Study On The Correlation Between TCM Syndromes Of Type 2 Diabetes Mellitus And Complicated Diabetic Kidney Disease In The Elderly

Objective:Through follow-up of clinical data and T2DM syndromes in elderly patients with type 2 diabetes（T2DM）,explore the T2DM patients prone to diabetic kidney disease（DKD）TCM syndromes and risk factors,and initially reveal the development of DKD The evolution law of TCM syndrome types in the process,and its correlation with DKD renal function indexes and risk factors.Methods:Through a single-center cross sectional survey study,prospect-ively included 218 T2DM patients with normal renal function（age≥60 years old,disease duration≥5 years）who were hospitalized in the 960 Hospital of the People’s Liberation Army from September 2018 to June 2020.Follow up for≥6 months.Until the end of the follow-up in January 2021,12 cases were eliminated and dropped out,with an average follow-up time of 332.79±126.14days.Among them,40 T2DM patients had new DKD（DKD group）,and 166 T2DM patients had no new DKD（non-DKD,NDKD group）.Collect clinical data of patients,including general data,TCM syndrome types,combined diseases,physical and chemical indicators,etc.The statistical software SPSS 22.0was used to statistically analyze the clinical data of patients in the DKD group and the NDKD group before and after follow-up.Multivariate Logistic regression was used to analyze the risk factors of T2DM complicated by DKD,and the correlation between T2DM syndrome types and renal function indicators and risk factors was analyzed.Results:1.The average age of 218 T2DM patients was 70.05±8.40 years old,of which50.9%was male,and the average course of disease was 13.00（9.00,19.00）years.The average body mass index was 25.45±3.20（kg·m^<sub>2）.Patients with overweight and obesity(≥24kg·m^-2)accounted for 68.8%of the total population,and those who smoked and drank alcohol were 30.3%and 30.9%,respectively.The distribution of TCM syndrome types are mainly qi-yin deficiency syndrome（29.4%）and yin-yang deficiency syndrome（23.4%）.The main concomitant disea-ses were hypertension（72.5%）and coronary heart disease（43.6%）.2.Correlation analysis of TCM syndrome types and various factors of T2DM:There were statistically significant differences in age（F=2.518,P=0.041）,course of disease（F=6.754,P<0.001）,BMI（F=2.316,P=0.012）,BUN（F=2.287,P=0.025）and UACR（Z=44.447,P<0.001）with different TCM syndrome types（P<0.05）.Comparison between the two groups:From yin defici-ency and heat exuberance syndrome→qi and yin deficiency syndrome,blood stasis and collateral syndrome,phlegm（dampness）heat mutual syndrome→yin and yang deficiency syndrome development,age,diabetes course and smokers increase,BMI,BUN,UACR levels increase.3.Comparison of baseline clinical data between DKD group and NDKD group:The BMI level of DKD group was higher than that of NDKD group（P<0.05）,and the proportion of combined hypertension was higher than that of NDKD group（90.0%VS 67.5%,P<0.05）.The ALB level of the DKD group was lower than that of the NDKD group,while the FPG,Hb A1c,and UA levels were higher than that of the NDKD group（P<0.05）.4.Comparison of clinical data after follow-up between NDKD group and DKD group:（1）Distribution and evolution of TCM Syndrome Types:the DKD group is mainly composed of Yin and Yang deficiency（27.5%）and Qi and Yin deficiency（25.0%）.With the decline of kidney function,the TCM syndromes change from Qi and Yin deficiency and Yin and Yang deficiency Syndrome→blood stasis,vein and collateral syndrome,phlegm（damp）-heat mutual syndrome development.The NDKD group is still dominated by Qi and Yin deficiency syndrome（29.5%）,Yin and Yang deficiency syndrome（24.7%）,and blood stasis and veins syndrome（22.3%）.The evolution of TCM syndromes（starting from the most common witness type in the early stage of the disease）generally develops from Yin deficiency and heat increasing syndrome→Qi and Yin deficiency syndrome→Yin and Yang deficiency syndrome;blood stasis vein syndrome,Qi and Yin deficiency syndrome and Yin and Yang deficiency syndrome evolve each other;phlegm（dampness）and heat intermingling syndrome can develop into other four syndromes.（2）Comparison of physical and chemical indexes:BUN and UACR in NDKD group increased before and after follow-up,and the difference was statisti-cally significant（P<0.05）.In DKD group,ALB,FPG and e GFR decreased,while LDL-C,UA,Scr,BUN and UACR increased（P<0.05）.After follow-up,the levels of ALB and e GFR in NDKD group were higher than those in DKD group,while the levels of LDL-C,Hb A1c,UA,Scr,BUN and UACR were lower than those in DKD group.5.Multivariate Logistic regression analysis shows:hypertension level 2（OR=4.888,P=0.031）,hypertension level 3（OR=4.965,P=0.013）,ALB（g/L）<35（OR=9.659,P<0.001）,Hb A1c（%）>7.0（OR=10.058,P=0.002）is a risk factor for DKD.6.After follow-up,the correlation between TCM syndrome types and risk factors and renal function indexes in DKD group:the Hb A1c level of Yin deficiency and heat syndrome is lower than the other four syndrome types.There is a trend of decline in renal function from the syndrome of yin deficiency and heat hyperactivity→Qi and Yin deficiency syndrome→Yin and Yang deficiency syndrome.Conclusion:1.DKD TCM syndrome types are mainly qi-yin deficiency syndrome and yin-yang deficiency syndrome.With the decline of renal function,TCM syndrome types are developed by qi-yin deficiency syndrome,yin-yang deficiency syndrome,blood stasis and collateral syndrome,phlegm（dampness）heat syndrome.The distribution of T2DM TCM syndrome is mainly qi-yin deficiency syndrome.Simarly,Yin-yang deficiency syndrome and blood stasis vein syndrome are also important.2.ALB<35g/L,Hb A1c>7.0%and the combination of hypertension grade2 and hypertension grade 3 are the risk factors of T2DM complicated with DKD.3.There is a certain relationship between T2DM TCM syndrome type and age,course of diabetes,smoking history,BMI,BUN,UACR distribution:With the development of TCM syndromes from Yin deficiency and heat syndrome→Qi and Yin deficiency syndrome,blood stasis and veins syndrome,phlegm（damp）and heat mutual syndrome→Yin and Yang deficiency syndrome,the age and the course of diabetes gradually increase,and the proportion of smoking patients increases.The levels of BMI,BUN,and UACR also gradually increased.4.There is a certain relationship between DKD TCM syndrome type and Hb A1c:as the TCM syndrome develops from Yin deficiency and heat syndrome→Qi and Yin deficiency→Yin and Yang deficiency syndrome,Hb A1c levels gradually increase,and renal function gradually declines.