| Objective:Through the evaluation and analysis of the distribution characteristics of TCM symptoms and sleep quality in patients with end stage renal disease(ESRD)in the Department of Nephrology of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,we discuss the correlation between sleep disorders and TCM symptoms in ESRD patients and summarize the factors affecting the sleep quality of ESRD patients.It provides a scientific and theoretical basis for further clinical research on sleep disorders associated with ESRD,and provides a reference for the development of the synergistic prevention and treatment of sleep disorders associated with ESRD in Chinese and Western medicine,thus improving the overall level of synergistic prevention and treatment of sleep disorders associated with ESRD in Chinese and Western medicine.Methods:(1)In this retrospective study,ESRD patients treated in the Department of Nephrology of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine(TCMU)from September 2020 to December 2020 were enrolled in the study,and the general data,the data of the four Chinese medicine consultations and the relevant clinical indicators were collected by reviewing the electronic medical records of 350 ESRD patients eligible for the study.(2)In combination with the Pittsburgh sleep quality index(PSQI),the sleep quality of ESRD patients was assessed,and the patients were divided into the no sleep disorder group(PSQI ≤ 15 points)and the sleep disorder group(PSQI > 15 points)according to the assessment results.(3)A TCM evidence questionnaire was developed,and statistical analysis was performed using SPSS 26.0,and the distribution pattern of TCM evidence of the disease was analyzed by LSD(L)-t or T2 test;the general conditions and clinical indicators of ESRD patients were compared;Pearson or Spearman correlation analysis and one-way logistic The factors influencing sleep disorders in ESRD were investigated by Pearson or Spearman correlation analysis and one-way logistic regression analysis.Results:1.350 patients with ESRD,202(57.72%)were male and 148(42.28%)were female,with a mean age of 57.94±14.08 years.The primary disease was chronic glomerulonephritis in 256 cases(73.14%),which accounted for the largest proportion.The prevalence of sleep disorders in 350 patients with ESRD was 51.00%(51/100)in the non-dialysis period,55.00%(55/100)in the hemodialysis period,and 52.67%(79/150)in the peritoneal dialysis period.52.67%(79/150).2.Comparison of general conditions between the sleep disorder group and the no sleep disorder group: in terms of the duration of chronic kidney disease history,the patients in the sleep disorder group had significantly higher incidence and duration of disease history than the no sleep disorder group(P < 0.05).3.The distribution of TCM evidence in ESRD patients was as follows: all patients showed evidence of deficiency: 91 cases(26.00%)of Qi deficiency,109 cases(31.14%)of Yin deficiency,150 cases(42.86%)of Spleen and Kidney Yang deficiency;129 cases(36.86%)of deficiency were mixed with symptoms of standard reality,among which 26 cases(7.43%)were evidence of drowning toxicity and 33 cases were evidence of damp-heat.Among the symptoms of the symptoms,26(7.43%)were drowning toxicity,33(9.43%)were damp-heat,36(10.29%)were water-damp,and 34(9.71%)were blood stasis.There was no statistically significant difference between the no sleep disorder group and the sleep disorder group in terms of TCM evidence types(P > 0.05).4.The distribution of the TCM evidence types in the 185 patients with sleep disorder group were: 76 cases(41.08%)with spleen and kidney Yang deficiency evidence accounted for the most;64 cases(34.59%)with mixed standard evidence and 22 cases(11.89%)with blood stasis evidence accounted for the most.5.Comparison of relevant indexes between the group without sleep disorders and the group with sleep disorders: the differences in serum chloride,blood glucose,C-reactive protein,serum ferritin and 24-hour urine protein quantification between the two groups were statistically significant(P<0.05).6.Correlation analysis of sleep disorders with ESRD and indicators showed that: sleep disorders were positively correlated with the history of hypertension,cardiovascular disease and the length of chronic kidney disease(r=0.187,r=0.110,r=0.126);sleep quality was negatively correlated with serum chloride and C-reactive protein(r=-0.123,r=-0.233).7.Univariate Logistic regression showed that history of hypertension(OR=6.968,95%CI=2.004～24.235,P=0.002),length of chronic kidney disease history(OR=1.059,95%CI=1.018～1.101,P=0.005),high blood urea nitrogen(OR=1.055,95% CI=1.008 to 1.104,P=0.020),high cholesterol(OR=2.090,95% CI=1.080 to 4.046,P=0.029),low serum chloride(OR=2.447,95% CI=1.290 to 4.643,P=0.006),low serum phosphorus(OR=0.420,95% CI= 0.217 to 0.814,P=0.010),low carbon dioxide binding(OR=0.888,95% CI=0.792 to0.996,P=0.043),and low hemoglobin(OR=0.926,95% CI=0.867 to 0.990,P=0.023)were influential factors in patients with ESRD combined with sleep disorders.Conclusions:1.There were statistically significant differences in the length of chronic kidney disease history,serum chloride,blood glucose,C-reactive protein,serum ferritin,and 24-hour urine protein quantification levels between the sleep disorder group and the no sleep disorder group.2.History of hypertension,cardiovascular disease,length of history of chronic kidney disease,serum chloride and C-reactive protein were correlated with sleep quality in ESRD;history of hypertension,length of history of chronic kidney disease,high blood urea,high cholesterol,low serum chloride,low serum phosphorus,low carbon dioxide binding capacity,and low hemoglobin were influential factors in patients with ESRD combined with sleep disorders.3.In this study,the prevalence of sleep disorders in ESRD patients was 52.86%,suggesting that special attention should be paid to the sleep quality of ESRD patients and early intervention is expected to improve the survival quality of patients.The distribution of deficiency evidence in ESRD patients with sleep disorders was 41.08% for spleen and kidney yang deficiency,16.76% for qi and yin deficiency,16.76% for liver and kidney yin deficiency,13.51% for spleen and kidney qi deficiency,and 11.89% for lung and spleen qi deficiency;the blood stasis evidence(11.89%)was the most common type of symptoms in the clinical treatment of Chinese medicine.The results provide a theoretical reference for the clinical treatment of ESRD patients with sleep disorders by strengthening the spleen and warming the kidney,benefiting the qi and nourishing the yin,and activating blood stasis. |
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