progression;3.Correlation between "spleen"and"dampness"syndrome elements;4." Correlation between " spleen " "dampness" syndrome elements and clinical laboratory parameters.In order to expand the clinical thinking of TCM,further understand the evolution of TCM syndrome of chronic kidney disease,and provide new ideas for TCM syndrome differentiation of this disease.Methods:1.Using clinical survey methods,284 outpatients and inpatients who visited the Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine from February 2020 to January 2021 were selected,all of whom were definitely diagnosed with chronic kidney disease and met the clinical inclusion and exclusion criteria.2.Referring to the 2012 KDIGO guideline CKD staging criteria,the patients were divided into four groups according to the e GFR（m L/min/1.73m2）:stage 2 group（60≤e GFR≤89）;stage 3 group（30≤e GFR≤59）;stage 4 group（15≤e GFR≤29）;and stage 5group（e GFR < 15）.3.The data of the four diagnoses of the study subjects were collected through the four diagnoses information collection form and entered into the syndrome differentiation evaluation intervention system,and the data statistical software was used for calculation and analysis to draw a conclusion.Result:1.The overall disease location syndrome elements of the four groups of patients with chronic kidney disease are: kidney,spleen,liver,stomach,lung,bones and muscles,heart,mind,surface,gallbladder,etc.,mainly concentrated in the kidney,spleen,liver,and there is a very significant difference in the distribution of different syndrome element grades（P=0.000）2.The disease location syndrome elements of the stage group are: kidney,spleen,liver,stomach,lung,bones and muscles,surface,etc.,mainly concentrated in the kidney,spleen,and liver,and there is no significant difference in the distribution of different syndrome element grades（P=0.059）;the disease location syndrome elements of the stage 3 group are:spleen,kidney,liver,stomach,bones and muscles,lung,mind,surface,heart,and gallbladder,mainly concentrated in the spleen,kidney,and liver,and there is a very significant difference in the distribution of different syndrome element grades（P=0.000）;There was a very significant difference in the distribution of different syndrome element grades（P=0.000）;the syndrome elements of disease location in the five stage groups were: kidney,spleen,liver,lung,stomach,muscles and bones,heart,mind,and gall bladder,mainly concentrated in kidney,spleen,and liver,and there was a very significant difference in the distribution of different syndrome element grades（P=0.000）.3.The overall disease syndrome elements of the four groups of patients with chronic kidney disease are: dampness,qi deficiency,yang deficiency,phlegm,yin deficiency,blood deficiency,heat,qi stagnation,cold,yang hyperactivity,essence deficiency,blood stasis,water stop,external wind,body fluid deficiency,etc.,mainly concentrated in dampness,qi deficiency,yang deficiency,and very significant differences in the distribution of different syndrome element grades（P=0.000）4.The disease syndrome elements of the stage group are: dampness,qi deficiency,phlegm,heat,yang deficiency,yin deficiency,qi stagnation,blood deficiency,etc.,mainly concentrated in dampness,qi deficiency,phlegm,and very significant differences in the distribution of different syndrome element grades（P=0.008）;the disease syndrome elements of the stage 3 group are: dampness,qi deficiency,yang deficiency,phlegm,yin deficiency,blood deficiency,heat,qi stagnation,cold,blood stasis,yang hyperactivity,and essence deficiency,etc.There were very significant differences in the distribution of different syndrome element grades（P=0.000）;the pathological syndrome elements in the stage 4 group were: dampness,qi deficiency,yang deficiency,blood deficiency,phlegm,yin deficiency,qi stagnation,heat,cold,blood stasis,yang hyperactivity,essence deficiency,and water arrest,mainly concentrated in dampness,qi deficiency,and yang deficiency,and there were very significant differences in the distribution of different syndrome element grades（P=0.000）;the pathological syndrome elements in the stage 5 group were: qi deficiency,yang deficiency,dampness,yin deficiency,phlegm,blood deficiency,heat,qi stagnation,essence deficiency,yang hyperactivity,and cold,mainly concentrated in qi deficiency,yang deficiency,and dampness,and there were very significant differences in the distribution of different syndrome element grades（P= 0.000）.5.The disease factors that have a significant effect on the progression of chronic kidney disease are:kidney（P=0.000）,spleen（P=0.000）,stomach（P=0.026）,with statistical significance,and the corresponding P>0.05 for the other disease factors,without statistical significance;the disease factors that have a significant effect on the progression of chronic kidney disease are: dampness（P=0.000）,with statistical significance,and the corresponding P>0.05 for the other disease factors,with no statistical significance.6.In each group of chronic kidney disease,the disease element "spleen" and the disease element "dampness" were significantly correlated（P=0.000）7.The disease element "spleen" in chronic kidney disease was significantly correlated with e GFR,Scr,ALB,and HGB（Pe GFR=0.000,PScr=0.000,PALB=0.015,PHGB=0.001）,of which "spleen" was negatively correlated with e GFR,ALB,and HGB（re GFR=-0.269,r ALB=-0.156,r HGB=-0.211）and positively correlated with Scr（r Scr=0.282）;the disease element "dampness" in chronic kidney disease was significantly correlated with eGFR and Scr(P_eGFR=0.000,P_Scr= 0.001),but not significantly correlated with ALB and HGB(P_ALB=0.132,P_HGB=0.054).Where "dampness" was positively correlated with eGFR（reGFR=0.226）and negatively correlated with Scr（rScr=-0.220）.Conclusion:1.The overall syndrome elements of chronic kidney disease are mainly "kidney","spleen" and "liver",which also involve multiple viscera,suggesting that the disease is located in the kidney and is closely related to the spleen and liver.2.The empirical syndrome elements of chronic kidney disease are mainly "dampness","phlegm","heat" and "qi stagnation";the virtual syndrome elements are mainly "qi deficiency","yang deficiency","yin deficiency" and "blood deficiency".3." Spleen "dampness" syndrome element is closely related to the progression of chronic kidney disease,spleen dysfunction affects the development and prognosis of chronic kidney disease,dampness as an important pathological factor of this disease,its production and accumulation also has a significant impact on the progression of this disease.4.The syndrome element "spleen" of chronic kidney disease is significantly correlated with the syndrome element "dampness" of chronic kidney disease.Dampness is not only the pathological product of spleen but also the pathogenic factor of spleen,which is in line with the theory of "dampness trapping spleen" and "spleen deficiency and dampness" in traditional Chinese medicine.5.The syndrome elements of "spleen" and "dampness" run through the disease and are closely related to e GFR,ALB,HGB,and Scr.With the decrease of e GFR level and the increase of Scr level,the proportion of syndrome element "spleen" gradually increased,and the proportion of syndrome element "dampness" tended to decrease,indicating that with the progression of the disease,the evil factors gradually decreased,and the deficiency factors gradually appeared,in line with the change rule of "long illness and more deficiency" in traditional Chinese medicine;with the decrease of ALB and HGB levels,the proportion of syndrome element "spleen" gradually increased,in line with the theoretical basis of "spleen control blood" and "spleen main transport" in traditional Chinese medicine,and also further supporting the quality of spleen and stomach function affecting the nutritional status and physical function of patients.