| Objective:1.This study aims to further explore the risk factors of kidney disease in type 2 diabetes through the meta-analysis of the risk factors of kidney disease in type 2 diabetes,so as to provide references for clinical doctors,and to improve the early prevention,early detection,early diagnosis,early intervention and individual treatment of the disease.2.Based on Chinese medicine constitution classification in patients with type 2 diabetes kidney disease,general data and related statistical analysis of clinical physical and chemical indicators,understanding of TCM constitution of patients with type 2 diabetes kidney disease distribution characteristics and laws,and analyzes the physical characteristics and the correlation of clinical indicators,to adjust the constitution of traditional Chinese medicine "cure not ill" theory to provide clinical basis,so as to improve Chinese and western medicine together the overall level of prevention and treatment of type 2 diabetes kidney disease.Methods:1.The literatures related to the risk factors of kidney disease in type 2 diabetes mellitus published on January 1,2000(solstice,August 31,2019)in Chinese and foreign language databases were retrieved by computer,supplemented by manual retrieval and literature tracing.Remove the duplicated retrieved literature by End Note X9 software.Then,browse the titles and abstracts.Determine the literature included in the study according to the inclusion and exclusion criteria after downloading the full text of the literature related to the research content and evaluating the literature quality by using the Newcastle-Ottawa scale(NOS)score scale.Finally,extract the data and do Meta-analysis by using Review Manager5.3 software.Results:1.In the end,21 literatures,19 literatures in Chinese and 2 literatures in English were included in the meta-analysis.There were 20 case-control studies and 1 cohort study.A total of 12,612 cases were involved,including 7,483 patients with type 2 diabetes alone and 5,129 patients with type 2 diabetes complicated with diabetic kidney disease.2.Meta-analysis results of age and disease course: the OR combined value of age,disease course and T2DN was statistically significant under 95% CI(P<0.05).3.Meta-analysis results of lifestyle: the OR combined value of smoking and T2DN was not statistically significant under 95% CI(P>0.05).The combined OR values of alcohol consumption,vegetable intake,exercise,education level,body mass index and T2DN were statistically significant at 95% CI(P<0.05).4.Meta-analysis results of blood glucose related indicators: the combined OR value of fasting blood glucose(FPG)and T2DN was not statistically significant under 95% CI(P>0.05).The OR combined value of HbAlc and T2DN was statistically significant at 95% CI(P<0.05).5.Meta-analysis results of blood pressure-related indicators: the combined OR value of SBP and T2DN was statistically significant under 95% CI(P<0.05).The OR combined value of diastolic blood pressure(DBP)and T2DN was not statistically significant at 95% CI(P>0.05).6.Meta-analysis results of lipid-related indicators: the combined values of triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-c)OR were statistically significant under 95% CI(P<0.05).7.Meta-analysis results of kidney disease related indicators: the OR combined value of serum creatinine(Scr),blood urea nitrogen(BUN),blood uric acid(UA)and T2DN was not statistically significant under 95% CI(P>0.05).The OR combined value of plasma albumin(ALB)and T2DN was statistically significant at 95% CI(P<0.05).8.Meta-analysis results of other related indicators: the OR combined value of fasting cpeptide(FCP)and T2DN was not statistically significant at 95% CI(P>0.05).The OR combined value of FIB and T2DN was statistically significant at 95% CI(P<0.05).9.Meta-analysis results of related complications: the OR combined value of diabetic retinopathy,hypertension and T2DN was statistically significant at 95% CI(P<0.05).The OR combined value of the correlation index between T2DN and cerebrovascular disease,coronary atherosclerosis and T2DN was not statistically significant under 95% CI(P>0.05).10.Among the 195 patients in the clinical study,115 were males,accounting for 59.0%;A total of 80 cases were female,accounting for 41.0%.The youngest was 31 and the oldest 86,with an average age of 62.The age of the patients was mainly distributed between 50 and 79 years