Type 2 Diabetic Nephropathy Stage â…¢ â…£ Syndromes And Clinical Study

Objctive:Compare the disease characteristics and traditional Chinese Medicine(TCM) syndrome distribution between stage III and stage IV type-2diabetic nephropathy, explore the difference in general information and laboratory test results between each syndrome. To provide reference for TCM diagnosis and treatment in type-2diabetic nephropathy.Methods:Patients who were clinically diagnosed with type-2diabetic nephropathy stage III or stage IV were recruited from Dongzhimen Hospital and Wangjing Hospital during Aug2012to Feb2013. The general information and clinical information were collected and MICROSOFT SPSS20.0was used in statistic analysis. Descriptive analysis was used in general information, laboratory results, concomitances and TCM syndromes. Chi-square test was used in enumeration data. Independent-sample t-test was used in measurement data, and t’-test was used when heterogeneity of variance existed. After analysis, x±s and p were recorded. Analyze the disease characteristics and TCM syndrome distribution between stage III and stage IV type-2diabetic nephropathy. Compare the difference in glycosylated hemoglobin (HbAlc), serum creatinine(Scr), glomerular filtration rate(GFR),24hour urine protein quantitative (24-UPR)et al of each syndrome.Results:1.Participants on stage IV have higher levels of SBP, blood phosphorus, blood chlorine, APTT(p<0.05) and much higher levels of blood sodium, Scr, BUN, UA,24-UPR, cholesterol and FIB (p<0.01) than those on stage III. While the FT3level of stage IV participants are lower (p<0.05), and the FBG,2hPBG, RBC, Hb, blood calcium, total protein(TP), blood albumin(ALB) and GFR levels are much lower (p<0.01) than stage III participants.2. Compared with BMI normal group, BMI over-weight and obesity groups have higher levels of Scr, BUN and TG(p<0.05).WHR abnormal group has a higher level of HbAlc (p<0.05).3. The TCM syndromes of stage III and stage IV type-2diabetic nephropathy are characterized by deficient root and excessive superficial. Deficient syndromes are mainly Qi and Yin deficiency, followed by liver and kidney Yin deficiency, and spleen and kidney Yang deficiency, Yin and Yang deficiency syndrome is relatively rare. Excessive syndromes are mainly blood stasis syndrome, followed by phlegm muddiness syndrome, damp-heat syndrome and Qi stagnation syndrome.4. In deficiency syndromes, the HbAlc (p<0.05) and TG (p<0.01) levels are higher in Qi and Yin deficiency group than in non-Qi and Yin deficiency group. The grip strength are much lower in liver and kidney Yin deficiency group than in non-liver and kidney Yin deficiency group(p<0.01). The Scr, BUN, and24-UPR levels in spleen and kidney Yang deficiency group are higher than in non-spleen and liver Yang deficiency group(p<0.05). While the GFR, ALB levels are lower (p<0.05), and the grip strength and HGB are much lower (p<0.01) in spleen and kidney Yang deficiency group are higher than in non-spleen and liver Yang deficiency group. The Yin and Yang deficiency group has a lower level (p<0.05) of grip strength but a higher level(p<0.05) of Scr than non-Yin and Yang deficiency group.5. In excess syndromes, Qi stagnancy group has a lower level of grip strength than non-Qi stagnancy group(p<0.05). Phlegm muddiness group has a higher level of BMI than non-phlegm muddiness group(p<0.05). Blood stasis group has a higher Scr level than non-blood stasis group (p<0.05).Conclusions:1. Obesity is very common in patients with type-2diabetic nephropathy. Stage IV patients have a higher SBP, an increased urine protein, a lower renal function, a higher FIB and lower levels of RBC, HGB, blood calcium and FT3than stage Ⅲ patients.2. The TCM syndromes of type-2diabetic nephropathy are characterized by deficient root and excessive superficial.The most common deficient syndrome is Qi and Yin deficiency,and the most common excessive syndrome is blood stasis syndrome.The disease progress might follow the order of Qi and Yin deficiency to liver and kidney Yin deficiency to spleen and kidney Yang deficiency to Yin and Yang deficiency, with blood stasis throughout the disease.3. The blood glucose and blood lipid levels of Qi and Yin deficiency group are much more worse than non-Qi and Yin deficiency group. The renal function is much more worse in spleen and kidney Yang deficiency group than in non-spleen and kidney Yang deficiency group. Patients in phlegm muddiness group are fatter than in non-phlegm muddiness group.Qi stagnancy group has a lower level of grip strength than non-Qi stagnancy group. The renal function is lower in blood stasis group than in non-blood stasis group.