Study On Relationship Between TCM Syndrome Type Of Maintenance Peritoneal Patients And The Calcium Phosphorus Metabolism

ObjectiveTo collecting the Chinese mdicine syndrom type of patientsundergoing continuous ambulatory peritoneal dialysis in ChineseandWestern Medicine Hospital in Wuhan dialysis center,to observethe characteristics of different Chinese mdicine syndrom typepatients with metabolism of calcium and phosphorus.Observedbetween different TCM syndrome types of patients with peritonealthe solute clearance and residual renal function have any differ-ence. If there are differences between patients with different TCMsyndrome types calcium-phosphorus metabolism, the differen-ce is related to solute clearance and residual renal function or not.Methods:1.To enroll157cases of patients undergoing continuous ambul-atory peritoneal dialysis in the study,all the patients were from Wuhan First Hospital department of Nephrology in2012,and average dialysis duration was more than3months.2.Every patient’s syndrome type was differentated by a spe-cific HerbDoctor, syndrome differentiation of traditional Chinese medicine refer to Chinese Medicine in2006,and laied down“the observation table of four diagnostic methods of TCM syndrome type”. According to the Chinese mdicine syndrom type of the patients were divided into Gan-Shen yin-deficien-cy,Pi-Shenyang-deficiency,Pi-Shen qi-deficiency,qi-yin deficiency and yin-yang deficiency five groups.3.To record the test results of electrolyte analysis，PTH，if the patients did not inspect on the day of syndrome differentiation of traditional Chinese medicine,recording the recent res ults in before and after a month.4.To record24hours urine output, abdomen through ultrafiltrat-ion volume24hours,TFR，Kt/V total one week,total Ccr one week,residual kidney Ccr, residual kidney GFR and PET of each patients.5.Compare various TCM syndrome types of Ca,P,PTH,Hb,Alb, totalKt/V one week,total Ccr one week and residual kidney Ccr, observethe indicators if there is a difference.6.Observe calcium phosphorus metabolism if there is a diff-erence between the group of solute removal fully（total Kt/V＞1.7）and solute removal not fully （Kt/V total≤1.7）; if there is adiff erence between the group of GFR＞2ml/min and the group of GFR≤2ml/min; if there is a difference between the group of the groupof TFR＞1000ml/d and the group of TFR≤1000ml/d; if there is adifference between patients with different PET.7.Statistical analysis: The measurement data by t-test,datawere mean±standard deviation （±S）,multivariate sample comparison using variance analysis, enumeration data using X2tes t, P＜0.05was statistically significant.Results:1.All157patients,including Gan-Shen yin-deficiency39cases （24.8%）,Pi-Shen yang-deficiency20cases（12.7%）, Pi-Shen qi-deficiency55cases（35.0%）,qi-yin deficiency55cases（15.9%） and yin-yang deficiency18cases（11.5%）. Syndrome yin-yang deficiency with an average age（66±12y） of the highest, higher thanother four syndromes （P＜0.05）. Syndrome yin-yang defi-ciencyalso with longest duration of dialysis（50.6±20.7m）, compared with the other four syndrome had statistical signi-ficance（P＜0.05）.2.Only five syndromes’s Ca²⁺all below2.10mmol/L expect Gan-Shen yin-deficiency. Gan-Shen yin-deficiency’s Ca²⁺is the highest（2.10±0.17mmol/L）, Pi-Shen yang-deficiency’s Ca²⁺is the lowest（1.95±0.21mmol/L）,there is statistical significance between them （P＜0.05）. Syndrome yin-yang deficiency has the highestP（1.95±0.24mmol/L）, compared with the other four syndrome had statistical significance（P＜0.05）,other four syndrome’s P allall below1.78mmol/L, Pi-Shen yang-deficiency’s P is the lowest（1.60±0.48mmol/L）. Five syndr-omes’s PTH all higher than the300pg/ml, syndrome yin-yang deficiency has the highest PTH（808.58±825.93pg/ml）, compared with the other four syndrome had statistical significance（P＜0.05）, Pi-Shen yang-deficiency’s PTH is the lowest（436.37±461.19pg/ml）, compared with the other syndrome had statist-ical significance（P＜0.05） expect Pi-Shenqi-deficiency.3.Pi-Shen qi-deficiency has the highest Hb（98.22±22.6g/L）.qi-yin deficiency has the lowest Hb（84.12±17.57g/L）, comparedwith the other syndrome had statistical significance（P＜0.05）expect yin-yang deficiency. Gan-Shen yin-deficiency has the highest Alb（37.42±4.66g/L）,the second is pi-Shen qi-defici-ency,yin-yang deficiency has the lowest Alb（33.5±4.8g/L）, comparedwith the Gan-Shen yin-deficiency and pi-Shen qi-defi-ciency had statistical significance（P＜0.05）. Pi-Shen yang-deficiency has the highest total Kt/V（1.94±045）, yin-yang deficiency’s is the lowest（1.74±0.47）,but compared with the other syndrome had no statistical significance. Gan-Shen yin-deficiency has the highest total Ccr（67.93±50.37L/1.73m2），yin-yang deficiencyhas the lowest total Ccr（52.53±11.23L/1.73m2）, but compared with the other syndrome had no statistic-al significance. Gan-Shen yin-deficiency has the highest residual renal function（24.8±55.5L/1.73m2）, yin-yang defici-ency has the lowest residualrenal function（6.72±9.54L/1.73m2）, yin-yang deficiency compared with the other syndrome had no statistical significance（P＜0.05）.4. There has no statistical significance between the group of solute removal fully and solute removal not fully in Ca²⁺，Pand PTH.The group of has residual renal function’s P is1.48mmol/L, the group of has no residual renal function’s P1.77mmol/L there has statistical significance between this two group（P＜0.05）. The group of has residual renal function’s PTH is357±250.71pg/ml, the group of has no residual renal function’s P TH is677.63±705.02pg/ml,there has statistical significance between this two group（P＜0.05）. There has no statistical significance between the group of TFR＞1000ml/d and TFR≤1000ml/d inCa²⁺，P and PTH.5.There has no statistical significance between the diffrenctPET in Ca²⁺，P and PTH.Conclusion:1.This study included157patients, the most common type isPi-Shen qi-deficiency,the least is yin-yang deficiency. Syndrome yin-yang deficiency with an average ageof the highest, higher than other four syndromes. Syndrome yin-yang deficiency alsowith longest duration of dialysis.2.This center CAPD patients, calcium, phosphorus metabolicdiso-rder is mainly characterized by hypocalcemia and high PTH andlow PTH levels, especially in the PTH disorder, hyperphos-phatemiarates are both low. Only five syndromes’s Ca²⁺all below2.10mmol/Lexpect Gan-Shen yin-deficiency, Pi-Shen yang-deficiency’s Ca²⁺is lower than Gan-Shen yin-deficiency.3.There has no statistical significance between the fivesyndromes in total Kt/V and total Ccr. Yin-yang deficiency has thelowest residual renal function. Qi-yin deficiency’s Hb is lowerthan Gan-Shen yin-deficiency, Pi-Shen qi-deficiency and Pi-Shenyang-deficiency’s. Yin-yang deficiency’s Alb is low-er thanGan-Shen yin-deficiency and Pi-Shen qi-deficiency.4.In this study, the calcium-phosphorus metabolism of patientsundergoing CAPD is with no obvious relationship between soluteclearance,TFR and PET,the patients’residual renal function haveobvious influence on it.5.Yin-yang deficiency’s P and PTH are higher than other fourtype of syndrome obvious, considering to the low residual renalfunction.