Study On The Correlation Between TCM Syndrome Factors, Medication Rules And Test Indicators Of Diabetic Kidney Diseas

Background:Diabetic kidney disease(DKD)is a type of chronic kidney disease caused by diabetes mellitus.The clinical features of DKD are persistent increase of albuminuria and/or progressive decrease of glomerular filtration rate.In the past decade,the incidence and prevalence of DKD in China have increased significantly,and 16.4%of the 120 million patients with chronic kidney disease in China are caused by diabetic kidney disease.According to statistics,there were 114 million adult diabetic patients in China in 2017.About 20%-40%of diabetic patients were complicated with diabetic kidney disease,which seriously endangers the physical and mental health of Chinese residents.Objective:The purpose of this study was to analyze the cases of inpatients with diabetic kidney disease in Dongzhimen Hospital of Beijing University of Chinese Medicine(hereinafter referred to as Dongzhimen Hospital)by using data mining method,to understand the characteristics of TCM syndromes of diabetic kidney disease,to explore the correlation between TCM syndrome elements and Laboratory test parameters,and to systematically summarize the treatment ideas based on syndrome differentiation and prescription medication of experts in Dongzhimen Hospital for diabetic kidney disease.Methods:The inclusion and exclusion criteria were formulated and used to collect the clinical data of patients with diabetic nephropathy.Microsoft Excel 2021 was used to establish a clinical data database.The patients’ data were imported into the ancient and modern cloud medical record platform software,and the clinical symptoms,traditional Chinese medicine names and meridions that had been entered were standardized and unified.The general information,four diagnostic information and syndrome elements of the patients were analyzed by descriptive statistics,and the data were organized and analyzed by the data mining function module to summarize the rules of prescription and medication.The patient data were imported into SPSS,and Logistic regression analysis was used to explore the relationship between TCM syndrome elements and Laboratory test parameters.Results:397 cases of diabetic kidney disease were analyzed for TCM syndromes and medication rules,and 132 cases of diabetic kidney disease were analyzed for the correlation between TCM syndromes and test indicators.The results were as follows:1.The common TCM syndrome elements in patients with diabetic kidney disease mainly include blood stasis syndrome,qi deficiency syndrome,water dampness syndrome,phlegm dampness syndrome,Yang deficiency syndrome,knot heat syndrome,Yin deficiency syndrome and phlegm heat syndrome.2 The common clinical symptoms of patients with diabetic kidney disease included fatigue,foamy urine,obesity,dry mouth,nocturia,edema,blurred vision,insomnia,numbness,cold limbs,etc.The common tongue manifestations were dark tongue,red tongue,light tongue,etc.The common tongue coating is greasy,yellow,white,etc.The common pulse signs were pulse string,pulse heavy,pulse slippery,etc.3 The drugs with high clinical use frequency of diabetic kidney disease included Astragalus membranaceus,Salvia miltiorrhiza,Angelica sinensis,Atractylodes atractylodes,Bupleurum,Scutellaria baicalensis,Poria,Pinellia,Rehmanniae,Chuanxiong,etc.4 Salvia miltiorrhiza,Angelica sinensis,Pinellia sinensis,Chuanxiong,Rehmanniae radix,rhubarb,red peony root,Gegeng,Niuxi,etc.,were highly correlated with blood stasis syndrome.The drugs with high correlation with qi deficiency syndrome were Astragalus membranaceus,Salvia miltiorrhiza,Angelica sinensis,Atractylodes rhizoma,Poria cocos,etc.Salvia miltiorrhiza,Angelica sinensis,Radix bupleurum,Scutellaria baicalensis,Pinellia,Rehmanniae,etc.,were highly correlated with knot heat syndrome.The drugs with high correlation with water-dampness syndrome were Astragalus membranaceus,Angelica sinensis,Salvia miltiorrhiza,Atractylodes atractylodes,Poria cocos,Zhuling,etc.The drugs with high correlation with phlegm-dampness syndrome included Atractylodes rhizoma,Astragalus membranaceus,Poria cocos,Tangerine