old,among which,the male and female patients aged between 60 and 69 years old distributed the most.There were 20 patients(10.3%)in G1 stage,31(15.9%)in G2 stage,17(8.7%)in G3 a stage,26(13.3%)in G3 b stage,61(31.3%)in G4 stage and 40(20.5%)in G5 stage.11.Overview of TCM constitution distribution: 195 patients had TCM constitutions,including mild and 8 kinds of biased constitutions.There were 15 cases(7.7%)of mild quality,and the biased constitution from high to low was: 62 cases(31.8%)of qi deficiency quality,25 cases(12.8%)of phlegm and dampness quality,24 cases(12.3%)of Yin deficiency quality,23 cases(11.8%)of dampness and heat quality,22 cases(11.3%)of Yang deficiency quality,21 cases(10.8%)of blood stasis quality,2 cases(1.0%)of qi stagnation quality,and 1 case(0.5%)of special report quality.12.General information and constitution: gender,age,body mass index,smoking history and drinking history showed no statistical difference among different TCM constitution types(P>0.05).13.CKD stage and constitution: there was a statistically significant difference between CKD stage and TCM constitution distribution(P<0.05).The phases G1 and G2 were mainly composed of mild and Yin deficiency,G3 a and G3 b were mainly composed of qi deficiency and phlegm dampness,and G4 and G5 were mainly composed of qi deficiency,Yang deficiency,phlegm dampness,blood stasis and dampness and heat.14.Comorbidities and constitutions: the distribution of comorbidities with hypertension,coronary heart disease and cerebrovascular diseases was not statistically significant(P>0.05).15.Blood pressure and constitution: there was no statistical difference between SBP and DBP in different TCM constitution types(P>0.05).16.Blood glucose and body constitution: fasting blood glucose(FPG)and glycosylated hemoglobin(HbA1c)showed no statistical difference among different TCM body constitution types(P>0.05).17.Blood lipid and body constitution: there was no statistical difference among different TCM constitution types in triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)(P>0.05).18.The related parameters of renal function and constitution: serum creatinine(Scr)in the peace and the deficiency of qualitative,Yang deficiency,phlegm wet mass,damp and hot,blood stasis,Yin deficiency and Yang deficiency between mass,damp and hot,blood stasis was statistically difference(P<0.05),characterized by qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis quality variety of biased constitution of Scr are high quality is generally calm,Yang deficiency,mass transfer,hot and humid,Scr is generally Yin deficiency and blood stasis quality high quality.Urea nitrogen(BUN)in peace and qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis,Yin deficiency and Yang deficiency between mass,damp and hot,blood stasis was statistically difference(P<0.05),characterized by qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis of biased constitution BUN were all high quality is generally calm,Yang deficiency,mass transfer,hot and humid,BUN is generally Yin deficiency and blood stasis quality high quality.Glomerular filtration rate(eGFR)in peace and qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis,Yin deficiency and qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis quality between statistically significant(P<0.05),characterized by qi deficiency,Yang deficiency,phlegm wet,hot and humid and eGFR of blood stasis were generally more gentle quality,Yin quality is low.Cystatin-C(Cys-C)in a peaceful and qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis,Yin deficiency and qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis quality between statistically significant(P<0.05),characterized by qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis qualitative Cys-C were generally more gentle quality,Yin quality high.Uric acid(UA)was not statistically significant in different constitution types(P>0.05).21.The 24 h urine protein urine index and physical: quantitative(24 pro)in peaceful mass with qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis quality between statistically significant(P<0.05),characterized by qi deficiency,Yang deficiency,phlegm wet mass,damp and hot,blood stasis qualitative 24 high quality pro are generally a peaceful,among them,the hot and humid,Yang deficiency,phlegm wet qualitative 24 pro level obviously is higher.Urinary n-acetyl glucosidase(NAG)and galactosidase(GAL)did not have