Correlation Between Tongue Images And Partial Heart Failure Indicators In Dialysis Patients

BackgroundIn recent years,with the increase of incidence of diabetes,hypertension and aging of population,the incidence of chronic kidney disease(CKD)has been increasing rapidly all over the world,and has become a major public health problem in the world.If CKDs failed to get timely and effective treatment,it was sustained progressive development and eventually entered end-stage kidney disease(ESRD).Patients with end-stage renal disease rely on renal replacement therapy(including renal transplantation,hemodialysis and peritoneal dialysis)to maintain life,because of the limited source of renal transplantation donor,renal replacement therapy mainly was dialysis.Of the dialysis treatment in patients,hemodialysis patients accounted for about 80%to 90%.Maintenance hemodialysis(MHD)is one of the most commonly used and most important methods of renal replacement therapy.But in fact hemodialysis only partially replaced the renal excretion of metabolites and toxins,and the kidney to maintain homeostasis and endocrine function has not been significantly improved,long-term maintenance hemodialysis will cause many complications such as residual renal function decline,cardiovascular events,micro inflammation and malnutrition,renal osteodystrophy,kidney anemia.Due to the special nature of disease and treatment,they also bear the economic burden of family and society,easy to produce a series of psychological problems in patients.At the same time it had a serious impact on the quality of life,the physiological function,the social function of patients.The survey found that cardiovascular events were the most common and most serious complication of hemodialysis patients and the leading cause of death in MHD.Among them,congestive heart failure(CHF)is an important complication of cardiovascular system in maintenance hemodialysis patients.It has a high incidence of 20%-30%,which accounts for the death cause of end-stage renal disease.Therefore,identifying the complications of heart failure quickly and early is beneficial to reduce the mortality of cardiovascular events in dialysis patients,and has important social and economic significance for improving the quality of life of dialysis patients.ObjectiveUnder the guidance of Chinese medicine theory,collected 77 cases of MHD patients with tongue information to objective study of tongue diagnosis.To study the distribution of tongue image in that 77patients with maintenance hemodialysis and its correlation with some indexes of the heart failure,including hemoglobin(Hb),the renal function before dialysis(Cr,BUN,UA),serum albumin(ALB),B type natriuretic peptide(BNP)and calculate urea clearance index(Kt/V),the rate of urea decline(URR),the rate of decline of interdialysis weight gain(IDWG%),found the intrinsic link between them.To identify the objective basis of tongue diagnosis for dialysis patients complicated with heart failure,so as to reduce the mortality of cardiovascular events in dialysis patients.MethodsTaking the maintenance hemodialysis patients(? 3 months)as the research object,the tongue image data of the patient's supine position was adopted by the portable tongue image instrument,and the tongue picture was introduced into the "TCM tongue diagnosis expert system".Three experts who are over deputy director of the physician level will quantitate and analysis 16 parameters of tongue image including the tongue spirit,the tongue color,the tongue shape,the teeth marks,cracks and etc to dialysis patients "distribution features of tongue manifestations.To collect the patient's condition strictly according to the four diagnosis of traditional Chinese medicine,make a further proof of the syndrome and analyze the tongue image of the patients in the maintenance hemodialysis.At the same time take the blood samples on the first day of tongue shooting,including blood routine,renal function,ion detection,serum albumin,BNP before hemodialysis,and calculate urea clearance index(Kt/V),the rate of urea decline(URR),the rate of decline of interdialysis weight gain(IDWG%).Then analysis the correlation of tongue manifestations and the objective indexes and found the rules from.Results1 Among the 77 maintenance hemodialysis patients,there were 41 males and 36 females.The frequency of deficiency syndrome of TCM syndrome differentiation is mainly:liver kidney yin deficiency syndrome(23 cases)>Qi and Yin deficiency syndrome(22 cases)>spleen kidney yang deficiency syndrome(15 cases)>Yin and yang deficiency syndrome(10 cases)>spleen kidney qi deficiency syndrome(7 cases).2 Dialysis patients mainly tongue manifestation is pale-red and swollen tender tongue,thin yellow coating.3 Teeth mark tongue quantitative score is positively correlated with the weight gain rate of dialysis interval.(P<0.01)4 The quantitative score of purple tongue,dark tongue,ecchymosis and thick coating was positively associated with BNP,which was positively correlated with congestion tongue,suggesting that the hemodialysis patients showed congestion tongue is extra body sodium and water retention,and ecchymosis area,dark purple and BNP were increased significantly with.(P<0.01)Conclusion1 In the maintenance hemodialysis patients,the deficiency of liver and kidney is the most common syndrome,but Yin deficiency is not common.Dialysis patients mainly tongue manifestation is pale-red and swollen tender tongue,thin yellow coating.2 There was a positive correlation between the teeth mark tongue and the interdialysis weight gain rate in maintenance hemodialysis patients.There is a positive correlation between the congestion tongue and the serum BNP,and the congestion tongue may indicate the elevation of the serum BNP level.Therefore,the tongue mark of the congestion tongue can be used as a reference for the heart failure of the dialysis patients.3 The objective study of the tongue diagnosis and the combination of laboratory indexes provide a tangent point for the combination of traditional Chinese and Western medicine.It provides a way of thinking for "treating the disease without disease",and embodies the potential diagnosis and application value of tongue diagnosis in the rapid identification of critical diseases.