peel,Pinellia pinellia,etc.Salvia miltiorrhiza,Angelica sinensis,Radix bupleurum,Radix scutellariae,Atractylodes atractylodes were highly correlated with phlegm-heat syndrome.The drugs with high correlation with Yang deficiency syndrome were Astragalus,Angelica,Salvia miltiorrhiza,Poria,Chuanxiong,etc.Salvia miltiorrhiza and Rehmanniae were highly correlated with Yin deficiency syndrome.5 The high correlation between symptoms and medication included as follow.Fatigue:Astragalus membranaceus,Salvia miltiorrhiza,Angelica sinensis,Poria cocos.Fat body:Astragalus membranaceus,Angelica sinensis,Atractylodes rhizoma,Scutellaria baicalensis;Foam urine:salvia miltiorrhiza,bupleurum;Dry mouth:salvia miltiorrhiza,Bupleurum,Scutellaria baicalensis;Edema:Astragalus membranaceus,Angelica sinensis,salvia miltiorrhiza;Blurred vision:Astragalus,salvia miltiorrhiza,Angelica;Limb numbness:Astragalus membranaceus,salvia miltiorrhiza;Nocturia frequency:salvia miltiorrhiza,Angelica;Cold limbs:Astragalus membranaceus.6 The effect of elevated HB on blood stasis syndrome was statistically significant(OR=0.026,95%CI 0.001-0.538,P=0.018).The effect of CREA elevation on qi deficiency syndrome was statistically significant(OR=4.965,95%CI 1.481-16.648,P=0.009).The effect of elevated U-Cr on heat accumulation syndrome was statistically significant(OR=0.127,95%CI 0.023-0.703,P=0.018).The effect of lower U-Cr group on Yin deficiency syndrome was statistically significant(OR=4.765,95%CI 1.322-17.175,P=0.017),and the effect of IL-6 on Yin deficiency syndrome was statistically significant(OR=0.212,95%CI 0.05-0.904,P=0.017).P=0.036).SBP had a statistically significant effect on Yin deficiency syndrome(OR=0.199,95%CI 0.075-0.53,P=0.001).The influence of BMI on phlegm dampness syndrome was statistically significant(OR=9.434,95%CI 2.558-34,796,P=0.001).TG had a statistically significant effect on Yang deficiency syndrome(OR=3.407,95%CI 1.357-8.551,P=0.009),U-UV elevated group had a statistically significant effect on Yang deficiency syndrome(OR=1.594,95%CI 0.567-4.482,P=0.038).U-cr elevated group had a statistically significant effect on phum-heat syndrome(OR=11.294,95%CI 1.38692.03,P=0.024),HCY had a statistically significant effect on phum-heat syndrome(OR=3.697,95%CI 1.252-10.916,P=0.024).The effect of α1-MG on phlegm-heat syndrome was statistically significant(OR=0.178,95%CI 0.035-0.896,P=0.036),and The effect of BMI increased group on phlegm-heat syndrome was statistically significant(OR=43.609,95%CI 3.726-510.4,P=0.003).Conclusion:The core drugs of traditional Chinese medicine for diabetic kidney disease in Dongzhiben Hospital are Astragalus membranaceus,salvia miltiorrhiza,Angelica sinensis,Atractylodes atractylodes,Radix bupleurum,Scutellaria baicalensis,Poria,Chuanxiong,Tuporia,Rehmannia,etc.The commonly used drug pairs are Astragalus membranaceus-Radix salvia miltiorrhiza,Angelica membranaceus-Radix salvia miltiorrhiza,Atractylodes membranaceus,Poria membranaceus membranaceus,etc.The core prescriptions of diabetic kidney disease were:①Angelica sinensis,Astragalus membranaceus,salvia miltiorrhiza;②Atractylodes rhizoma,Poria cocos;③Radix bupleurum and Radix scutellariae;④Tangerine peel,pinellia;⑤leech,bitter orange,achyranthes bidentata and cinnamomum twig;⑥White peony and red peony;⑦Chuanxiong Rhizoma,Zhuling poria,Tuporia and rhubarb.Elevated hemoglobin may be a protective factor for blood stasis syndrome of diabetic kidney disease.Elevated serum creatinine may be a risk factor for qi deficiency syndrome.Increased urine creatinine may be a protective factor for heat transfer syndrome.Decreased urine creatinine may be a high risk factor for Yin deficiency syndrome,and increased interleukin-6 and systolic blood pressure may be protective factors for Yin deficiency syndrome.Increased body mass index may be a risk factor for phlegm dampness syndrome.Elevated triglyceride and 24-hour urine output may be risk factors for Yang deficiency syndrome.The increased level of urine creatinine,homocysteine and body mass index may be the high risk factors of phlegm-heat syndrome,and the increased level of α1-microglobulin may be the protective factor of phlegm-heat syndrome.