Study On The Evolution Of TCM Syndromes And The Correlation Between Psychosomatic Factors And Prognosis In Maintenance Hemodialysis Patients

Objectives:To study the evolution of TCM syndromes and the correlation between psychosomatic factors and prognosis in maintenance hemodialysis patients,in order to improve the long-term survival rate of dialysis patients.Methods:This study used a retrospective study method to collate and analyze the clinical data of 140 patients with maintenance hemodialysis from the Blood Purification Center of Guang'anmen Hospital from 2014 to 2019,divided into two studies.The first study was to study the distribution characteristics and evolution rules of MHD patients at three time points,including 24 months and 48 months,and analyze the correlation with the prognosis of patients.The second study divided the clinical outcomes of patients as of December 31,2019 into the death group and the survival group.The psychosomatic factors of the two groups of patients,including the five-state personality scale,SAS,SDS,HRV,basic data and laboratory data were compared to analyze the correlation with prognosis.Results:Among the 140 subjects at the time of enrollment,the spleen and kidney qi deficiency syndrome was the most common in the death group(15 cases),the liver and kidney yin deficiency syndrome was the least(5 cases),and the survival group was mostly the qi-yin deficiency syndrome(22 cases),the yin-yang deficiency syndrome was the least(14 cases).The death group mostly had damp-turbidity syndrome(26 cases)and blood stasis syndrome(18 cases),while the survival group mostly had damp-turbidity syndrome(36 cases)and damp-heat syndrome(31 cases).At 24 months,104 patients in the study group had more qi-yin deficiency syndrome(8 cases),liver and kidney yin deficiency syndrome was the least(3 cases),and survival group had more qi-yin deficiency syndrome(24 cases),the yin-yang deficiency syndrome was the least(3 cases).The death group had multiple blood stasis syndrome(9 cases),and the survival group had damp-turbidity syndrome(35 cases)and damp-heat syndrome(21 cases).At 48 months,in the 75 cases,the death group was mostly with qi-yin deficiency syndrome(3 cases),and the spleen and kidney deficiency syndrome and liver and kidney yin deficiency syndrome were absent.The survival group was mostly qi-yin deficiency syndrome(17 cases),and liver and kidney yin deficiency syndrome was the least(9 cases).The death group had multiple blood stasis syndrome(5 cases),and the survival group had multiple damp-turbidity syndrome(30 cases)and damp-heat syndrome(21 cases).Symptom transformations occurred during the study period.Among the syndromes,79 cases(56.4%)occurred from the time of enrollment to 24 months,of which 14 died,and 42 cases occurred from 24 to 48 months(40.4%),of which 3 died;in the combined certificate,62 cases(44.3%)of syndrome conversion occurred from the time of enrollment to 24 months,of which 15 died,and 24 cases of syndrome conversion occurred from 24 to 48 months(23.1%),including 3 deaths.Among them,it can be observed in the early stage that the spleen and kidney deficiency syndrome and liver and kidney yin deficiency syndrome do not convert to the yin-yang deficiency syndrome,and the patients who convert the yin-yang deficiency syndrome to other syndromes survive;as the time to enter hemodialysis increases,more the patient's syndrome was converted to yin-yang deficiency syndrome,with a total of 15 patients,accounting for 35.7%of all conversions;the yin-yang deficiency syndrome did not convert to spleen and kidney qi deficiency syndrome and liver and kidney yin deficiency syndrome;more patients concurrently converted to blood stasis syndrome,a total of 10 patients accounted for 41.7%of all conversions;all patients who died were converted from damp-turbidity syndrome to blood stasis syndrome.Compared with the survival group,patients in the death group had higher age,SF,serum creatinine,blood phosphorus,low density lipoprotein,parathyroid hormone.The SDNN,LF/HF value,serum albumin,hemoglobin,blood calcium,high-density lipoprotein,and blood uric acid value was low,and the differences were statistically significant(P<0.05).There were no statistically significant differences in degrees,including gender,primary disease,five-state personality scale,self-rating anxiety and depression scale,RMSD,TP,HF,LF,VLF,red blood cell count,serum iron,transferrin,total iron binding capacity,transferrin saturation,blood urea nitrogen,calcium-phosphorus product,total cholesterol,triglycerides,potassium,and serum sodium(P>0.05).Logistic regression analysis showed that SDNN,LF/HF,serum albumin,blood calcium,blood phosphorus and high-density lipoprotein were statistically significant.Every 1 ms increase in SDNN reduced the risk of death by 0.95 times;every 1 increase in LF/HF,The risk of death is reduced by 0.31 times;each increase in serum albumin is 1g/L,the risk of death is reduced by 0.81 times;each increase in blood calcium is 1mmol/L,the risk of death is reduced by 0.08 times;each increase in high density lipoprotein is 1mmol/L,the risk of death decreased by 0.07 times;and for every 1 mmol/L increase in blood phosphorus,the risk of death increased by 4.43 times.Conclusion:1.The evolution of the syndromes in MHD patients is roughly the spleen-kidney qi deficiency syndrome/liver-kidney yin deficiency syndrome?spleen-kidney yang deficiency syndrome?yin-yang deficiency syndrome,and the qi-yin deficiency syndrome has been converted and transferred throughout.The evolution of the various types of syndromes is roughly damp-turbidity syndrome/damp-heat syndrome?wind movement syndrome?blood stasis syndrome.2.The prognosis of patients with MHD who transform from the yin-yang deficiency syndrome to other syndromes is good,and the conversion from damp-turbidity syndrome to blood-stasis syndrome may cause poor prognosis.3.The five-state personality measurement and anxiety and depression scores of MHD patients had no significant correlation with their 5-year prognosis.The Shaoyin personality and severe anxiety and depression may be associated with poor prognosis.4.In the HRV test of MHD patients,the frequency-domain indicator SDNN and time-domain indicator LF/HF are significantly correlated with prognosis.Low SDNN and low LF/HF value have a poor prognosis.5.If the older the MHD patient is,the lower the serum albumin,hemoglobin,calcium,and high-density lipoprotein and blood uric acid;and the higher the serum ferritin,serum creatinine,blood phosphorus,low-density lipoprotein,and parathyroid hormone,the higher the risk of death.