Study On The Relationship Between The Level Of Aortic Stiffness In Chronic Kidney Disease Patients With Metabolic Syndrome

Objective:To study the relationship between the level of blood glucose,blood fat,body mass index(BMI),waist circuferrence,blood pressure,pulse pressure, carotid-femoral pulse wave velocity(CF-PWV)and the different TCM syndrome in Chronic Kidney Disease(CKD)patients with Metabolic Syndrome(MS),in order to find the objective evidence of differentiation of symptoms and signs of traditional Chinese medicine of metabolic syndrome and to guide clinic treatment better.Methods:Two hundred and forty seven CKD patients with MS were divided into six group through TCM differentiation,the deficiency of spleen Qi and kidney Qi syndrome group,the deficiency of Qi and Yin syndrome group,the deficiency of liver Yin and kidney Yin syndrome group,the deficiency of spleen yang and kidney yang syndrome group,the phlegm and abiding spleen syndrome group,the phlegm and blood stasis syndrome group.Twenty one patients belonged to the deficiency of spleen Qi and kidney Qi syndrome group,twenty nine patients belonged to the deficiency of Qi and Yin syndrome group,twenty six patients belonged to the deficiency of liver Yin and kidney Yin syndrome group,forty three patients belonged to the deficiency of spleen yang and kidney yang syndrome group,sixty nine patients belonged to the phlegm and abiding spleen syndrome group,fifty nine patients belonged to the phlegm and blood stasis syndrome group.Body height,body weight and waist circumference were measured. BMI was calculated.Blood glucose,blood fat,serum albumin,creatinine, creatinine clearance rate(Ccr),supersensitive C reactive protein(sCRP), CF-PWV,and etc,were checked.Analysis the differences of all the indices between each TCM syndrome group.Analysis the dependability between carotid-femoral pulse wave velocity and other indices.In addition,all the indices of the control group(50 persons)who were healthy were checked and compared with all the groups of metabolic syndrome. Results:1.The main TCM syndrome of the CKD patients with MS was phlegm and abiding spleen syndrome(27%),and others were phlegm and blood stasis syndrome(24%), the deficiency of spleen yang and kidney yang syndrome(17%),the deficiency of Qi and Yin syndrome(12%),the deficiency of liver Yin and kidney Yin syndrome(11%)and the deficiency of spleen Qi and kidney Qi syndrome(9%).2.The proportion of CKD stage in each TCM syndrome group were different.The deficiency of spleen Qi and kidney Qi syndrome group,the deficiency of Qi and Yin syndrome group;and the deficiency of liver Yin and kidney Yin syndrome group are mainly in CKD stage 1,CKD stage 2 and CKD stage 3.But in the deficiency of spleen yang and kidney yang syndrome group,phlegm and abiding spleen syndrome group and phlegm and blood stasis syndrome group were mainly in CKD stage 4 and CKD stage 5.3.BMI,waist circumference,fasting blood glucose,blood glucose after meal, trig]yceride(TG),high density lipid cholesterol(HDL-C),creatinine,sCRP, systolic blood pressure,diastolic blood pressure,pulse pressure and CF-PWV of each TCM syndrome group were all higher than the control group(P＞0.05);the serum albumin and Ccr were lower than the control group(P＜0.05).4.BMI and waist circumference of phlegm and blood stasis syndrome group were significant higher than any other group(P＜0.05),there was no significant difference of BMI between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also no significant difference between the deficiency of Qi and Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group(P＞0.05),and there was significant difference of BMI between the other groups(P＜0.05);there was no significant difference of waist circumference between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also no significant difference between the deficiency of Qi and Yin syndrome group and the deficiency of liver Yin and kidney Yin syndrome group(P＞0.05);and there was significant difference of waist circumference between the other groups(P＜0.05).5.There was no significant difference of fasting blood glucose and blood glucose after meal betweeneach TCM syndrome group(P＞0.05);there were no significant difference of TG and HDL-C between the deficiency of liver Yin and kidney Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group,(P＞0.05);and there was significant difference of TG and HDL-C between the other groups(P＜0.05).6.There was no significant difference of creatinine and creatinine clearance rate among each TCM syndrome group(P＞0.05);there was no significant difference of serum albumin between spleen yang and kidney yang syndrome group and the deficiency of Qi and Yin syndrome group(P＞0.05);and also no significant difference between the liver Yin and kidney Yin syndrome group and the deficiency of spleen Qi and kidney Qi syndrome group(P＞0.05);and there was significant difference of serum albumin between the other groups(P＜0.05).There was no significant difference of sCRP between phlegm and blood stasis syndrome group and phlegm and abiding spleen syndrome group(P＞0.05),and also nosignificant difference between spleen yang and kidney yang syndrome group and the deficiency of Qi and Yin syndrome group; and there was significant difference of sCRP between the other groups(P＜0.05).7.The pulse pressure and CF-PWV:phlegm and blood stasis syndrome group＞phlegm and abiding spleen syndrome group＞spleen yang and kidney yang syndrome group＞the deficiency of Qi and Yin syndrome group＞the deficiency of liver Yin and kidney Yin syndrome group＞the deficiency of spleen Qi and kidney Qi syndrome group,there was significant difference between each group(P＜0.05).8.There was significant difference of CF-PWV level proportion between each group(P＜0.05);the proportion of sever level patients of phlegm and blood stasis syndrome group was significantly higher than any other group(P＜0.05);the proportion of normal level patients of he deficiency of spleen Qi and kidney Qi syndrome group was significantly higher than any other group(P＜0.05),the deficiency of spleen Qi and kidney Qi syndrome group＞the deficiency of liver Yin and kidney Yin syndrome group＞the deficiency of Qi and Yin syndrome group＞spleen yang and kidney yang syndrome group＞phlegm and abiding spleen syndrome group＞phlegm and blood stasis syndrome group(P＜0.05).9.There was significant positive correlation between CF-PWV and age,systolic blood pressure,pulse pressure(P＜0.001);there was positive correlation between CF-PWV and TG,sCRP(P＜0.05);there was negative correlation between CF-PWV and HDL-C,Alb(P＜0.05).10.In a multivariate regression analysis,CF-PWV was independently determined by age(＜0.05),SBP(＜0.05),PP(＜0.05),and HDL-C(＜0.05).Adjusted R~2 of the model was 0.567.The regression equation:CF-PWV(m/s)=2.981+0.025 age(years old)+0.032SBP(mmHg)+0.044PP(mmHg)+0.230HDL-C.Conclusion:1.The most common TCM syndrome in CKD patients with MS were phlegm and blood stasis syndrome and phlegm and abiding spleen syndrome.2.There is high level of all the indices in the CKD patients with MS.3.There was significant difference of the indices between each TCM syndrome group.There was close relationship between TCM syndrome and the indices.CF-PWV could be the objective evidence of different TCM syndrome.And the CF-PWV could be utilized as an index to evaluate the clinical effect and prognosis.