| ObjectiveTo investigate the general characteristics,clinical and pathological features,and the distribution of TCM syndromes in patients with diabetsic kidney disease in Guangzhou,and to explore the relationship between clinical indexes and pathological features of diabetsic kidney disease and TCM syndromes.To provide a reference for the clinical diagnosis and treatment of diabetsic kidney disease and to judge the prognosis of the disease,and to provide the Chinese medicine basis for the rational application of TCM in the treatment of DKD.Methods:A total of 415 cases of DKD confirmed by renal biopsy in outpatient and ward of Guangdong Provincial Hospital from January 2009 to February 2019 were collected,among which 80 cases were diagnosed by renal biopsy.The patients completed medical history,clinical features,pathological data,treatment situation and TCM syndrome of the selected patients were retrospectively studied.The statistics were analysed by SPSS22.0 software.According to the age groups,obesity,hypertension,hyperurieemia,anaemia and renal function were divided into two groups,and the correlation of clinical and pathological data and TCM syndrome type were compared.The patients were divided into two groups according to their age,hypertension,hyperuricemia,anaemia and renal function.Results:1.Of all the 415 patients with DKD,the ratio of male to female was 1.82:1.The age was53.3±12.4 years old.The time from onset to diabetes mellitus was 8.2±5.9 months.The 24 hours of urine protein quantification was 4.58±3.20g/L.There were 261(62.9%)cases with hypertension.There were 238(57.4%)cases with hyperuricemia.There were 295(71.1%)cases with anaemia.The eGFR<90 ml/(min·1.73m2)were involved in 349(84.1%)cases.2.Compared with the young group,the course of diabetes,the incidence of hypertension,the incidence of anemia,the incidence of renal dysfunction,systolic blood pressure,serum creatinine,blood urea nitrogen,serum uric acid and total cholesterol in the middle-aged and elderly group were higher than those in the young group.The level of eGFR was significantly lower than that of the young group(P<0.05),and the difference was statistically significant(P<0.05).Compared with the middle-aged group,the course of diabetes mellitus,systolic blood pressure,diastolic blood pressure,serum creatinine and serum uric acid levels in the elderly group were significantly higher than those in the middle-aged group,while the eGFR levels were lower than those in the middle-aged group(P<0.05).3.The age,duration of diabetes,incidence of hyperuricemia,anemia,incidence of renal dysfunction,serum creatinine,urea nitrogen,uric acid and 24-hour urinary protein levels in hypertension group were higher than those in normal blood pressure group.There was statistical difference(P<0.05).The levels of hemoglobin,plasma albumin and eGFR in hypertension group were lower than those in normal blood pressure group(P<0.05).4.The age,the incidence of hypertension,the incidence of anemia,the incidence of renal dysfunction,systolic blood pressure,serum creatinine and urea nitrogen in the hyperuricacid group were higher than those in the normal uric acid group,while the levels of hemoglobin and eGFR were lower than those in the normal uric acid group.The difference was statistically significant(P<0.05).5.The levels of plasma albumin,total cholesterol,triglyceride and eGFR in the anemia group were lower than those in the non-anemia group.In age,duration of diabetes,incidence of hypertension,hyperuricemia,incidence of renal dysfunction,systolic blood pressure,24-hour urinary protein quantification,serum creatinine,urea nitrogen and systolic blood pressure levels were high.The difference was statistically significant(P<0.05).6.The age,the course of diabetes,the incidence of hypertension,the incidence of anemia,the incidence of hyperurieemia,the systolic blood pressure,the blood myositis,the blood urea nitrogen and the 24-hour urinary protein were higher than those in the normal group,and the level of hemoglobin and plasma albumin was lower(P<0.05).Logistic regression analysis showed that the decline of renal function in DKD patients was related to age,blood myositis and hemoglobin.7.Renal biopsy was performed in 80 cases,of which 0 cases were in type I,14(17.5%)cases were type in ?a,10(12.5%)cases were in type ?b(12.5%),and 36(45.0%)cases were in type ?,grade 20(25.0%)cases were in type ?.In patients with severe glomerular injury,systolic blood pressure,serum creatinine,blood urea nitrogen,hemoglobin,glomerular filtration rate,hypertension,hyperuricemia and decreased renal function were higher in patients with severe glomerular injury,and lower levels of hemoglobin and glomerular filtration rate,and higher incidence of hypertension,hyperuricemia and decreased renal funct.ion in patients with severe glomerular injury.Systolic blood pressure,serum creatinine,blood urea nitrogen,uric acid,24-hour urine protein level were higher,hemoglobin,plasma albumin,triglyceride level were lower,the difference was statistically significant(P<0.05).8.There were 130(31.3%)cases diagnosed as chronic renal failure,98(23.6%)cases were followed by turbid urine,88(21.2%)cases