The Improvement Of Hemodialysis Patients With Malnutrition By The Moxibustion And Its Influence On Body Composition

BackgroundHemodialysis is one of the main alternative treatment for end-stage kidney disease(ESRD);due to the rising incidence of ESRD,the number of hemodialysis patients is on the rise.With the continuous development of hemodialysis technology,it has become a means on which ESRD patients depend on for survival.At the same time,long-term hemodialysis patients face a variety of complications,that bring heavy economic burden to the family and society.As a common complication of hemodialysis,malnutrition can lead to a decrease in immune function and a loss of physical activity,making patients susceptible to anemia,infection and functional decline of vital organs.And it is independent risk factor associated with mortality,hospitalization,and quality of life in hemodialysis patients.Therefore,improvement in malnutrition status of hemodialysis patients has become a hot field for research both home and abroad.Objective1 Through a multicenter,cross-sectional study of hemodialysis patients with malnutrition,the shared traits of Traditional Chinese Medicine(TCM)syndromes,and the correlation between nutritional state and spleen deficiency syndrome would be explored,to provide an important entry point for the TCM treatment of this ailment.2 Through the study of 190 cases of hemodialysis patients with malnutrition,the effects of moxibustion would be evaluated to provide clinical research evidence for the application of this technique on these patients.3 Through pre-and post-moxibustion bioelectrical impedance analysis,the impact on body composition was assessed and used to elucidate the possible targets for moxibustion treatment.Methods1 Association study between hemodialysis patients with malnutrition and spleen deficiency syndromeFrom February to April 2015,236 hemodialysis patients with malnutrition were enrolled from the dialysis centers of Wangjing Hospital of the Chinese Academy of Sciences Traditional Chinese Medicine,Changping Traditional Chines and Western Medicine Hospital,Aviation General Hospital,Beijing Fangshan Hospital of Traditional Chinese Medicine and Dongzhimen Hospital in a cross-sectional study and evaluated by Subjective Global Assessment(SGA).TCM syndrome diagnostic criteria and syndrome score were based on 2002 guidelines issued by the State Food and Drug Administration.Statistical analysis was carried out on the following aspects:? the characteristics of TCM syndromes in haemodialysis patients with malnutrition;?the relationship between the SGA score and syndrome score;?correlation analysis of SGA scores and symptom scores.2 Clinical study on moxibustion to improve hemodialysis patients with malnutritionFrom April to August 2015,190 hemodialysis patients with malnutrition fulfilling the criteria of SGA<5 and spleen-deficiency were enrolled from the dialysis centers of Wangjing Hospital of the Chinese Academy of Sciences Traditional Chinese Medicine,Changping Traditional Chinese and Western Medicine Hospital,Aviation General Hospital,Beijing Fangshan Hospital of Traditional Chinese Medicine and Dongzhimen Hospital in a prospective,randomized,multicenter study.They were randomly divided into the control and treatment groups,with 95 patients in each group.The control group received conventional western medicine treatment,while the treatment group received a 2-zhuang moxibution to SP06 and ST36 till local skin rubor,twice a week,for a total of 12 weeks.Observation indicators included:?evaluation of the SGA scale;? laboratory index including serum albumin,hypersensitive c-reactive protein,total iron binding force,triglycerides,blood urea nitrogen,serum creatinine,former albumin,transferrin,cholesterol,hemoglobin;?anthropometry indexes,including height,weight,body mass index(BMI),triceps skinfold(TSF),midarm circumference(MAC),upper arm muscle circumference(AMC)and body fat percentage.Statistical method was applied to analyze the change in the nutritional indexes before and after moxibustion,while the Calgar method,TCM syndrome criteria was used to assess the efficacy based on 2002 guidelines issued by the State Food and Drug Administration.3 Effects of moxibustion on body composition of hemodialysis patients with malnutritionFrom April to August 