Study On TCM Syndrome Factors In Patients With Moderate- And High-risk Diabetic Nephropathy Combined With Hyperhomocysteinemi

ObjectiveThis study aims to investigate the distribution of TCM syndrome factors in patients with medium and high risk diabetic nephropathy complicated with hyperhomocysteinemia,and to study the correlation between TCM syndrome factors and general conditions,laboratory tests and disease grading,so as to provide clinical basis for TCM dialectics in clinical practice.MethodsA total of 106 patients with diabetic nephropathy complicated with hyperhomocysteinemia were enrolled in this cross-sectional survey from March 2021 to March 2023.All patients were from the outpatient department of Nephrology and the inpatient departments of Nephrology and Endocrinology of Dongfang Hospital,Beijing University of Chinese Medicine.The basic information,general situation,laboratory examination and four diagnosis methods information of patients were recorded.The data of TCM clinical syndromes were collected according to the "Patient Data questionnaire of diabetic nephropathy complicated with hyperhomocysteinemia",and the syndrome factors were diagnosed according to the "weight Table of syndrome differentiation factors".SPSS software was used for statistical analysis.Rstudio’s Aripori association rules were used to analyze the correlation between syndrome factors.Binary logistics regression model was used to screen the correlation between the distribution of syndrome factors and the general condition of patients,laboratory indicators such as DKD and HHcy grades.ResultsGeneral data analysis:A total of 106 patients with diabetic nephropathy complicated with hyperhomocysteinemia were included in this study,including the number of male patients:the number of female patients=71:35,the percentage of male patients:the percentage of female patients=67%:33%.The age range of the included patients was between 28 and 86 years old,with an average age of 63.92 ± 10.53 years old,and the median age was 64 years old.According to the age of the patients,the patients were divided into young,middle-aged and elderly age groups,and the percentage of patients in the three age groups was young:middleaged:elderly=9:71:21;The duration of diabetes was 15.22± 9.032 years,with a median of 14 years.In terms of comorbidities and complications,it can be found that the top three comorbidities and complications of the included patients were hypertension,dyslipidemia and diabetic retinopathy.Among them,the incidence of hypertension and dyslipidemia in patients with DKD combined with HHcy was higher than 60%.In terms of the history of adverse habits,the proportion of patients with a history of smoking and drinking was 36%and 26%,respectively,which were less than 50%.Laboratory examination analysis showed that the distribution of BUN,eGFR,HDL and LDL was 6.2 ± 2.6 mmol/L,87.06 ± 18.48 ml/min/1.72 m2,1.27±0.37 mmol/L and 2.73±0.99 mmol/L,respectively.The distribution of TC was 4.36 ± 1.46 mmol/L,HbAlc was 7.68±1.96%,and the median of Hcy was 13.56 μmol/L.The range of eGFR stage was between stage 1 and 3a,mainly in stage 1 patients,no patients in stage 1 proteinuria stage,and the proportion of stage 2 and stage 3 was about 7.3,the risk classification was mainly medium risk,and the ratio of medium and high risk was about 7:3.Multivariate logistic regression analysis showed that gender was an independent risk factor for the progression of hyperhomocysteinemia(P<0.05).Compared with men,women had a 28.4%increased risk of progression from mild to moderate to severe HHcy grade.Distribution analysis of TCM syndromes:a total of 134 different symptoms and signs were collected from 106 patients in this study.The top 7 symptoms and signs with occurrence rates greater than or equal to 50%were as follows:Fatigue(54.72%),greasy tongue(53.77%),slippery pulse(53.77%),pulse string(50.94%),cloudy urine(50.00%),blurred vision(50.00%),thirst(50.00%).The distribution of disease location syndrome factors from high to low was kidney(64.15%),liver(42.45%)and spleen(38.68%).The distribution of essence deficiency syndrome elements from high to low was Yang deficiency(66.98%),Yin deficiency(62.26%),qi deficiency(59.43%)and blood deficiency(43.40%),The standard factors from high to low were dampness(61.32%),phlegm(43.40%),heat(41.51%),and blood stasis(19.81%).According to the degree of syndrome factors,no matter the deficiency syndrome factors,the degree of disease syndrome factors is mainly grade 1 syndrome factors(mild)and grade 2 syndrome factors(obvious),and the frequency of grade 3 syndrome factors is relatively rare.According to the composition of syndrome elements,the occurrence rate