Study On The Characteristics Of TCM Syndrome And Physico - Chemical Index Of Diabetic Nephropathy

ObjectiveMetabolic syndrome(MS), type 2 diabetes mellitus(T2DM) and diabetic nephropathy(DN) have an obvious rule about the occurrence and development. Along with the aggravation of the condition, treatment effect is poorer and less. Clinical practice found that some patients with high susceptibility to DN. Therefore, early detection and early intervention are the difficulty and key point in clinic. The paper, based on the Beijing science and technology major project issues of "Common kidney disease mainly the quantitative diagnosis of syndromes of traditional Chinese medicine model" (D131100004713004), and state of traditional Chinese medicine industry special "TCM prevention and control of chronic disease community management mode study" (201207012) aims to research on TCM syndrome and characteristics of the physical and chemical indicators of the origin and development of DN, and provide a reference for prevention and control of early DN with traditional Chinese and western medicine.Methods1. Literature research:Clinical reports on DN were collected in recent 10 years CNKI, and syndrome differentiation, various types of statistical frequency, frequency and percentage were counted.2. Formulating the TCM Syndrome Scale:Previous data (literature review, previous research foundation, relevant specification) combined with rounds of expert consultation.3. Clinical research:Researchers were trained to assess syndrome scale for consistency check, after which ≥85%,361 patients included with 120 MS,121 T2DM(diabetes without DN), and 120 DN (Mogensen Ⅲ&Ⅳ period) in the 14 hospitals in Beijing and the Beijing Dongcheng community health management center were prospectively observed. TCM syndromes information and objective laboratory indexes and other related information were collected, database was established, and each index was analyzed, to compare physical and chemical indicators, and the traditional characteristics of syndrome distribution of the three groups. The main disease and syndrome characteristics in different stages were analyzed by the cluster analysis and principal component analysis. The correlations between TCM Syndromes and physicochemical index were analyzed by canonical correlation analysis.Results1 Literature researchSyndrome types of traditional Chinese medicine of 4484 cases of DN in the top ten were blood stasis, Qi and yin deficiency syndrome, yin deficiency, Qi deficiency, yang deficiency, yin and yang deficiency syndrome, phlegm dampness, blood deficiency syndrome, damp heat syndrome, and yin deficiency syndrome.165 cases of early DN showed mainly deficiency in origin, such as the dryness heat due to yin deficiency syndrome and Qi and yin deficiency syndrome, without Yang deficiency and excess in superficiality syndrome. Syndrome types of 1839 cases of DN III period in the top ten were Qi and yin deficiency syndrome, blood stasis, yin deficiency, Qi deficiency, yang deficiency, phlegm dampness, the dryness heat due to yin deficiency syndrome, damp heat syndrome, liver and kidney yin deficiency, and dampness. 1732 cases of DN IV period in the top ten were blood stasis, yin deficiency, Yang deficiency, Qi deficiency, Qi and yin deficiency, yin and yang deficiency, phlegm dampness, blood deficiency, and Qi and blood deficiency syndrome.748 cases of DN IV stage in the top ten were blood stasis, yang deficiency, yin and yang deficiency, blood deficiency, dampness and turbid, Qi and yin deficiency, yin deficiency, spleen and kidney yang deficiency, and Qi deficiency syndrome. The literature suggested that with the progression of the disease, ratios of blood stasis, yang deficiency, yin and yang deficiency, blood deficiency syndrome, and dampness (phlegm and dampness syndrome, Wet muddy syndrome) increased gradually. Blood stasis syndrome was throughout the period of DN.2 Results of clinical research2.1 Characteristics of the physical and chemical indicators among the MS, diabetes without DN and DNAt baseline, There was no significant difference in sex and age among the MS, diabetes without DN and DN (P>0.05). Compared with MS group, diabetes without DN group had a lower proportion of smoking(P<0.05), and DN group had a lower proportion of smoking and alcohol consumption(P<0.05).There were more overweight and obese subjects (BMI>25kg/m2,male WHR>0.86,female WHR>0.82)in MS group than in diabetes without DN and DN groups(P<0.05). There were more overweight subjects (BMI 25-27.9kg/m2) in diabetes without DN group than in DN group(P<0.05). Abdominal obesity accounted for absolute advantage in three groups. There was no difference between MS group and the other two, and there were more abdominal obesity subjects in DN group than in diabetes without DN group(P<0.05). There was no difference in diastolic blood pressure, BUN, Ccr and GFR among the three groups(P>0.05). Levels of BMI, SCr, UA, TG, LDL, TC were significantly higher in