were edema,80(19.3%)cases were turbid urine,and 29(7.0%)cases were others.There were 118(41.8%)cases with deficiency of spleen and kidney yang,70(24.8%)cases with deficiency of both qi and blood,46(16.3%)cases with deficiency of both qi and yin,and 48(17.0%)cases with deficiency of liver and kidney yin,followed by Qi-blood deficiency 70(24.8%),Qi-yin deficiency 46(16.3%)and liver-kidney yin deficiency 48(17.0%).In the youth group,30(7.2%)cases had deficiency of both qi and yin,followed by syndrome of deficiency of spleen and kidney 21(5.1%)cases.There were 20(4.8%)cases with yin deficiency and dryness-heat syndrome and 13(3.1%)cases with yin-yang deficiency syndrome.In the middle-aged group,98(23.6%)cases were spleen-kidney qi deficiency syndrome,91(21.9%)cases were yin-yang deficiency syndrome,29(7.0%)cases were qi-yin deficiency syndrome,28(6.7%)cases were yin deficiency and dryness-heat syndrome,and then 91(21.9%)cases were Yin-yang deficiency syndrome,29(7.0%)cases were Qi-yin deficiency syndrome.In the elderly group,34(8.2%)cases had Yin-Yang deficiency syndrome,followed by spleen-kidney Qi deficiency syndrome 31(7.5%)cases,Yin deficiency and dryness-heat syndrome 14(3.4%)cases,Qi-yin deficiency syndrome 6(1.4%)cases.9.The age,the incidence of hypertension,the incidence of anemia,the systolic blood pressure,the blood myositis,the blood urea nitrogen,the blood uric acid and the 24-hour urinary protein were significantly higher than that of the other three types of deficiency.The course of diabetes of both yin and yang deficiency was higher than that of the deficiency of both yin and yang.The level of serum albumin and eGFR was lower than that of other 3 kinds of deficiency.The level of fat and fat in the two groups of yin and yang was lower than that of the other three kinds of deficiency,and the level of total cholesterol was lower than that of both the deficiency of Qi and yin,and the difference was of statistical significance(P<0.05).By logistic regression analysis,the deficiency of both yin and yang of diabetic nephropathy and plasma albumin,systolic blood pressure and blood red Protein,serum creatinine is related.10.Type Ila syndrome of deficiency of both qi and yin,pathological type?b deficiency of spleen and kidney qi,type ? deficiency of yin and yang,deficiency of both qi and yin,and deficiency of both yin and yang in type IV were the main types of diabetic nephropathy.The difference was statistically significant(P<0.05).In both the deficiency of Qi and yin,the mild IFTA and the interstitial inflammation were higher than that of other groups;in both the deficiency of Qi and yin,the moderate to severe IFTA and the degree of vascular sclerosis were higher than that of other groups;in the deficiency of both yin and yang,the interstitial inflammation was 3,and the degree of vascular sclerosis was higher than that of other groups.The difference was statistically significant(P<0.05).Conclusion:1.The diabetic nephropathy usually occurs in middle-aged and old people.Proteinuria is the main clinical manifestation,which is often accompanied by hypertension,hyperuricemia,anemia and renal insufficiency.2.The patient who was elderly,complicated with hypertension,hyperuricemia with the lower renal function,kidney damage.High levels of serum creatinine and hemoglobin are risk factors for renal dysfunction in patients with DKD.3.In patients with severe glomerular injury,systolic blood pressure,serum creatinine,blood urea nitrogen,hemoglobin,glomerular filtration rate,hypertension,hyperuricemia and decreased renal function were higher in patients with severe glomerular injury,and lower levels of hemoglobin and glomerular filtration rate,and higher incidence of hypertension,hyperuricemia and decreased renal function in patients with severe glomerular injury.Systolic blood pressure,serum creatinine,blood urea nitrogen,uric acid,24 hours urine protein level were higher,hemoglobin,plasma albumin,triglyceride level were lower.In all DKD patients,spleen-kidney qi deficiency syndrome was most common in traditional Chinese medicine,qi-yin deficiency syndrome in young group,spleen-kidney qi deficiency syndrome in middle-aged group,and yin-yang deficiency syndrome in elderly group.The patients with Yin-Yang deficiency syndrome are the most serious,which is the outcome of the evolution of TCM syndrome type of DKD.4.The syndrome of deficiency of spleen and kidney qi was the most in DKD patients,followed by deficiency of both yin and yang,deficiency of qi and yin,and dryness-heat of deficiency of yin.There is a certain correlation between TCM syndrome type and clinical manifestation and biochemical indexes.With the progress of diabetic nephropathy,the TCM syndrome shows the evolution rule of deficiency of yin and heat,deficiency of qi and heat of spleen and deficiency of spleen and kidney and deficiency of yin and yang.5.The distribution of DKD syndrome type in different pathological types has a certain rule,and with the development of TCM syndrome type,the pathological changes of glomerular injury grade,ITFA and interstitial inflammation are gradually increased. |
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