from high to low was double disease,seven disease,four disease,six disease,five disease(frequency>10%),the frequency of each disease combination was<5%,The combinations with relatively high frequency from high to low were Yin deficiency(4.72%),Yin deficiency+heat(4.72%),qi deficiency+blood deficiency+Yin deficiency+Yang deficiency+heat+dampness+phlegm(3.77%),qi deficiency+blood deficiency+ Yang deficiency+Yin deficiency+heat+dampness+qi stagnation(2.83%),qi deficiency+blood deficiency+Yang deficiency+Yin deficiency+dampness+phlegm(2.83%),qi deficiency+blood deficiency+Yang deficiency+Yin deficiency+dampness+phlegm(2.83%),and qi deficiency+blood deficiency(2.83%).In summary,the distribution characteristics of disease syndrome factors in patients with medium and high risk DKD combined with HHcy are mainly deficiency and excess.Deficiency can be seen in qi,blood and Yin Yang deficiency,and sputum,dampness,heat and blood stasis are more common in the empirical manifestation,and the manifestations are relatively mild.The distribution of TCM syndrome types:five syndrome types were obtained by cluster analysis:water stagnation of heart and lung,qi and blood stasis,liver-blood deficiency,kidney-yang deficiency,phlegm-dampness trapping spleen,heat syndrome,and Yin deficiency syndrome.Through the analysis and integration of association rules,six related rules of syndrome elements were obtained:(1)heat,Yin deficiency,blood deficiency and kidney=>Liver;(2)liver,qi deficiency,phlegm and Yin deficiency=>Deficiency of blood;(3)spleen,kidney,liver,Yin deficiency,Yang deficiency,blood deficiency,phlegm,dampness=>Qi deficiency;(4)deficiency of liver,heat and blood=>Yin deficiency;(5)spleen,kidney,phlegm,heat,Yang deficiency,qi deficiency=>Wet;(6)liver,spleen,phlegm,heat,dampness,Yang deficiency,blood deficiency;Yin deficiency,qi deficiency=>Kidney;Six syndrome types of DKD combined with HHcy in this study were obtained:(1)liver heat and Yin deficiency syndrome(2)phlegm dampness accumulation and spleen syndrome(3)kidney deficiency and dampness heat syndrome(4)kidney deficiency and water extensive syndrome(5)liver and spleen deficiency syndrome(6)Qi stagnation and blood stasis and water stagnation syndrome.The correlation analysis between syndrome elements and other factors showed that the history of hypertension was an independent risk factor for the diagnosis of dampness(P<0.05).The risk of the diagnosis of dampness in patients with hypertension was 3.06 times that in patients without hypertension.Gender is also one of the risk factors of syndrome element dampness.Compared with men,the probability of syndrome element dampness in women decreases by 35%.Elevated LDL was a risk factor for phlegm(P<0.05).For each unit increase in LDL,the risk of diagnostic sputum increased by 64%.The increase of age was an independent risk factor for heat syndrome element(P<0.05).For each increase of age from young people,the odds of being diagnosed with heat syndrome element increased by 4.42 times.Elevated TC was an independent risk factor for blood stasis(P<0.05).For every 1 unit increase in TC,the risk of blood stasis increased by 2.29 times.Hyperuricemia was also a risk factor for blood stasis(P<0.05).Compared with patients without a history of hyperuricemia,the risk of blood stasis increased by 6.48 times.The history of dyslipidemia was an independent risk factor for Yang deficiency(P<0.05).Compared with patients without a history of dyslipidemia,the probability of diagnosis of Yang deficiency was increased by 2.89 times.Diabetic retinopathy was an independent risk factor for blood deficiency(P<0.05),that is,compared with patients without diabetic retinopathy,the probability of diagnosis of blood deficiency in patients with DKD combined with HHcy was 3.3 times higher.Conclusion(1)The distribution of syndrome factors in patients with medium and high risk DKD combined with HHcy is mainly kidney,liver and spleen.The deficiency syndrome is mainly characterized by Yang deficiency,Yin deficiency,qi deficiency and blood deficiency.Damp,ness,phlegm,heat and blood stasis were the main factors in the standard empirical factors.(2)The syndrome types of patients with medium and high-risk DKD combined with HHcy from high to low were(1)liver heat and Yin deficiency syndrome(2)phlegm dampness accumulation and spleen syndrome(3)kidney deficiency and dampness heat syndrome(4)kidney deficiency and water extensive syndrome(5)liver and spleen deficiency syndrome(6)Qi stagnation and blood stasis and water stagnation syndromeGender,age,history of hypertension,hyperlipidemia,diabetic retinopathy,history of hyperuricemia,TC,LDL were independently correlated with multiple syndrome factors.