Research On The Correlation Between TCM Syndrome Types And Clinical Indicators Of CKD And Professor Li Jianmin's Experience In Treating CKD

Research purposes:Recently,the prevalence of Chronic Kidney Disease(CKD)has been increasing gradually year by year on global scale.So CKD has become one of the world’s public health problems.Based on the analyses of clinical medical cases of CKD in nephrology department of Beijing integrated traditional Chinese and Western Medicine Hospital,this research is designed to understand the characteristics of the distribution of Traditional Chinese medicine(TCM)syndromes of CKD,the relationship between TCM syndromes of CKD and clinical parameters in order to supplement the modern research on TCM syndrome and pathogenesis of CKD,and to summarize the experience of Professor Li in the treatment of CKD.Research methods:This research is needed to collect CKD clinical cases from January 2017-December 2019 in traditional Chinese and western medicine hospital of Beijing,and to formulate unified observation list(including general data,laboratory indexes,TCM syndromes and so on),then to record information from observation list into the "Predominant disease management platform for nephropathy patients" for building a database on which CKD patients who meet the criteria are selected by inclusion and exclusion criteria.With the application of the analysis software SPSS22.0 which is used to analyze and mine data,the differential clinical parameters under the TCM syndromes of CKD are explored.Next the differential clinical parameters and TCM syndromes are defined as independent variable and dependent variable respectively,which are designed to construct multiple logistical regression equation for analyzing risk factors affecting TCM syndrome types,which are finally assigned to Receiver-Operating-Characteristic curve to find a clinical parameter with useful and critical diagnostic value for various of TCM syndrome types of CKD.Finally,with Professor Li’s understanding of the pathogenesis of CKD and using drugs features,to summarize the clinical experience of his in the treatment of CKD.Results:1.A total of 221 eligible patients were included in this study,who are mainly distributed in the age group of 45-60 years and 60-75 years,and the overall male-female sex ratio is 1.83:1.Upon inspection,there is no statistical difference in gender distribution among different age groups(P>0.05).The proportion of patients of CKD with hypertension and diabetes was higher,accounting for 85.5%and 80.5%respectively.According to statistics.there are four TCM syndromes of all the 221 CKD patients,qi-yin deficiency with poison and blood stasis(103 cases),Spleen-kidney qi deficiency with poison and blood stasis(74 cases),Spleen-kidney yang deficiency with poison and blood stasis(20 cases),Spleen-kidney yang deficiency with water-dampness(24 cases).There are 43 cases,42 cases,56 cases,31 cases,49 cases from CKD 1 to 5 stage.The distribution of TCM syndromes in CKD different stages is different,and the difference is statistically significant(P<0.05).Through TCM syndromes’comparison,there are eleven differential clinical parameters,Age,Diabetes or no,SCr,BUN,HUA,β2-MG,TP,ALB,UTP,Hb,D-D.By using multiple logistical regression equation to study the correlation between TCM syndromes and 11 differential clinical parameters,it is found that the obvious elevation of serum uric acid(UA>460umol/L)and mild anemia(90≤Hb<110g/L)are risk factors for the qi-yin deficiency with poison and blood stasis of TCM syndrome of CKD,elevated blood β2-microglobulin is a risk factor for Spleen-kidney qi deficiency with poison and blood stasis,age and heavy proteinuria are risk factors for the Spleen-kidney yang deficiency with poison and blood stasis,and Spleen-kidney yang deficiency with water-dampness.By plotting ROC curves,the results show that the AUC of serum uric acid and hemoglobin in diagnosis of qi-yin deficiency with poison and blood stasis are 0.607(95%CI:0.533,0.779),0.298(95%CI:0.230,0.367)respectively;the AUC of bloodβ2-microglobulin in diagnosis of Spleen-kidney qi deficiency with poison and blood stasis is 0.645(95%CI:0.569,0.721);the AUC of age and proteinuria in diagnosis of Spleen-kidney yang deficiency with poison and blood stasis are 0.538(95%CI:0.398,0.679).0.734(95%CI:0.631,0.838)respectively;the AUC of age and proteinuria in diagnosis of Spleen-kidney yang deficiency with water-dampness are 0.637(95%CI:0.512,0.716),0.683(95%CI:0.544,0.823)Conclusion:1.CKD patients in our department are mainly middle-aged and elderly,and the overall prevalence rate is higher in men than women.However,with the increase of age,the prevalence of male and female gradually tends to be balanced,which may be related to the protective effect of estrogen on women and some chronic diseases accompanying with them,such as diabetes,hypertension and so on2.The TCM syndromes of CKD in our department are divided into 4 types,among which the syndrome of qi-yin deficiency with poison and blood stasis is mainly distributed in stage 1 to 3 of CKD,Spleen-kidney yang deficiency with poison and blood stasis and Spleen-kidney yang deficiency with water-dampness are in stage 3 to 5 of CKD.In the course of CKD progression,the pathogenesis of TCM has some regularity,which is the Spleen-kidney qi deficiency,the Spleen-kidney yang deficiency and the water-dampness syndrome gradually aggravates with the progress of the disease.3.By using multiple logistical regression equation and ROC curves,the outcome is that Serum uric acid greater than 456 has diagnostic value for qi-yin deficiency with poison and blood stasis of TCM syndrome of CKD,blood β2-microglobulin greater than 3.11 has diagnostic value for Spleen-kidney qi deficiency with poison and blood stasis,proteinuria greater than 0.975 has diagnostic value for Spleen-kidney yang deficiency with poison and blood stasis,both of proteinuria greater than 6.6845 and age over than 77.5 have diagnostic value of Spleen-kidney yang deficiency with water-dampness.