| Objective:First To study the correlation of the general condition,basic medical history,laboratory parameters and blood lipid levels in patients with chronic kidney disease(CKD)accompanied by dyslipidemia.Second to explore the characteristics and risk factors of blood lipid in patients with CKD.Third to study the distribution of Traditional Chinese Medicine(TCM)syndrome type and the regularity of TCM medication in patients with CKD accompanied by dyslipidemia.It aims to provide a theoretical basis for the combined treatment for chronic kidney disease accompanied by dyslipidemia by TCM and Western medical science.Methods:In this cross-sectional study,a total of 220 CKD patients with dyslipidemia who met the inclusion and exclusion criteria and were hospitalized in the Department of Nephrology of the First Teaching Hospital of Tianjin University of TCM from January 1,2019 to June 30,2019 were included.We recorded patients' basic information,general conditions,basic medical history and laboratory parameters,used TCM four diagnosis steps to identify the types of patients' TCM symptoms and counted patients' use of Chinese medicine.Statistical analysis of the data was performed in SPSS 21.0 software.Results:1.There were 220 patients with CKD accompanied by dyslipidemia in this study,including 114 males and 106 females.The primary diseases were mostly chronic glomerulonephritis,followed by diabetic nephropathy,hypertensive kidney damage,and other primary diseases were less frequent.CKD Patients had the highest number of patients with hypertension,followed by hyperuricemia and diabetes.2.Triglyceride levels and HDL cholesterol levels are significantly different in different stages of CKD.Patients with CKD have multiple dyslipidemias,with hypertriglyceridemia predominating in CKD1-3 and CKD4 patients,low-density lipoproteinemia predominating in CKD5 stage.There was no significant difference in triglyceride levels in the CKD4 group compared with the CKD1-3 group,and triglycerides and high-density lipoprotein cholesterol levels of the CKD5 group were significantly reduced.3.In patients with CKD and dyslipidemia,different primary diseases exhibit differentcharacteristics of elevated blood lipids.The prevalence of hypertriglyceridemia is high in patients with a primary disease of chronic glomerulonephritis,and hypertriglyceridemia is high in patients with a primary disease of diabetic nephropathy,and low-density lipoproteinemia is high in patients with a primary disease of hypertensive kidney damage.4.For patients with CKD and dyslipidemia,TC levels were positively correlated with platelet and 24-hour urine protein quantification levels,and with the serum albumin was negatively correlated;TG levels were positively correlated with platelet and 24-hour urine protein quantification levels;HDL-C levels were only positively correlated with serum albumin;LDL-C levels were positively correlated with diastolic blood pressure and platelets and negatively correlated with serum albumin.5.There are differences in the distribution of TCM syndrome type in patients with different stages of CKD with dyslipidemia.In the distribution of TCM original syndrome,with the progression of CKD,the distribution of spleen and kidney Qi deficiency symptoms gradually decreased,while the distribution of Yin and Yang both deficiency symptoms gradually increased.In the distribution of TCM assistant syndrome,the distribution of blood stasis gradually increased as kidney function declined.6.Different primary diseases have some influence on the distribution of TCM syndrome type in patients with CKD accompanied by dyslipidemia.Kidney Qi deficiency accounts for the highest proportion of dyslipidemia in patients with chronic glomerulonephritis,both Qi and Yin deficiency accounts for the highest proportion of dyslipidemia in patients with diabetic nephropathy.In the distribution of TCM assistant syndrome,dampness and heat accounted for the highest proportion of patients with dyslipidemia in chronic glomerulonephritis,while blood stasis accounted for the highest proportion of patients with diabetic nephropathy.7.There are differences in the frequency of TCM medication for patients in different stages of CKD with dyslipidemia,and the main treatment for CKD stages D1-3 is to tonify Qi and strengthen the spleen,reduce turbidity and reduce lipid,the main drugs are astragalus,atractylodes,CAULIS SINOMENII,hawthorn,pinellia,alisma etc.The main treatment for CKD stage 4 is to tonify the Qi and Yang,resolve stasis and reduce lipid,the main drugs include astragalus,dried ginger,atractylodes,salvia and panax notoginseng etc.The maintreatment for CKD stage 5 is Yin and Yang tonification,resolving stasis and resolving collaterals to reduce lipid,the main drugs are aconite,cinnamon,earthworm,salvia miltiorrhiza,wolfberry,panax notoginseng etc.8.There are differences in the frequency of TCM medication in patients with different primary diseases of CKD with dyslipidemia,and the main treatment in the chronic glomerulonephritis group is Qi tonification and spleen strengthening,heat clearing,diuresis and lipid reducing,the main drugs are astragalus,radix scutellariae,alisma,bupleurum,pueraria,hawthorn,etc;the main treatment in diabetic nephropathy group is to benefit Qi and nourish Yin,resolve stasis and improve blood circulation to reduce lipids,the main drugs are astragalus,Chinese yam,Gordon Euryale,earthworm,twig of Winged Euonymus,salvia,kudzu root,panax notoginseng,etc;The main treatment in hypertensive kidney damage group is to nourish the kidneys and Yin,dissolves turbidity and reduce lipid,the main drugs are alisma,wolfberry,polygonum multiflorum,coix seed,salvia,poria,hawthorn etc.Conclusion:1.CKD Patients have different characteristics in different stages and primary dyslipidemia,Patients in CKD 1-3 are predominantly hyper-TGemia,CKD 4 is also predominantly hyper-TGemia,and CKD5 is predominantly hypo-HDL-Cemia.The prevalence of hyper-TGemia was high in patients with primary disease of chronic glomerulonephritis,the prevalence of hyper-TGemia and hypo-HDL-Cemia was high in patients with primary disease of diabetic nephropathy,and the prevalence of hypo-HDL-Cemia was high in patients with primary disease of hypertensive kidney damage.2.The occurrence of dyslipidemia of chronic kidney disease is associated with PLT,24 h UPR,ALB,DBP and other factors,and relevant indicators should be actively monitored and blood lipids should be intervened as soon as possible.3.There are differences in the distribution of TCM syndrome type in patients with different primary diseases of CKD accompanied by dyslipidemia and different stages,with the progression of CKD,the distribution of spleen and kidney Qi deficiency syndrome gradually decreased,while that of Yin and Yang deficiency syndrome and blood stasis syndrome gradually increased.Damp-Heat and spleen and kidney Qi deficiency accounted for the highest proportion of dyslipidemia in patients with chronic glomerulonephritis,and Qi andYin deficiency and blood stasis accounted for the highest proportion of patients with dyslipidemia in diabetic nephropathy.4.The TCM medication and treatments for patients of different primary diseases of CKD with dyslipidemia and different stages are different.With the progression of CKD,the treatment gradually shifted from tonifying the qi and strengthening the spleen,resolving turbidity and reducing lipids to dual tonification of Yin and Yang,resolving stasis and reducing lipids;The main treatment for chronic glomerulonephritis group is to tonify Qi and strengthen the spleen,clear heat and diuresis to reduce lipids;the main treatment for diabetic nephropathy group is to benefit Qi and nourish Yin,resolve stasis and improve blood circulation to reduce lipids;the main treatment for hypertensive kidney damage group is to nourish the kidney and Yin,resolve turbidity and reduce lipids. |
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