Evaluation Of The Curative Effect Of Integrated Traditional Chinese Medicine Therapy On Diabetic Nephropathy Based On Markov Model

Objective:1.Using Markov model to evaluate the advantages of TCM comprehensive therapy for DKD;2.To evaluate the effect of TCM comprehensive therapy intervention on DKD.Methods:Retrospective cohort study:From January 2009 to December 2019,the archived medical records of DKD patients who were hospitalized in Guang'anmen Hospital of the Chinese Academy of Chinese Medical Sciences were retrospectively analyzed,and patients with diabetic kidney disease who had been followed up for 1 year with complete data were selected,totaling 198 cases.Investigate the basic conditions,symptoms,signs,and laboratory indicators of 198 patients with diabetic kidney disease,and divide them into a western medicine treatment group of 92 cases and a Chinese and western medicine treatment group of 106 cases according to whether they have been treated with TCM.Calculate the transition probability of the CKD staging change of DKD patients after 12 months of Western medicine treatment and Chinese and Western medicine treatment.SPSS 19.0 software was used to statistically analyze the data.Using TreeAge Pro Healthcare 2020 software to apply Markov model to predict the prognosis of DKD patients.Results:1.A total of 198 patients with diabetic kidney disease were included in this study.The ratio of male to female was 2.19:1,and the average age was 59.28 years.61 cases(30.81%)with a normal BMI,4 cases(2.02%)who were thin,74 cases(37.37%)who were overweight,and 59 cases(29.80%)who were obese.The average course of disease was 67.54 months.2 cases(1.01%)had no comorbidities,187 cases(94.44%)had hypertension,118 cases(59.60%)had hyperlipidemia,84 cases(42.42%)had coronary heart disease,42 cases(21.21%)had a history of fatty liver,17 cases(8.59%)had osteoporosis,and 14 cases(7.07%)had lung disease.96 cases(48.48%)had a smoking habit,75 cases(37.88%)had a drinking habit.Before enrollment,14 cases(7.07%)had not received treatment,49 cases(24.75%)had intermittent treatment,and 135 cases(68.18%)received systemic treatment.At the time of enrollment,there are 29 cases(14.65%)of CKD stage 1 patients,34 cases(17.17%)of CKD stage 2 patients,43 cases(21.72%)of CKD stage 3 patients,28 cases(14.14%)of CKD stage 4 patients,and 64 cases(32.32%)of CKD stage 5 patients.2.Among the enrolled DKD patients,there are 84 patients(42.42%)of the main syndrome with deficiency of both Qi and Yin,7 patients(3.54%)with yin deficiency of liver and kidney,17 patients(8.59%)with deficiency of Qi and blood,and 90 patients(45.45%)with yang deficiency of spleen and kidney.124 patients(62.63%)without accompanying syndrome,10 patients(5.05%)with yin deficiency with yang hyperactivity,38 cases(19.19%)with blood stasis syndrome,and 26 cases(13.13%)with bladder damp-heat.158 cases(79.80%)without changed syndrome,30 cases(15.15%)with turbid poison invades gastric,1 cases(0.51%)with urine poison into the brain,and 9 cases(4.54%)with attack of the heart by retained fluid.3.After 12 months,the total metastasis probability of CKD1 in the traditional Chinese and western medicine treatment group progressed to CKD2,CKD3,CKD4,CKD5 and death/end-stage renal disease was 0.406 lower than that in the western medicine treatment group.The total metastasis probability of CKD2 progressed to CKD3,CKD4,CKD5 and death/end-stage renal disease was reduced by 0.155 compared with the western medicine treatment group.The total metastasis probability of CKD4 stage to CKD5 and death/end-stage renal disease was 0.082 lower than that of the western medicine treatment group.4.The average life expectancy or renal survival(4.11 years)of the traditional Chinese and western medicine treatment group in the next 5 years is longer than that of the western medicine treatment group(3.23 years).Prediction of DKD patients after 5 years found that the cumulative probability of the traditional Chinese and western medicine treatment group in CKD1 stage is 11.5%higher than that of western medicine treatment group,CKD2 stage is 9.9%higher than that of western medicine treatment group,CKD3 stage is 9.5%higher than that of western medicine treatment group,CKD4 stage is 3.1%higher than that in the western medicine treatment group;the cumulative probability of the traditional Chinese and western medicine treatment group in the CKD5 stage is 18.9%lower than that in the western medicine treatment group,and 15%lower in the ESRD/Dead stage than that in the western medicine treatment group.5.In the next 5 years,the average time of CKD1 in the traditional Chinese and western medicine treatment group is 0.56 years longer than that in the western medicine treatment group,0.37 years longer in CKD2 phase than that in the western medicine treatment group,0.31 years longer in CKD3 stage than that of the western medicine treatment group,and 0.18 years longer in the CKD4 stage than that in the western medicine treatment group;the average time in the ESRD/Dead stage of traditional Chinese and western medicine treatment group was 0.53 years shorter than that in the western medicine treatment group.6.The average life expectancy or kidney survival period(18.02 years)of the traditional Chinese and western medicine treatment group in the next 20 years is longer than that of the western medicine treatment group(16.23 years).The prediction of DKD patients 20 years later found that the cumulative probability of CKD1 in the traditional Chinese and western medicine treatment group is 1.8%higher than that of the western medicine treatment group,CKD2 stage is 1.9%higher than that of the western medicine treatment group,CKD3 stage is 2.2%higher than that of the western medicine treatm ent group,and CKD stage 4 is 0.8%higher than that of western medicine treatment group;the cumulative probability of CKD stage 5 in the traditional Chinese and western medicine treatment group is 2.6%lower than that of western medicine treatment group,and ESRD/Dead stage is 4%lower than that of western medicine treatment group.7.In the next 20 years,the average time of CKD1 in the traditional Chinese and Western medicine treatment group is 1.08 years longer than that in the western medicine treatment group,in CKD2 phase is 0.78 years longer than that in the western medicine treatment group,in CKD3 stage is 0.56 years longer than that of the western medicine treatment group,in CKD4 stage is 0.33 years longer than that in the western medicine treatment group,and in the CKD5 stage was 0.28 years longer than that in the western medicine treatment group;the average time in the ESRD/Dead stage was 1.25 years less than that in the western medicine treatment group.Conclusion:1.The Markov model can be used to evaluate the long-term curative effect of comprehensive TCM therapy for DKD;2.The comprehensive therapy of TCM for diabetic kidney disease can delay the development of chronic kidney disease in patients with DKD to a certain extent,improve the average life expectancy or renal survival of DKD patients.