2015,64 patients fulfilling the criteria of SGA<5 and spleen-deficient were enrolled from the dialysis center of Wangjing Hospital,China Academy of Traditional Chinese Medicine.They were randomly divided into the treatment and control groups,with 32 cases in each group.The observation indexes included body fat(fat mass,FM),water content(total body water,TBW),intra-and extra-cellular water(ICW,ECW),ECW to ICW ratio(E/I),ECW to water content ratio(E/T)?muscle content,visceral fat,basal metabolic rate.Variation of the component indexes was analyzed by statistical analysis.The main statistical method used in this paper is the analysis of SPSS18.0 software.All statistical tests were double-sided,and the difference was statistically significant for P?0.05.The measurement data is calculated by means of the mean number or plus or minus standard deviation,and the difference between the group is compared with the independent sample t test or the rank and test.The counting data is calculated by frequency(composition ratio),and the ratio of chi-2 to precise probability is calculated.The correlation analysis involves the continuous variable,and the multivariate linear regression analysis is applied,which involves the logistic regression analysis of the hierarchical data.Results1 Correlation study between hemodialysis patients with malnutrition and spleen deficiency syndrome1.1 The relationship between the SGA score and the syndrome score1.1.1 The comparison of the total points of the syndrome is given by different SGA ratings.According to the SGA score,the difference of the total points in the SGA score was compared,and the difference was statistically significant.1.1.2 Different SGA scores for the comparison of the total integral of the virtual cardIn this paper,137 cases of simple virtual syndrome were analyzed and compared with the different SGA scores.P<0.05,the difference is statistically significant.1.2 The study of the SGA scores and symptoms1.2.1 The trend of the change of symptoms in different SGA scoresEach symptom integral was compared under different SGA scores.As malnutrition is aggravating,languid,less food,stay,shortness of breath lazy speech,GanYan dry mouth,lumbar debility,pleural effusion,convulsive spasm,faint,often abdominal distension,mouth full oily skin,a fault,lumbago and night urine qing long wait for a symptom of the mean symptom scores showed a trend of increasing.1.2.2 The logistic regression analysis of syndromes of TCM and the SGA score.The SGA score as the dependent variable,in patients with 26 symptoms as independent variables,orderly classification more logistic regression was used to statistics,the results showed that eating less stay(X3),shortness of breath lazy speech(X2),often abdominal distension full(X18),P<0.05,with statistical significance.E2?-0.085,E3 =-0.281,E18 =-0.236;So logit(P1 + P2 + P3)=-1.713 + 0.085 X2 +0.281 X3 + 0.236 X18,OR the OR value,e0.085 = 1.088,e0.281= 1.3 24,e0.236= 1.266.2 Clinical study on moxibustion in improving hemolysis patients with malnutrition2.1 The degree of malnutrition was comparedAfter treatment the treatment group patients with mild-to-moderate malnutrition(31.2%),normal nutrition patients(68.8%),no severe malnutrition patients,control group patients with mild-to-moderate malnutrition(91.4%),normal nutrition patients(8.6%),no patients with severe malnutrition,compared two groups,have examined the exact probability method,P<0.05,the difference was statistically significant.2.2 Comparison of the SGA scoreWithin the SGA group two groups of patients before and after treatment,the treatment group after treatment before 4.36±0.60 to 5.61±0.58,the control group from 4.60 ±0.59 to 4.81 ±0.67,the rank and inspection,P<0.05,the difference was statistically significant.The comparison of SGA difference between the two groups was compared with the treatment group of 1.21 plus or minus 0.63,the control group was 0.19 plus or minus 0.53,with the rank and test,P<0.05,the difference was statistically significant.2.3 Comparison of measurement anthropometryTreatment group patients with body mass index(BMI)compared with before treatment,body fat percentage content of different BMI from 22.14 ± 3.59 to 22.38±3.64,body fat percentage from 28.71 ± 7.11 to 28.96 ±7.35,P<0.05,the difference was statistically significant.Compared with