statistical significance in different constitution types(P>0.05).22.Plasma albumin,hemoglobin and constitution: plasma albumin(ALB)showed statistically significant differences between ALB and yang-deficiency,and between ALB and damp-heat(P<0.05),showing that ALB of yang-deficiency and damp-heat was generally lower than that of damp-heat.Hemoglobin(HGB)with qi deficiency,Yang deficiency in peaceful mass,damp and hot,blood stasis,Yin deficiency and Yang deficiency,damp and hot,blood stasis,qi deficiency and Yang deficiency,phlegm wet and Yang deficiency,mass transfer,hot and humid there were statistical differences(P<0.05),characterized by Yang mass,damp and hot,blood stasis qualitative HGB peace is generally low quality,Yin quality,Yang quality deficiency of low quality,Yang quality,and the mass,damp and hot is phlegmy wet mass is low.23.Coagulation indexes and constitution: fibrinogen(FIB)showed statistical differences in the properties of qi deficiency,Yang deficiency,phlegm dampness,dampness and heat,and blood stasis(P<0.05),showing that the properties of qi deficiency,Yang deficiency,phlegm dampness,dampness and heat,and blood stasis were generally higher than those of qi deficiency.D2 polymer(D-Dimer)showed statistically significant differences between mild and humid heat,Yin deficiency and humid heat(P<0.05),and the expression of D-Dimer was generally higher than that of mild and Yin deficiency.There was no statistical significance of Hcy in different constitution types(P>0.05).24.Relevant indexes of calcium and phosphorus metabolism and constitution: serum calcium(Ca)showed statistical differences between Yang deficiency,Yin deficiency,qi deficiency,Yin deficiency,and damp and hot deficiency(P<0.05),showing that the Ca of Yang deficiency was generally lower than that of Yang deficiency,qi deficiency,Yin deficiency,and damp and hot deficiency.There was a statistical difference between serum phosphorus(P)and blood stasis(P<0.05),showing that blood stasis P was generally higher than that of blood stasis.Parathyroid hormone(i PTH)showed statistical differences between the mild and Yang asthenia,blood stasis,qi asthenia and Yang asthenia,Yin asthenia and Yang asthenia(P<0.05).IPTH of Yang asthenia was generally higher than that of Yang asthenia,qi asthenia and Yin asthenia,and i PTH of blood stasis was also generally higher than that of Yang asthenia.25.Blood sedimentation and constitution: there were statistical differences between blood sedimentation(ESR)and qi deficiency,Yang deficiency,phlegm-dampness,damp-heat,blood stasis,Yin deficiency and Yang deficiency(P<0.05),which showed that ESR of qi deficiency,Yang deficiency,phlegm-dampness,damp-heat,and blood stasis were generally higher than that of qi deficiency,Yang deficiency,phlegm-dampness,damp-heat,and blood stasis were generally higher than that of Yin deficiency.Conclusions:1.Age,long course of disease,history of alcohol consumption,inactivity,high BMI,high HbAlc,high SBP,high TG,high TC,high LDL-C,low ALB,high FIB,and hypertension are risk factors for kidney disease secondary to type 2 diabetes.High vegetable intake,high educational level and high HDL-C are protective factors for kidney disease secondary to type 2 diabetes.Patients with type 2 diabetes with diabetic retinopathy are more likely to have DKD.2.The majority of kidney disease patients with type 2 diabetes are middle-aged and elderly,and the influence of gender has not been determined.3.The clinical discovery rate of kidney disease in patients with type 2 diabetes at stageG2-G4 is high.4.The TCM constitutions of kidney diseases in type 2 diabetes mellitus can be composed of mild,asthenic and partial constitutions(qi-deficiency,yin-deficiency and yang-deficiency)and solid and partial constitutions(phlegm-dampness,damp-heat and blood-stasis),among which qi-deficiency and partial constitutions are the most.5.The distribution of constitution varies with the disease progression in different disease stages.At the early stage,DKD is mainly composed of mild and Yin deficiency,and later,qi deficiency and phlegm dampness.6.Serum creatinine,urea nitrogen,glomerular filtration rate,serum cystatin C,24 h urine protein quantification,plasma albumin,hemoglobin,fibrinogen,D2 polymer,serum calcium,serum phosphorus,parathyroid hormone,and blood sedimentation were different in different constitutions. |
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