| ObjectiveThe prevalence of diabetic nephropathy are rising, it has become the second common cause of chronic kidney disease and end-stage renal disease in China. At present, western medicine therapy of DN has been studied systematically, While Chinese medicine therapy studies were scattered. And there was no comprehensive and systematic studies about the effect of chronic disease self-management in diabetic nephropathy prognosis. Therefore, this research is going to analyze the data collection of diabetic nephropathy patients in the nephrology department of Guangdong Provincial Hospital of Traditional Chinese Medicine (TCM) in the past five years. We observed the living-time of the patients and the changes of estimating glomerular filtration rate to analyze the relevant factors, expecting to provide a reference for clinical practices and further researches.MethodsThe cases were those DN patients with eGFR between 10 to 60 ml·min-1·1.73 m-2 (not dialysis) who consulted in nephrology department of Guangdong Provincial Hospital of Traditional Chinese Medicine from May,2010 to May,2015, with age from 18 to 80 years. Those whose clinical data was missing or the follow-up time was less than half a year were excluded. The data collection includes patients’ basic information, disease features, laboratory tests, chinese and western medicine therapies and their status with chronic disease self-management of TCM. Using the SPSS 17.0 software to process statistical analysis. At first, the patients were divided into two groups by whether they participated the chronic disease self-management of TCM or not, and all the influence factors were compared between the two groups to figure out whether it was statistical significance. Secondly we considered the eGFR＜5 ml·min-1·1.73 m2 or entering to renal replacement therapy or death as outcome events, with survival analysis of the two groups, using Cox regression analysis to find out the influent factors of the outcome events. Afterward,we put the statistically significant factors into Cox regression model and establish relevant model to do some evaluation.ResultsThis research included a number of 92 DN patients and the median follow-up time was 116.64 weeks. The patients were divided into two groups by whether they were involved in the chronic disease self-management of TCM. From the survival analysis curve, the average survival time of the management group was longer than the non-management group, the difference between the two groups was statistically significance (P=0.012<0.05).In this study, a total number of 27 patients experienced outcome events (eGFR＜5 ml·min-1·1.73m-2 or receiving renal replacement therapy or death), with 10 cases in the management group and 17 cases in the non-management group. By Cox regression analysis, we found out the influence factors on the outcome events. The results showed that participating in the chronic disease self-management of TCM, taking Chinese medicine decoction were the independent protective factors for the progression of DN. Those who accepted the chronic disease self-management of TCM (HR was 0.305 (95%CI 0.115,0.812) and took Chinese medicine decoction (HR 0.058 (95%CIO.017,0.195) would have a low risk of outcome events.ConclusionThis study showed that accepting the chronic disease self-management of TCM, taking Chinese medicine decoction were the independent factors in the progression of DN, both of them were the protective factors. It suggested that Chinese medicine plays an important role in the treatment of DN, chronic disease self-management of TCM programs in our centre also have a role in improving the clinical efficacy in DN cases. Therefore, we suggest that chronic disease self-management of TCM should become one part of DN conventional therophy. We took a long-term effective communication and education with patients to improve their adherence and awareness of DN, at the same time, we teached them about Chinese medicine diet and some sports, expecting to keep them healthy and improve the therapeutic effect. However, there was some limitations in this study, the large samples and more detailed design are needed to prove the conclusion. |
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