MS group than in diabetes without DN group (P<0.01),and levels of FPG and HbA1c were significantly lower(P<0.01).Compared with diabetes without DN group, there were higher levels of FPG and HbAl c and lower level of HDL in DN group(P<0.05). Level of systolic blood pressure was much higher in stage Ⅲ DN group than in diabetes without DN group(P<0.05),and there was no difference in SCr, UA, FPG, HbAlc, TG, HDL, LDL and TC(P>0.05). Level of systolic blood pressure was higher in stage IV DN group than in stage Ⅲ DN group(P<0.05),and levels of WHR, SCr and FPG were much higher(P<0.01), and level of HDL was lower(P<0.05).DN subjects had much higher levels of BMI and WHR. From stage Ⅲ to stage Ⅳ, levels of WHR,SCr and FPG increased, and HDL decreased. Level of systolic blood pressure increased from diabetes without DN group to DN group.2.2 TCM syndrome among the MS, diabetes without DN and DNQi deficiency and yin deficiency had the highest rate of syndrome in the three groups. Damp heat and blood stasis syndromes were more common in MS and diabetes without DN groups. Blood stasis and phlegm syndromes were more common in DN group. Rate of dampness syndrome was very low.Qi deficiency, blood deficiency, Yang deficiency, heat, blood stasis and phlegm turbidity syndrome factor among three groups were not the same (P<0.05), while there was no difference in yin deficiency, qi stagnation water wet and damp heat syndrome(P>0.05). Proportions of Qi deficiency, blood deficiency and yang deficiency of MS were significantly lower than diabetes without DN group (P<0.05), while heat proportion was significantly higher (P< 0.05). Proportions of Qi deficiency, yang deficiency, blood stasis, and phlegm of DN were significantly higher than diabetes without DN group(P< 0.05).Rate of phlegm turbidity syndrome was much higher in stage III DN group than in diabetes without DN group(P< 0.05),and rates of Qi deficiency and blood deficiency in stage IV DN group were much higher than in stage Ⅲ DN group(P< 0.05).From the laws of syndrome factor combination, combination of two syndromes was the largest proportion in the three groups. Combinations of two, three, five, seven and eight syndromes made no difference(P>0.05). Proportion of single syndrome was lower in DN group than in MS group (P< 0.05). There were higher proportions of combinations of four, six and nine syndromes in DN group (P< 0.05).Combinations of ten syndromes never appeared.Proportions of syndromes of intermingled deficiency and excess were the most, which made significant difference with deficiency syndrome and excess syndrome (P< 0.05). Proportion of deficiency syndrome made no difference(P>0.05).Compared with MS group, proportions of excess syndrome were lower in the other two groups(P< 0.05).There was no difference in excess syndrome and syndromes of intermingled deficiency and excess between diabetes without DN group and DN group(P>0.05).It could be seen that from MS to diabetes and DN, with progress of the disease, syndrome factor combination gradually increased, proportions of syndrome of intermingled deficiency and excess was more, and simple deficiency or excess syndrome proportion was lower, and syndromes became more complex.2.3 Four diagnostic methods information among the MS, diabetes without DN and DNTop 10 frequency of four diagnostic information in three groups:MS:dry mouth, pharynx dry mouth bitter dry mouth, irritability or depression or sigh, languid, dizzy, waist knee soreness and body weight, spontaneous perspiration, tinnitus, deafness, afraid of hot sweat or night sweats; Diabetes:pharynx dry mouth, languid, brown urine, less gas lazy words, waist and knee pain, loss of libido, five upset hot, spontaneous perspiration, afraid of hot sweat or night sweats, tinnitus deafness; DN:languid, spontaneous perspiration, less gas lazy words, pharynx dry mouth, afraid of hot sweat or night sweats, dizziness, loss of libido, five upset hot, cold brown urine, cold limbs.Pharynx dry mouth, languid, spontaneous perspiration, and afraid of hot sweat or night sweats had a higher ratio, which reflected Qi deficiency and yin deficiency were the basic pathogenesis of each group.2.4 Classification characteristics of MS, diabetes without DN and DN After clustering analysis combining principal component analysis MS is divided into 5 types:Type 1:Qi and Yin deficiency syndrome:the main symptoms include afraid of hot sweat or night sweats, dry eyes, five upset hot; Secondary symptoms including less gas lazy words.Type 2:Both Qi and blood deficiency and blood stasis, diseases in heart,spleen,renal:the main symptoms include abdominal distention after having dinner, often abdominal distension, loss of libido, itchy skin. Secondary symptoms, including oral, dark purple heart palpitations palpitation, numbness of limbs, forgetfulness, dizziness, insomnia, much dream.Type 3:Qi and Yin deficiency and Qi oppilate,diseases in liver and kidney:the main symptoms include spontaneous perspiration, tinnitus, deafness