| BackgroundDiabetic kidney injury is a common and serious complication of diabetes,it is the second cause of end-stage renal disease in our country,early clinical manifestations is glomerular hyperfiltration,and then gradually developed microalbuminuria,proteinuria and progressive renal dysfunction.Clinical treatment is controlling blood pressure,blood lipids,blood glucose-based.Currently recognized prognostic factors of diabetic nephropathy include blood pressure,blood lipids,blood glucose and urine protein quantification.Obesity is one of the causes of diabetes,related reports indicate that obesity can cause kidney damage.At the same time,it is relatively less reported in the domestic reports that obesity has a significant impact on TCM syndromes and pathological changes of diabetic nephropathy.BMI is the most widely used indicator of obesity.Therefore,this topic explores the relationship between BMI index and TCM syndromes and clinical pathology of diabetic nephropathy,to initially clarify the characteristics of TCM syndromes and the relationship between BMI index and the prognosis of diabetic nephropathy in obese diabetic nephropathy.PurposePreliminary discuss the correlation between BMI and TCM syndrome,clinical indicators and renal pathological of diabetic nephropathy.MethodsCollecting 150 cases from January 2012 to June 2017 in China Academy of Traditional Chinese Medicine hospital diagnosed by biopsy diagnosis/clinical diagnosis of diabetic nephropathy in the Department of Nephrology,According to the BMI criteria into higher BMI(overweight/obesity)are 103 cases,47 cases of normal BMI.The differences between the two groups are retrospectively analyzed with TCM syndromes,clinical manifestations(clinical complications and laboratory indicators such as blood routine,24-hour urine protein quantification,blood biochemistry),and the kidney pathological type.The results1 General information(1)Gender:Among the patients with high BMI,there are 75 males and 28 females,with a ratio of 2.68:1;in the normal BMI index group of patients,there are 30 males and 17 females,male to female ratio of 1.76:1.There is no significant difference between men and women inthe two groups(P = 0.27.>0.05).(2)Age:In the high BMI group,the average age is 55.81 ± 11.36 years old,16 cases are young(15.53%),48 cases are middle aged(46.60%)and 39 cases are elderly(37.86%);the average age of the normal BMI group is 57.79 ± 12.04 years,7 cases(14.89%)are young,17 cases(36.17%)are middle-aged and 23 cases(48.94%)are elderly.There is no significant difference between the two groups(P = 0.41、>0.05).(3)Diabetes duration during first kideny biopsy:The high BMI group,Diabetes duration during first kideny biopsy is 10.64±6.75 years;the normal BMI group,Diabetes duration is 11.06±5.12 years.No statistical difference between the two groups(P=0.83、>0.05).2 Relationship between BMI and TCM Syndromes of Diabetic Nephropathy2.1 Deficiency syndromeIn the high BMI group,there are 45 cases(43.69%)with spleen and kidney qi(yang)deficiency,25 cases(24.27%)with qi and yin deficiency,yin deficiency and heat in 4 cases(3.88%),liver and kidney yin deficiency in 6 cases(5.83%),yin and yang deficiency in 17 cases(16.50%).The distribution of TCM syndromes in normal BMI group is 21 cases(44.68%)in spleen and kidney qi(yang)group,8 cases(17.02%)in qi and yin deficiency,in deficiency and heat in 1 cases(2,13%),liver and kidney yin deficiency in 3 cases(6.38%),yin and yang deficiency in 10 cases(21.28%).Deficiency syndrome are no significant difference between the two groups(P>0.05).2.2 EmpiricalThe distribution of TCM syndromes in high BMI group is 83 cases(61.94%)with wet syndrome,33 cases(24.63%)with blood stasis,17 cases(12.69%)with fever,lcases(0.75%)with cloud poison.In the normal group,there are 39 cases(60.00%)with wet syndrome,17 cases(26.15%)with blood stasis,6 cases(9.23%)with fever,3 cases(4.62%)with cloud poison.Phlegm syndrome is statistically significant difference between the two groups(P = 0.03),The rest of the actual syndromes were no significant difference between the two groups(P>0.05).The phlegm syndrome is more common among high BMI standard.3 Correlation between BMI and clinical manifestations of diabetic nephropathy3.1 Correlation between BMI and clinical complications of diabetic nephropathy(1)High blood pressure:the high BMI group of paitients with normal blood press ure of 29 cases(28.12%),level 1 of 35 cases(33.98%),level 2 of 27 cases(26.12%),level 3 of 12 cases(11.65%);the normal BMI group of paitients with normal blood press ure of 14 cases(29.79%),level 1 of 17 cases(36.17%),level 2 of 10 cases(21.28%),lev el 3 of 6 cases(12.77%).It is no statistical difference between the two group(p=0.94、>0.05).