Relationship Between C-reactive Protein/albumin (CAR) And TCM Syndromes Of Diabetic Nephropathy Stage Ⅲ And Ⅳ And Analysis Of Carotid Artery Plaqu

Purpose:1.To explore the difference of CAR in DKD stage Ⅲ and Ⅳ and the relationship between CAR and relevant laboratory indicators,to explore the correlation between CAR and various TCM syndroms of DKD,and to evaluate the development of DKD disease.2.To observe the correlation between CAR and carotid plaque,so as to provide reference for guiding the occurrence and development of arteriosclerotic diseases.Material and method:A total of 180 diabetic nephropathy patients admitted to the endocrinology ward of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2022 to December 2022 were collected.General information such as gender,age,blood pressure,systolic blood pressure(SBP),diastolic blood pressure(DBP),disease course,body mass index(BMI),smoking history and so on were collected.To record the results of the patient’s post-admission examination,Fasting blood glucose(FPG),glycated hemoglobin(Hb A1c),serum creatinine(Scr),urea nitrogen(BUN),blood uric acid(UA),Urinary Albumin/ creatinine(UACR),glomerular filtration rate(e GFR),total cholesterol(CHOL),triglyceride(TG),high-density lipoprotein(HDL-C)were extracted,low-density lipoprotein(LDL-C),C-reactive protein(CPR),albumin(ALB),CAR ratio calculated,carotid ultrasound report.DKD cases were divided into 103 cases of DKD stage Ⅲ and 77 cases of DKD stage Ⅳ by UACR level.The data differences between the two groups were compared,and the relationship between CAR and related physicochemical indexes was further analyzed.The four diagnosis information of patients was collected and classified according to the classification standard of traditional Chinese medicine,which was divided into primary deficiency syndrome and standard demonstration.There were 56 cases of Yin deficiency,57 cases of Yang deficiency,53 cases of qi deficiency and 14 cases of blood deficiency.The standard evidence was divided into 99 cases of blood stasis syndrome and 81 cases of phlegm turbidity syndrome.The distribution of syndrome types was analyzed,and the relationship between CAR and TCM syndrome and carotid artery plaque was analyzed.Excel was used to input data into the database,SPSS26.0 and Medcalc were used for statistical analysis.First,the measurement data were tested for normality and homogeneity of variance.If they were consistent with normal distribution and homogeneity of variance,they were represented by mean ± standard deviation and T-test was conducted;otherwise,they were represented by median interquartile spacing and rank-sum test was conducted.Counting data was expressed by the number of cases percentage and chi-square test was conducted.According to the normal distribution,the correlation analysis of the two factors was conducted by Person or Spearman correlation.Multiple Logistic regression was used to analyze the influencing factors.Receiver operation characteristic(ROC)curve was plotted to evaluate the efficacy of CAR in predicting diabetic nephropathy and carotid artery stenosis,including AUC value,sensitivity and specificity,and Cut-off value was calculated.(P < 0.05)indicated statistically significant difference.Results:1.deficiency syndrome,Yin deficienc The BMI of DKD stage III patients was higher than that of stage IV patients,and the difference was statistically significant(P< 0.05).DKD stage IV patients had higher blood pressure than stage III patients,and the difference in SBP was statistically significant(P < 0.05).However,there were no significant differences in gender,course of disease,smoking history,age and DBP between the two groups(P>0.05).2.e GFR decreased with the progression of the disease between the two groups,the difference was statistically significant(P< 0.05),and there were statistically significant differences in TG,CHOL,FPG,Hb A1 c,Scr,UA,ALB and UAER between the two groups(P< 0.05).3.The difference in CAR level between the two groups was statistically significant(P< 0.05),and the CAR level was increasing successively.4.In DKD stage III,Yin deficiency syndrome distributed the most,followed by qi deficiency syndrome,Yang deficiency syndrome and blood deficiency syndrome.In DKD stage IV,Yang deficiency syndrome was the most distributed,followed by qi deficiency syndrome,blood deficiency syndrome and Yin deficiency syndrome.In the standard demonstration,blood stasis syndrome was more distributed,followed by phlegm turbidity syndrome.5.The CAR value of this deficiency syndrome from high to low was blood deficiency syndrome,Yang deficiency syndrome,qi y syndrome.Blood stasis syndrome was the highest,followed by phlegm-turbidity syndrome.6.Correlation between CAR and diabetic nephropathy: CAR was positively correlated with DKD(r=0.225,P< 0.05).ROC curve analysis: The tangent point value of CAR predicted DKD was 0.33,the sensitivity was 87.01%,the specificity was 74.76%,and the area under the curve(AUC)was 0.861(0.802-0.908)(P< 0.01).7.Correlation analysis between CAR and carotid plaque: CAR was positively correlated with carotid plaque(r=0.152,P<0.05).ROC curve analysis: CAR predicted carotid plaque tangency value of 0.06,sensitivity of 88.80%,specificity of 36.36%,area under curve(AUC)of 0.664(0.5899-0.732),(P< 0.01).8.Correlation analysis between diabetic nephropathy and carotid plaque: DKD was positively correlated with carotid plaque(r=0.208,P< 0.05).ROC curve analysis: DKD predicted the tangent point value of carotid plaque was 1,the sensitivity was 80.52%,the specificity was38.83%,and the area under the curve(AUC)was 0.597(0.521-0.669)(P < 0.05).Conclusions:1.In this syndrome,.DKD is based on Yin deficiency at the beginning,and gradually develops into qi deficiency,Yang deficiency and blood deficiency with the progress of the disease.CAR is also on the rise.Demonstrated that as the disease continues to change,the level of inflammation in the body increases gradually.In the standard demonstration,the CAR value of blood stasis syndrome was significantly higher than that of phlegm-turbidity syndrome.Blood stasis is both a pathogenic factor and pathological product.Blood stasis always runs through DKD and is the central and important link.CAR can evaluate the disease progression of DKD and is expected to be a new evaluation index of DKD disease.2.CAR was positively associated with the likelihood of developing carotid plaque.The higher the CAR number,the higher the level of inflammation in the patient,and the more likely the patient to develop carotid plaque.It can provide reference for arteriosclerotic diseases.