Study On TCM Syndrome Of Type Ⅲ And Ⅳ Type 2 Diabetic Nephropathy

ObjectExplore the regulation of Traditional Chinese Medicine(TCM) syndrome, syndrome element distribution in III, IVstage Type 2 diabetic nephropathy(DN), and make a thorough inquiry of correlativity between TCM syndrome, syndrome element and laboratory indicators, in order to imply the reference of the TCM differentiation syndrome in treatment of DN.MethodCollecting the case data of 215 patients, who were diagnosised as III, IV stage Type 2 DN from August 2012 to February 2014, treated in six hospitals of Dongzhimen Hospital Attached to Beijing TCM University, Dongzhimen East Hospital, Beijing Oriental Hospital, Wangjing Hospital attached to China Academy of TCM, Beijing Hospital of Integrated Chinese and Western Medicine, Beijing Chinese Medicine Hospital of Capital Medical University. The date of patients included general information, laboratory indicators and information of traditional Chinese medicine. The material of cases were input Excel to set up research database and dealt with software SPSS 22.0. The data of general information and laboratory indicators were computed by descriptive statistics. The data of TCM was using the method of factor analysis and canonical correlation analysis.ResultThe patient of Diabetic nephropathy were mainly in middle and old aged people. About 83.7% of all patients combined hypertension,38.1% patients combined coronary heart disease,27.4% patient merger of cerebrovascular disease. The ratio of merger hypertension in IV stage patients was higher than that of patient in III phase (P<0.05), and serum uric acid, serum creatinine, blood urea nitrogen, systolic pressure, diastolic pressure were increased in patient of stage IV compared with those of patient in stage III, while hemoglobin, red blood cell, estimated glomerular filtration rate, blood albumin, fasting blood glucose, glycosylated hemoglobin, serum calcium, serum phosphate, were decreased in patient of stage IV compared with those of patient in stageIII.More DN patients in stage IV had edema of lower extremity, urine bubble than those in stage III, while less ratio in stage IV patients with whole body fatigue, swelling of limbs heavy, soreness and weakness in waist and knees, deep-colored urine than those of stage III patient. Traditional syndrome differentiation displayed that patients of deficiency syndrome in stage III displayed predominantly with qi-deficiency (73.41%),yin-deficiency (52.78%), yang-insufficiency (56.94%), while patient of deficiency syndrome in stage IV displayed mainly syndrome of qi-deficiency (70.63%) and yang-deficiency (74.13%). The superficiality excess syndrome in patients of stage III and IV mainly had the phlegmatic hygrosis and blood stasis. To compare patients of stage III with stage IV, the latter displayed more syndrome of yang-deficiency, blood-insufficiency, and blood stasis, while yin-deficiency, qi-deficiency, and phlegmatic hygrosis were relatively fewer. The increasing of yang-def iciency was statistic significant (P<0.05).Statistic of common factor analysis drawing sixteen factors indicated that the syndrome of similar spleen-kidney in yang-deficiency factor (F14) and similar yin-deficiency and internal heat factor (F12) was more displayed (7.91%) than other factors. The syndrome of similar spleen-kidney yang-def iciency factor(F14) displayed in stage IV more than that of in stage III (P <0.05), while the syndrome of similar damp heat and liver-kidney yin-deficiency factor(F3) and similar both spleen-kidney qi yin-deficiency with phlegm dampness and qi-stagnation factor (F1) decreased in patients of stage IV(P<0.05). Statistics the frequency of the syndrome elements which included in factors showed that yin-deficiency was the main deficiency syndrome, occupied 44.65%, the next were qi-deficiency (22.33%), yang-deficiency (19.53%) and blood-insufficiency (10.70%). Blood stasis (26.98%) and internal thermal (25.12%) were the main display of the superficiality excess syndrome, the next in turns were qi-stagnation (18.60%), phlegm dampness (12.09%), and endogenous wind (12.09%). The disease mainly located in liver (51.63%), spleen (57.21%), kidney (42.33%), also involved in heart (6.51%).The canonical correlation analysis of common factor and laboratory indicators displayed that the factor of similar qi-stagnation and depression of liver and blood stasis syndrome (F16) was proportional to blood calcium, the factor of similar spleen-kidney yang deficiency syndrome (F14) was proportional to 24h urine protein quantitation, and inversely proportional to blood albumin.Conclusionpatients of deficiency syndrome in stage III, IV displayed predominantly with qi-deficiency,yin-deficiency, yang-insufficiency. yin-deficiency was more significant in deficiency syndrome. The superficiality excess syndrome mainly displayed internal thermal and blood stasis, also have qi-stagnation, phlegmatic hygrosis, and endogenous wind. Yang-deficiency is more displayed in patient of stage IV than which of stage III, while qi-stagnation, yin-deficiency and phlegmatic hygrosis were relatively few. The disease mainly located in liver, spleen, kidney. The syndrome of similar qi-stagnation, depression of liver and blood stasis was proportional to blood calcium. The syndrome of similar spleen-kidney yang-deficiency was proportional to the 24h urine protein, but inversely proportional to blood albumin.