(2)Atherosclerosis:The high BMI group,there are 79 cases(76.70%)with atheros clerosis;the normal BMI group,there are 39 cases(82.98%)with atherosclerosis.No statistical difference between the two groups(P=0.38、>0.05).(3)diabetic retinopathy:The high BMI group,diabetic retinopathy 83 cases(80.58%);the normal BMI group,diabetic retinopathy 36 cases(76.60%).No statistical difference between the two groups(P=0.58>>0.05).3.2Correlation between BMI and laboratory indicators of diabetic nephropathy(1)Renal function:In the high BMI group of eGFR median is 46.00 ml/min(1.73m 2),serum creatinine median is 139.00umol/1,BUN median tendency for 10.00mmol/I,CK D1 period for 16 cases(15.53%),CKD2 period for 20 cases(19.41%),CKD3 period for 33 cases(32.04%),CKD4 period for 34 cases(33.01%);in the normal BMI group of eGFR median is 50.00 ml/min(1.73m2),serum creatinine median is 137.00 umol/1,BUN median tendency for 9.0mmol/1,CKD1 period for 7 cases(14.89%),CKD2period for 11 cases(23.40%),CKD3 period for 18 cases(38.30%),CKD4 period for 11cases(23.40%).It is no statistical difference between the two group in eGFR,serum creatinine,B UN and CKD stage(eGFR P=0.32 serum creatinine P=0.53、BUN P=0.53、CKD stage P=0.66).(2)Blood routine:the high BMI group,HGB is 119.74t22.68g/L,PLT(221.12+66.76)*109/L;the normal BMI group,HGB is 113.08±21.71g/L,PLT(238.53±62.45)*109/L.No statistical difference between the two groups(HGB P=0.18,PLT P=0.13).(3)24 hours urinary protein:The median of 24-hour urinary protein in the high BMI group is 4158.00 mg/24h,the normal BMI group is 3456.00 mg/24h.No statistical difference between the two groups(P=0.90、>0.05).(4)Other blood chemistryBlood lipids:high BMI group CHO median is 5.84mmol/1,TG median 2.00mmol/1,HDL-C median 1.OOmmol/1,LDL-C median 3.00mmol/1;the normal BMI group CH O median is 5.15mmol/1,TG median 1.86mmol/1,HDL-C median 1.03mmol/1,LDL-C median 3.00mmol/1.The levels of CHO,HDL-C and LDL-C in the two groups were statistically significant(CHO P=0.02,HDL-C P=0.00,LDL-C P=0.01);no statistical difference in TG(P=0.12、>0.05).Blood glucose:high BMI group fasting blood glucose median is 6.6mmol/L,glyc ated hemoglobin median 7.1%;fasting blood glucose median in normal BMI group is 8.3mmol/L,glycated hemoglobin median 8.3%.There is no significant difference in fasting blood glucose and glycated hemoglobin between the two groups(fasting blood glucose P=0.05,glycated hemoglobin P-0.05).UA:high BMI group uric acid is 418.45±78.72umol/L,normal BMI group is 380.09±97.82umol/L.It is statistical difference between the two groups(P=0.01),high uricacid in high BMI group.Plasma proteins:the high BMI group,ALB is 33.44±7.44g/L,TP 58.51±9.91 g/L;the normal BMI group,ALB is 29.97±6.70 g/L,TP 55.24±9.82 g/L.It is statistical d ifference between the two groups in ALB(P=0.03),no statistical difference between the two groups in TP(P=0.10.>0.05).Plasma albumin level is higher in High BMI group.Electrolytes:the high BMI group,blood Ca median 2.00mmol/L,blood P median 1.08mmol/L,blood K median 4.00mmol/L;the normal BMI group,blood Ca median 2.00mmol/L,blood P median 1.02mmol/L,blood K median 4.00mmol/L.No statistical difference between the two groups in Ca、P、K(P>0.05).4 Correlation between BMI and pathology of diabetic nephropathyHigh BMI group,there are 33 cases diagnosed by renal biopsy,among the type I diabetic nephropathy in 0 case,type Ⅱa 3 cases(9.09%),type Ⅱb 6 cases(18.18%),type Ⅲ 24 cases(72.73%),no case with type Ⅳ;IFTA with focal changes 15 cases(45.45%),with multifocal changes 18 cases(54.55%);kidney arterioles lesions 10 cases(30.30%)with only thickening,18 cases(54.55%)with thicken + glass-like change.Normal BMI group,there are 16 cases diagnosed by renal biopsy,among them type I diabetic nephropathy in 0 case,type II a 3 cases(18.75%),type II b 1 cases(6.25%),type Ⅲ12 cases(75.00%),no case with type IV;IFTA with focal changes 5 cases(31.25%),with multifocal changes 11 cases(68.75%);kidney arterioles lesions 7 cases(43.75%)with only thickening,9 cases(56.25%)with thicken + glass-like change.No statistical difference between the two groups(P>0.05).Conclusion1.There are no differences in the gender distribution and age of diabetic nephropathy with different BMI.2.Patients with different BMI indexes of diabetic nephropathy have no difference in deficiency syndrome,standard evidence to phlegm syndrome is more common in high BMI group.3.High BMI patients are often accompanied by hyperuricemia and dyslipidemia,high levels of plasma albumin.4.There are no differences in pathological features of kidneys in different BMI indexes. |
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