Study On The Characteristics Of Body Composition In Diabetic Nephropathy Stage Ⅲ-Ⅴ Wet Syndrome Based On Bioelectrical Impedance Technology

Objective:Through literature research and clinical research,the bioelectrical impedance technology-based body composition analyzer is used to collect relevant information of patients with DKD dampness syndrome,and the syndrome investigation and body composition indicators are analyzed to explore the syndrome characteristics of dampness syndrome.Method:1 Literature research:search the Chinese Journal Full-text Database,Wanfang Database,and Weipu Database from January 1,2001 to December 21,2020 on DKD staging and syndrome differentiation,and use Microsoft Excel 2016 to count the occurrence of various syndrome types in different stages Article frequency,frequency ratio,number of cases and percentage of articles.2 Clinical study:Include patients with DKD Ⅲ-Ⅴ who were in the ward of the Department of Endocrinology and Endocrinology of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1,2018 to December 30,2020 and met the inclusion criteria of this study.Collect the general information of the patients,and use the DBA-550 expert body sub-analyzer to detect their body composition indicators.Use SPSS 24.0 for statistical analysis,use Spearman correlation analysis,use t test or non-parametric rank sum test for difference analysis,and use logistics regression analysis to explore changes in wetness syndrome symptom scores and body composition.Result:1 Literature research1.1 Distribution of syndrome types in each stage of DKD:The top ten syndrome types in the percentage of cases of DKD stage Ⅲ are:blood stasis syndrome(15.07%)>Qi and Yin deficiency syndrome(13.73%)>Yin and Yang deficiency syndrome(12.61%)>Qi deficiency syndrome(10.65%)>Yin deficiency syndrome(9.85%)>Dampness syndrome(7.91%)>Damp-heat syndrome(4.95%)>Yang deficiency syndrome(4.66%)>Yin deficiency dry-heat syndrome(3.56%)>Spleen and kidney Qi deficiency Certificate(3.49%).The top ten syndrome types in the percentage of DKD Ⅳ cases are:blood stasis syndrome(18.69%)>dampness syndrome(15.73%)>qi deficiency syndrome(10.23%)>yang deficiency syndrome(8.76%)>yin deficiency syndrome(7.73%)>Qi and Yin deficiency syndrome(7.36%)>Yin and Yang deficiency syndrome(5.05%)>Blood deficiency syndrome(4.64%)>Damp-heat syndrome(4.20%)>Spleen and kidney Qi deficiency syndrome(3.40%).The top ten syndrome types in the percentage of cases of DKD V stage are:wet syndrome(19.59%)>blood stasis syndrome(16.31%)>Yang deficiency syndrome(11.36%)>Qi deficiency syndrome(10.62%)>blood deficiency syndrome(9.15%))>Yin deficiency syndrome(6.40%)>Yin and Yang deficiency syndrome(4.44%)>Spleen and kidney Qi deficiency syndrome(4.02%)>Qi and Yin deficiency syndrome(3.41%)>Damp-heat syndrome(3.05%).1.2 In the included literature,there were 3168 cases of wet syndrome,of which 506 were DKD stage Ⅲ,accounting for 4.95%of stage Ⅲ cases,1429 were DKD stage Ⅳ,accounting for 15.73%of stage Ⅳ cases,and 931 cases were DKD stage Ⅴ,accounting for 19.59%of stage Ⅴ cases..2 Clinical research2.1 The distribution of symptoms of DKD Ⅲ-Ⅴ stage damp syndrome patients is different.The top ten of DKD stage Ⅲ symptom distribution are as follows:facial and foot edema(77.42%)>mental fatigue(61.29%)>physical obesity(58.06%)>Whole body drowsiness(54.84%)>sticky mouth or urine smell in the mouth(48.39%)>chest tightness and spleen(45.16%)>dry throat and thirst(41.94%)>dark purple mouth(35.48%)>heavy head swelling(32.26%)>Frequent nocturia(29.03%).The top ten in the order of DKD stage Ⅳ symptom distribution are:facial