the control group,the upper arm circumference(MAC),the upper arm muscle circumference(MAC),compared to the treatment,P>0.05,the difference was not statistically significant.2.4 Comparison of the symptom scoreTwo groups of patients after treatment of TCM symptom integral comparison between group and treatment group before and after treatment,the treatment group from 26.69±9.81 to 12.74±6.03,the rank and inspection,P<0.05,the difference was statistically significant.Compared with the control group,the control group changed from 25.43 ±10.46 to 24.63 ±10.75,the rank and test,P>0.05,the difference was not statistically significant.2.5 Efficacy evaluation2.5.1 Evaluation of the therapeutic effect of malnutritionThe treatment group was 90.0%effective,the control group was 11.1%effective,the control group was 11.1%?and the P<0.05 was statistically significant.2.5.2The evaluation of the curative effect of TCM syndromeTwo groups of TCM syndromes were compared,the treatment group was 93.7 percent effective,the control group was 8.6%effective,with chi 2 test,P<0.05,the difference was statistically significant.3 The effects of moxibustion on the body composition of hemodialysis patients with malnutrition3.1 Comparison of SGA scoreBefore the treatment,observation group compared with control group in SGA score no statistical difference(P>0.05),the control group was 4.60 ± 0.67 before treatment,the treatment group was 4.58±0.62,the control group after treatment was 5.07±0.87,the treatment group was 5.76±0.44,compare the difference between two groups after treatment was statistically significant(P<0.05).3.2 The body component index is compared3.2.1 Comparison of treatment ingroups:The control group was treated before and after treatment:body fat,TBW,muscle,ICW,ECW,E/I,E/T,etc.,and the difference in the treatment was statistically significant(P<0.05).There was no statistical significance in visceral fat(P>0.05).The body fat content,ECW,E/I,E/T were raised before treatment,and the ICW,TBW and muscle content decreased before treatment.The treatment group before and after treatment comparison:body fat and visceral fat,ICW,ECW,E/I,E/T,basal metabolic rate,such as treatment,before and after treatment was statistically significant difference(P<0.05);TBW,muscle and other indicators,no statistically significant difference(P>0.05);The body fat,visceral fat,ECW,E/I,E/T,basal metabolic rate and other treatments were raised before treatment,and the treatment of ICW was reduced after treatment.3.2.2 Comparison of the two groups differenceThe differences between the two groups of fat,TBW,muscle and ICW were not statistically significant(P>0.05).The differences in visceral fat,ECW,and basal metabolic rate were statistically significant(P<0.05).Conclusions1 Through the TCM syndrome study of 236 cases of hemodialysis patients with malnutrition,spleen-deficiency related symptoms was found to show most related,i.e.spleen-deficiency syndrome is a common trait in hemodialysis patients with malnutrition.2 Through a prospective,multi-center,randomized,controlled study,hemodialysis patients with malnutrition were treated from the spleen and stomach through ST36 and SP06 moxibustion for a total of 12 weeks.Moxibustion was found to improve the SGA score,TCM syndrome score,body mass index and body fat percentage content,indicating that this treatment program can improve malnutrition status and deficiency syndrome.3 Application of bioelectrical impedance analysis on hemodialysis patients with malnutrition demonstrated that moxibustion improves visceral fat,delays muscle wastage and improves basal metabolic rate.This shows that moxibustion effects through the modulation of visceral fat,muscle content,and basal metabolic rate.Innovations1 The correlation between malnutrition and spleen deficiency syndrome was discussed in this study.2 Through the multicenter,randomized controlled trial study,the formula of SP06 and ST36 moxibustion improve malnutrition state of hemodialysis patients with evaluation,for the moxibustion scheme in the hemodialysis related application provides a clinical research in the field of evidence.3 Based on the bioelectric impedance technique,the action target for the improvement of malnutrition in patients with hemodialysis was preliminarily discussed from the angle of body composition analysis.