| Objective:The purpose of this study was to analyze the relationship between the reversal of phase and the general situation,clinical characteristics,follow-up process and prognosis of patients with CKD3 treated by traditional Chinese medicine,and to analyze the related factors of the time sequence and the duration of reversal.Methods:A total of 98 CKD3 patients with complete data were included from 2018.03.01 to 2019.08.01 in the outpatient department of Sun Wei,director of the department of renal medicine,Jiangsu province hospital of traditional Chinese medicine.According to the changes of CKD stage for the first time from the visit to the end of observation(2019.12.30),38 patients in the reverse group and 60 patients in the non-reverse group.The observation contents included basic information of patients,clinical data,diagnostic information of traditional Chinese medicine,visits and so on,and statistical analysis was carried out according to the data.Results:(1)The average age of 98 patients with CKD3 was(57.31±15.097)years old,including 47 males and 51 females.There were no significant differences in age and gender between the two groups.Among the primary diseases,there were 46 cases of primary glomerulonephritis,12 cases of hypertensive nephropathy,3 cases of diabetic nephropathy,1 case of hyperuric acid nephropathy,12 cases of other types,and 24 cases with unknown etiology,and there was no significant difference between the two groups(P>0.05).Among the concomitant diseases,there were 63 cases of hypertension,11 cases of diabetes,12 cases of hyperuricemia,13 cases of heart disease,2 cases of hyperlipidemia,5 cases of cerebral infarction and cerebral hemorrhage,3 cases of tumor,5 cases of renal calculi,5 cases of respiratory diseases,5 cases of infectious diseases,13 cases of surgical history,3 cases of rheumatic immune diseases and 5 cases of digestive system diseases,there was no significant difference in complicated diseases between the two groups(P>0.05);In the study,the course of disease was 38(11-87)(months)in the reverse group and 48.5(24-120)(months)in the non-reverse group,and there was no significant difference in the course of disease between the two groups(P>0.05).In the study,5 patients had acute aggravating factors when visiting the hospital,and there was no statistical difference between the two groups(P>0.05).There were 52 cases(53%)of patients in the two groups who had taken traditional Chinese medicine before our treatment,and 46 cases(47%)of patients who had not taken traditional Chinese medicine.There was a significant difference in the use of traditional Chinese medicine between the two groups(P<0.05).(2)There were significant differences in urinary microalbumin,ACR,BUN,Scr,eGFR,Hb and kidney size between the reversal group and the non-reversal group(P<0.05),but there was no significant difference in urine red blood cell,UA,C02CP,GLU,TG and LDL-C between the two groups,indicating that indicating that the reversal of the two groups was related to renal dysfunction,albuminuria,renal anemia and size of the kidney.(3)The main clinical symptoms of the 98 patients in this study were weakness,pain and weakness of the waist and knee,edema,followed by stool shapeless,low back pain,clear night urine,dizziness,poor night sleep,dry stool,fear of cold,dry mouth,numbness of limbs,nausea and vomiting,poor appetite,and headache.The main tongue condition are in sequence of pale tongue,reddish one,dark one,with teeth marks,slightly thin white one,white greasy one,moss less fluid,yellow and greasy fur;The main pulse condition are in sequence of wiry pulse,small pulse,deep pulse.The deficiency syndrome is mainly qi deficiency of spleen and kidney,followed by deficiency of both vital Qi and Yin syndrome,spleen-kidney yang deficiency syndrome,liver-kidney yin deficiency syndrome,yin-yang deficiency syndrome is rare.The asthenia syndrome of the primary are common for the damp turbidity,hydrosphere syndrome,blood stasis,damp heat syndrome,but rare for the wind-driven syndrome.There is no statistically significant differences between the two groups in the deficiency syndrome(P>0.05),but obvious difference are indicated in the asthenia syndrome(P=0.018).In addition,the damp-turbid syndrome was the main syndrome in the reversal group(44%)and the damp-heat syndrome in the unreversed group(27%),indicating that the difference between the two groups had a greater impact on the reversal of CKD3 stage.(4)There were no statistically significant differences in the number of visits,average visit interval and the regular use of Chinese medicine between the reversal group and the non-reversal group(P>0.05),while there was a statistical difference in whether or not to participate in chronic management(P=0.013).At the end of the observation period,the proportion of patients with CKD1-2 stage in the reversal group was significantly higher than that in the unreversed group,while the proportion of patients in CKD3-5 stage was significantly lower than that in the unreversed group.There was a significant statistical difference for the final CKD stage between the two groups(P=0.000).This shows that the progression of kidney disease in patients with CKD3 reversal slows down within a certain period of time.(5)Take 3 months as the sequence of time of reversal nodes,and 6 months as the duration of reversal nodes.There was no significant difference between the sequence of time of reversal and the course of disease,average visit interval and maintenance time(P>0.05).However,the total number of visits in the early reversal group was less than that in the late reversal group,and there was a statistical difference between the two groups(P=0.014).The reversal duration was not significantly different from that of eGFR,UA and Hb(P>0.05),but significantly different from that of ACR and GLU(P<0.05),which indicates that the maintenance time of the two groups was not significantly related to glomerular filtration rate,serum uric acid level and anemia,but related to the severity of proteinuria(P=0.003),and level of blood glucose(P=0.030).Conclusion:(1)The reversal of CKD3 is not related to primary disease,complication and acute aggravating factors,but related to the level of renal function,the amount of albuminuria,the degree of anemia,the size of kidney and the condition of taking traditional Chinese medicine,the lower the level of toxin in blood,the less albuminuria,the lighter the degree of anemia and renal atrophy,the use of traditional Chinese medicine before our treatment,the more easily reversed.(2)Traditional Chinese medicine syndromes of 98 patients with CKD3 stage are illustrated as below:deficiency is a most common syndrome in the deficiency of vital energy of spleen and kidney,then followed by deficiency of both vital Qi and Yin syndromethe,spleen-kidney yang deficiency syndrome,liver and kidney Yin deficiency syndrome,but yin and yang deficiency syndrome are rare;The wet muddy syndrome is a damp,blood stasis,damp-heat syndrome,of which the damp turbidity,hydrosphere syndrome,blood stasis,damp heat syndrome is more common,but rare for the wind-driven syndrome.Among them,damp-turbid syndrome was the main syndrome in the reversal group and damp-heat syndrome in the non-reversal group.(3)For CKD3 patients in the reversal group,the stage of CKD after reversal could be maintained for a period of time,and with the extension of observation time,the proportion of patients with CKD stage progression was relatively small compared with the unreversed group,but there was no significant difference between reversal time and the maintenance time.(4)The follow-up of patients with early reversal is poor,so the management of patients with early reversal should be strengthened;patients with low albuminuria will last longer after reversal. |
PDF Full Text Request