and foot edema(97.67%)>mental fatigue(65.12%)>physical obesity(62.79%)>dry throat and thirst(53.49%)>general drowsiness(51.16%)>Sticky mouth or odor of urine in the mouth(51.16%)>Itchy skin(44.19%)>Nausea and nausea(41.86%)>Low food,nausea,nausea and nausea(41.86%)>Chest tightness and rash(39.53%);DKD V The top ten in the order of symptom distribution are:facial and foot edema(79.16%)>mental fatigue(68.75%)>physical obesity(58.33%)>dry pharynx and thirst(56.25%)>chills with cold limbs(56.25%)>Skin itching(50.00%)>Eat less appetite,nausea and nausea(43.75%)>Sticky mouth or urine smell in the mouth(43.75%)>Skin malondox(37.50%)Whole body drowsiness(37.50%).2.2 The distribution of DKD Ⅲ-Ⅴ syndrome elements:DKD Ⅲ dampness syndrome combined with folder syndromes are Yang deficiency syndrome(45.16%)>blood stasis syndrome(41.94%)>Yin deficiency syndrome(25.81%)>Qi deficiency syndrome(22.58%)>blood deficiency syndrome(16.13%),DKD Ⅳ dampness syndrome and folder syndrome followed by Yang deficiency syndrome(51.16%)>blood stasis syndrome(41.86%)>yin deficiency syndrome(25.58%)>qi deficiency syndrome(9.30%)>Blood deficiency syndrome(0%),DKD V dampness syndrome combined with folder syndromes are followed by blood stasis syndrome(66.67%)>Yang deficiency syndrome(60.64%)>Yin deficiency syndrome(25.00%)>Qi deficiency syndrome(25.00%)>blood deficiency syndrome(8.33%).It can be seen from the table that as the course of DKD progresses from Ⅲ to Ⅴ,the frequency of yang deficiency and blood stasis syndrome gradually increases.2.3 There are differences in the scores of the syndromes in each stage of DKD Ⅲ-Ⅴ:the score of blood stasis syndrome in stage Ⅳ is lower than that of stage Ⅴ(P<0.01);the score of dampness syndrome and blood stasis syndrome in stage Ⅲ are lower than that of stage Ⅴ(P<0.05).2.4 There are differences in the scores of symptoms of wet syndrome in each stage of DKD Ⅲ-Ⅴ:the scores of chest tightness,irritation,skin pruritus and pruritus in stage Ⅲand Ⅳ are lower than those in stage Ⅴ(P<0.05);poor appetite and appetite,general drowsiness,head swelling,heavy limbs There was no significant difference in the scores of greasy or urine smell,body obesity,and dementia and irritability symptoms(P<0.05).2.5 There are differences in the body composition indexes of patients with DKD Ⅲ-Ⅴstages of wet syndrome.The results show that there are statistical differences in body fat mass between stages Ⅲ and Ⅴ and between stages Ⅳ and Ⅴ(P<0.05);The percentages are statistically different between phases Ⅲ and Ⅴ,and between phases Ⅳ and Ⅴ(P<0.05);the three indicators of intracellular fluid,extracellular fluid and total water are between phases Ⅲ,Ⅳ and Ⅲ There is a statistical difference between stage and stage Ⅴ(P<0.05),and there is no statistical difference between stage Ⅳ and stage Ⅴ(P>0.05);muscle mass,trunk muscle mass,and skeletal muscle mass are in stage Ⅲ and stage Ⅳ There was a statistical difference between phases Ⅲ and Ⅴ(P<0.05),and there was no statistical difference between phases Ⅳ and Ⅴ(P>0.05);fat-free body mass and basal metabolism were in phase Ⅲ and Ⅳ There are statistical differences between phases and between phasesⅢ and Ⅴ(P<0.05),and there is no statistical difference between phases Ⅳ and Ⅴ(P>0.05);the area of visceral fat is in phases Ⅳ,Ⅴ and Ⅲ There is a statistical difference between phases and Ⅴ(P<0.01);there is a statistical difference between the body mass index between phases Ⅳ and Ⅴ(P<0.05);two indexes of protein and inorganic salts are at phase Ⅲ and Ⅳ There was a statistical difference between the Ⅲ and Ⅴ stages(P<0.05),and there was no statistical