body trapped weight, waist and knee pain, languid; Secondary symptoms include dizziness, irritability or depression or sigh.Type 4:Blood stasis with overmuch heat and humid:main symptoms including pain have a fixed place especially at night, dark purple tongue sublingual vein circuity and blue. Secondary symptoms include thirst and cold drinks, brown urine, mouth too sticky.Type 5:Yang deficiency syndrome, disease in the spleen and kidney, urinary frequency capacity is much, loose stools, foot swelling.2.4.2 Diabetes without DN is divided into four categories:Type 1:Qi and Yin deficiency syndrome:including throat dry, dry mouth, languid.Type 2:Both Yin and Yang deficiency syndrome:the main symptoms include spontaneous perspiration, afraid of hot sweat or night sweats, waist and knee pain, tinnitus, deafness, loss of libido, secondary symptoms including less gas lazy words, form of a cold, cold extremities, five upset hot, brown urine.Type 3:Yin and blood deficiency and qi stagnation and blood stasis syndrome:the main symptoms, including palpitations palpitation, forgetfulness, vision dim, onyx, not extremities numbness, oral, dark purple skin to a fault, pain has a fixed place especially at night, dark purple tongue circuity purple sublingual vein, secondary symptoms include dry eyes, irritability or depression or sigh, insomnia, much dream.Type 4:Qi Yin and Yang deficiency syndrome, disease in the lungs, heart, spleen:the main symptoms, including palpitations, shortness of breath, cough low weak, dizzy, dizzy, pale yellow, lip color light. Minor symptoms, including loose stools, frequent urination quantity many, foot edema, eat less stay, chest swelling in about.2.4.3 DN is divided into four categories:Type 1:Qi and Yin deficiency syndrome and disease in renal:the main symptoms include loss of tooth and hair, waist and knee pain, loss of libido, less gas lazy words. Secondary symptoms include brown urine, dizziness, pharynx dry dry mouth, afraid of hot sweat or night sweats.Type 2:Hot sheng qi stagnation and blood stasis and qi deficiency syndrome:the main symptoms include oppilate, often abdominal distension full, chest side bilge full, palpitations palpitation, general edema, skin to a fault, pain has a fixed place especially at night, dark purple tongue circuity purple sublingual vein, oral dark purple. Minor symptoms, including palpitations, shortness of breath, low weak cough.Type 3:Blood deficiency and Yin deficiency and qi stagnation syndrome:the main symptoms include vision dim, lip nail color light; Secondary symptoms include irritability or depression or sigh, stool stem node.Type 4:Damp heat and blood deficiency Yang deficiency syndrome, disease in the spleen, heart, kidney, main symptoms include eating less stay, food after abdominal distension, insomnia, much dream, extremities numbness, dry mouth, mouth body trapped, yellow greasy coating on the tongue; Secondary symptoms include forgetfulness, night to urinate, frequent urination quantity, look bad.MS can be divided into five types, diabetes without is divided into four categories, DN is divided into four categories. Three comparison has the following characteristics:Qi and Yin deficiency syndrome can often be found in both groups. Much more syndrome factor combination; syndrome of intermingled deficiency and excess was more in MS and DN than that in diabetes without DN; More Blood deficiency syndrome in DN and DN than MS.2.5 The relationship of MS, diabetes without DN, DN and the physical and chemical index correlation. Syndrome factor and laboratory indexes of canonical correlation analysis found that the MS of LDL have negative correlation relationship with Yin deficiency syndrome (P<0.05); Systolic blood pressure and blood stasis syndrome of DN exist positive correlation (P<0.05).Conclusion1 Higher systolic blood pressure, BMI, WHR, Scr, FPG, HbAlc, and low HDL is DN (progression of DN) risk factors; Higher systolic blood pressure, WHR, SCr, FPG and low HDL is the progress of DN (stage Ⅲ to Ⅳ) risk factors.2 Yin deficiency, damp and hot is the MS, diabetes, kidney disease, DN is one of the common element of evidence, the factors are common pathogenesis characteristic, along with the progress, the type of increasingly complex; Qi deficiency, Yang deficiency is the development of DN progression to diabetes, MS of kidney disease and progression of DN) pathological factors and risk factors; Blood stasis and phlegm turbidity is DN (DN progression of DN) pathological factors and risk factors; Hemopenia kidney disease progression to diabetes is a MS as well as progress in DN (stage Ⅲ to Ⅳ) pathological factors and risk factors.3 Syndrome factor decision combined with clustering analysis and principal component analysis can be more accurate study of syndromes of diseases, but need enough number of cases.4 LDL have negative correlation relationship with Yin deficiency syndrome in MS; systolic blood pressure have positive correlation with Qi deficiency syndrome in DN.