Study On The Correlation Between Protein Energy Consumption And PLR, NLR And Other Indicators And TCM Syndrome Types In Hemodialysis Patient

Purpose:To investigate the relationship between protein-energy wasting(PEW)and serum platelet/lymphocyte ratio(PLR),serum neutrophil/lymphocyte ratio(NLR)in hemodialysis(HD)patients and the distribution pattern of TCM syndrome,screening out possible independent risk factors for concurrent PEW in HD patients,to explore whether PLR and NLR have predictive value for HD patients complicated with PEW,and thus to deepen the understanding of HD-PEW in Chinese medicine,provide a theoretical basis for the follow-up use of traditional Chinese medicine diagnosis and treatment technology for early intervention,relieve the economic pressure of patients,and improve their quality of life.Material and method:Using a case-control study method.Under the condition that the patients themselves or their families know the purpose and process of this trial and sign the informed consent voluntarily,collect the general data of outpatient routine HD patients from February 2021 to August 2021 in the Blood Purification Center of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,including: gender,age,dialysis age,occupation,primary disease,disease history,diet,etc;anthropometric indicators,including height,weight,upper arm circumference,triceps skinfold thickness,etc;and record laboratory indicators,including blood routine and blood biochemistry,such as platelet count,neutrophil count,lymphocyte count,hemoglobin,serum albumin,serum creatinine,parathyroid hormone,C-reactive protein,etc,and assess the adequacy of dialysis.According to the diagnostic criteria of PEW given by the International Society of Renal Nutrition and Metabolism in 2008,the enrolled patients were divided into the non-wasting group and the wasting group.At the same time,the TCM four diagnosis information of the patients was collected for syndrome differentiation.The data in the self-designed case investigation form(with attached photo)was entered with Excel software to establish a database.SPSS 25.0 statistical software was used for data analysis to derive the relationship between protein-energy wasting and PLR,NLR and other indicators in HD patients was obtained;draw ROC curve to analyze the predictive value of PLR and NLR for HD patients complicated with PEW;at the same time,looking for the distribution pattern of TCM syndrome types in HD-PEW patients and the relationship between PLR,NLR and TCM syndrome types in HD patients.Results:1.A total of 66 patients with HD were included in this study,including 48.48% in the non-wasting group and 51.52% in the wasting group.2.There was a correlation between protein-energy wasting and age,upper arm muscle circumference,serum albumin,serum prealbumin,C-reactive protein,PLR and NLR in HD patients(P<0.05);it was not related to gender,dialysis age,occupation,primary disease,disease history,body mass index,hemoglobin,serum total cholesterol,serum creatinine,blood urea nitrogen,parathyroid hormone and dialysis adequacy(P>0.05).3.Multivariate binary Logistic regression analysis showed that only age,upper arm muscle circumference,serum albumin,serum prealbumin,C-reactive protein and PLR were independent risk factors for PEW in HD patients(P=0.023,P=0.02,P=0.027,P=0.007,P=0.023,P=0.035);There was no significant correlation between NLR and HD-PEW(P=0.825>0.05).Among them,old age(OR=1.163,95% CI: 1.021-1.325),high C-reactive protein(OR=1.448,95% CI: 1.052-1.992)and high PLR(OR=1.021,95% CI: 1.001-1.040)can promote the complication of PEW in HD patients;High upper arm muscle circumference(OR=0.92,95% CI: 0.858-0.987),high serum albumin(OR=0.593,95% CI: 0.374-0.942)and high serum prealbumin(OR=0.958,95% CI: 0.929-0.989)can hinder the complication of PEW in HD patients.4.The ROC curve analysis showed that the area under the curve of C-reactive protein for predicting PEW in HD patients was 0.801(P=0.000<0.05,95% CI: 0.691-0.912);the area under the curve of PLR for predicting PEW in HD patients was 0.773(P=0.000<0.05,95% CI:0.662-0.885),and the optimal diagnostic cutoff was 181.66.5.The frequency of primary deficiency syndrome in HD patients: spleen and kidney qi deficiency syndrome(50%)> yin and yang deficiency syndrome(27.3%)> qi and yin deficiency syndrome(15.2%)> liver and kidney yin deficiency syndrome(7.5%),patients without spleen-kidney-yang deficiency syndrome.The frequency of occurrence of concurrent syndrome: dampness-turbidity syndrome(40.8%)> blood stasis syndrome(34.2%)>damp-heat syndrome(19.7%)> no syndrome(5.3%),patients with no water-qi syndrome;10cases with multiple concurrent syndrome,accounting for 15.2%.6.In terms of primary deficiency syndrome,the HD patients in the non-wasting group were dominated by spleen-kidney qi deficiency syndrome(71.8%),followed by qi and yin deficiency syndrome(12.5%);the wasting group were dominated by yin and yang deficiency syndrome(44.2%),and the second was spleen-kidney qi deficiency syndrome(29.4%);and there was a statistically significant difference in the proportion of HD patients between the two groups among the syndrome of primary deficiency syndrome(P=0.002<0.05).As far as the concurrent syndrome is concerned,the non-wasting group patients mainly had damp-turbidity syndrome(54.5%);the wasting group mainly suffered from blood stasis syndrome(44.2%),followed by damp-turbidity syndrome(30.2%);and there was a statistically significant difference in the proportion of HD patients between the two groups of concurrent syndrome(P=0.005<0.05).7.There was no statistical correlation between the level of PLR and each syndrome type of primary deficiency syndrome(P>0.05).The level of PLR was correlated with the blood stasis syndrome in the concurrent syndrome,and the difference was statistically significant(P=0.041<0.05);there was no statistical correlation between the level of PLR with other syndrome types in the concurrent syndrome(P>0.05).8.The deficiency of spleen and kidney qi accounted for the highest proportion of this deficiency syndrome in HD patients in low PLR level group and high PLR level group,which were 51.2% and 48% respectively;There was no significant difference in the proportion of HD patients in primary deficiency syndrome between the two PLR level groups(P>0.05).HD patients in low PLR level group took dampness turbidity syndrome as the main concurrent syndrome,accounting for 48.9%,and HD patients in high PLR level group took blood stasis syndrome as the main concurrent syndrome,accounting for 44.9%;There was no significant difference in the proportion of HD patients in concurrent syndrome between the two PLR level groups(P>0.05).Conclusion:1.The incidence rate of PEW in HD patients was 51.52%.2.PLR is an independent risk factor for PEW in HD patients.At the same time,age,upper arm muscle circumference,serum albumin,serum prealbumin and C-reactive protein in HD patients are also independent risk factors for PEW.3.PLR has certain predictive value for HD patients complicated with PEW.4.In terms of primary deficiency syndrome,HD-PEW patients are mainly yin-yang deficiency syndrome;In terms of concurrent syndrome,HD-PEW patients are mainly blood stasis syndrome,followed by dampness turbidity syndrome.5.There is a certain correlation between PLR level and blood stasis syndrome in HD patients.