difference between the Ⅳ and Ⅴ stages(P>0.05);there was no statistical difference between the waist-to-hip ratios in each stage Academic difference(P>0.05).2.6 The symptom scores of each stage of DKD Ⅲ-Ⅴ are correlated with human body composition:chest tightness and lumpy symptom scores are negatively correlated with extracellular fluid,total water,inorganic salts,protein,lean body mass,muscle mass,and basal metabolism(P<0.05),the correlation coefficients are R=-0.201,R=-0.189,R=-0.188,R=-0.211,R=-0.192,R=-0.190,R=-0.190;skin pruritus symptom score and extracellular fluid,Total water,inorganic salt,protein,lean body mass,muscle mass,and basal metabolism were positively correlated(P<0.05),the correlation coefficients were R=0.196,R=0.213,R=0.189,R=0.220,R=0.191,R=0.180,R=0.180;skin pruritus symptom score is negatively correlated with fat percentage(P<0.05),correlation coefficient R=-0.204;body obesity symptom score is correlated with intracellular fluid,extracellular fluid,total water,inorganic salt,Protein,body fat mass,visceral fat area,fat percentage,body mass index,waist-to-hip ratio,muscle mass,lean body mass,skeletal muscle mass,trunk muscle mass,and basal metabolism were positively correlated(P<0.05),and the correlation coefficients were respectively R=0.325,R=0.239,R=0.260,R=0.318,R=0.195,R=0.724,R=0.561,R=0.599,R=0.853,R=0.385,R=0.292,R=0.288,R=0.324,R=0.427,R=0.288;there was no significant correlation between the scores of symptoms of dysphagia and dysfunction with nausea and vomiting,general drowsiness,swelling of head and limbs,dementia and irritability(P>0.05).Regression analysis results showed that:physical obesity symptom score and muscle mass(OR=1.165,95%CI 1.029-1.320,P=0.016),physical obesity symptom score and body fat mass(OR=1.307,95%CI 1.186-1.440,P=0.000).Conclusion:1 Literature researchThe proportion of dampness syndrome gradually increases with the progression of the course of DKD.2 Clinical research2.1 The symptom scores of patients with wet syndrome of DKD stage Ⅲ-Ⅴ are different:stage Ⅲ and stage Ⅳ chest tightness and rash symptom score are lower than stage Ⅴ,and stage Ⅲ and stage Ⅳ pruritus symptom score are lower than stage Ⅴ.2.2 There are differences in the body composition of patients with DKD Ⅲ-Ⅴ stages of wet syndrome:stage Ⅲ intracellular fluid,extracellular fluid,total water,inorganic salt,protein,lean body mass,muscle mass,skeletal muscle mass,trunk muscle mass,The level of basal metabolism is lower than that of stage Ⅳ and stage Ⅴ,the body fat mass,percentage of fat,and visceral fat area of stage Ⅲ and Ⅳ are higher than stage Ⅴ,and the body mass index of stage Ⅳ is higher than that of stage Ⅴ.2.3 DKD Ⅲ-Ⅴ stage wet syndrome symptom score is correlated with human body composition:chest tightness,rash symptom score and extracellular fluid,total water,inorganic salt,protein,lean body mass,muscle mass,and basal metabolism are negatively correlated with skin pruritus The symptom score is positively correlated with extracellular fluid,total water,inorganic salt,protein,lean body mass,muscle mass,and basal metabolism,and negatively correlated with fat percentage;the body obesity symptom score is correlated with intracellular fluid,extracellular fluid,and total water,Inorganic salt,protein,body fat mass,visceral fat area,fat percentage,body mass index,waist-to-hip ratio,lean body mass,muscle mass,skeletal muscle mass,trunk muscle mass,and basal metabolism are positively correlated.The OR of the body obesity symptom score and muscle mass was 1.165,and the OR of the body obesity symptom score and body fat mass was 1.307.