Study On TCM Syndromes And Clinicopathological Features Of Chronic Kidney Disease Complicated With Type 2 Diabetes Mellitus

Objective:To study the correlation between TCM syndromes,clinical features and renal pathological features in patients with chronic kidney disease(CKD)complicated with type 2diabetes mellitus(T2DM),and to analyze and explore the clinical predictors of diabetic nephropathy(DN)and non-diabetic renal disease(NDRD).in order to provide a theoretical basis for better clinical diagnosis and treatment of such diseases.Methods:Collected 106 patients who were hospitalized in the Department of Nephrology of the First Teaching Hospital of Tianjin University of TCM from January 2015 to October 2020,were clearly diagnosed as CKD complicated with T2DM,and obtained satisfactory specimens after renal biopsy.General information,TCM syndromes,laboratory biochemical indices and renal pathology of patients were collected and recorded.According to the pathological results of kidney biopsy,the included patients were divided into DN group and NDRD group(including DN combined with NDRD).The differences in TCM syndromes,clinical data,and renal pathology between the two groups were retrospectively analyzed.Results:1 The 106 patients included in this study were mainly middle-aged and elderly(≥45years old).And more than half of the patients were overweight(67.4%)and had a history of diabetes for more than 5 years.84.9%of the patients already had hypertension at the time of treatment.2 The occurrence of DN was related to multiple factors.There were differences in the course of diabetes,BMI grouping,24h-PRO,Scr,BUN,UA,Cys C,HCY,K,and P between the two groups.Compared with NDRD group,patients in the DN group had longer course of diabetes,high levels of 24h-PRO,Scr,BUN,UA,K,Cys C,lower e GFR,higher incidence of anemia,hyperhomocysteinemia and hyperphosphatemia.There was no significant difference in sex,age distribution,family history of diabetes,diabetic retinopathy,history and course of hypertension,smoking,drinking,microscopic hematuria,FBG,Hb A1c,SBP,DBP,ALB,TC,TG,HDL-C,LDL-C,VLDL-C and Ca between the two groups.3 Among the deficiency syndromes,the most common syndrome in DN group was yin deficiency of liver and kidney,followed by deficiency of both qi and yin.In NDRD group,the proportion of spleen and kidney yang deficiency syndrome was the largest,followed by qi and yin deficiency syndrome.The distribution of spleen and kidney yang deficiency syndrome in NDRD group was significantly higher than that in DN group,and the distribution of liver and kidney yin deficiency syndrome in DN group was significantly higher than that in NDRD group.In the standard evidence,the blood stasis syndrome was the most common in the DN group,followed by the damp-heat syndrome.In NDRD group,damp-heat syndrome accounted for the largest proportion,followed by damp-turbid syndrome.The distribution of blood stasis syndrome in DN group was significantly higher than that in NDRD group.4 There are 7 pathological types of NDRD,including primary and secondary glomerular diseases.The most common pathological type in NDRD group is MN,followed by Mesangial proliferative glomerulonephritis and Ig A nephropathy.Among the secondary glomerular diseases,the most pathological type is benign arteriosclerosis.The degree of renal lesion in DN group was more severe than that in NDRD group,and the degree of spherical sclerosis and small vessel lesion(with or without sclerosis and inflammatory cell infiltration)in NDRD group was slighter than that in NDRD group,and the difference was statistically significant(P<0.01).There was no significant difference in the number of glomeruli,the incidence of glomerular crescents and interstitial fibrosis between the two groups(P>0.05).5 Logistic regression analysis was used to explore the risk factors and predictors of NDRD.Short course of diabetes,high glomerular filtration rate,and high hemoglobin were predictors of NDRD.Further evaluation and analysis by ROC curve,it is found that the sensitivity and specificity of glomerular filtration rate for predicting NDRD are 85.7%and70.7%,respectively;the sensitivity of hemoglobin for predicting NDRD is as high as 93.7%,and the specificity is only 62.8%.The area under the curve of glomerular filtration rate predicting NDRD is 0.831,and its optimal cut-off point is 58.9ml/min/m~2;the area under the curve of hemoglobin is 0.843,and its optimal cut-off point is 117g/L,that is,glomerulus When the filtration rate is greater than 58.9ml/min/m2 and/or hemoglobin exceeds 117g/L,the risk of developing NDRD is significantly increased;conversely,the glomerular filtration rate is less than 58.9ml/min/m~2and/or hemoglobin is low at 117g/L,the risk of developing DN is significantly increased.Conclusions:1 The prevalence of NDRD is higher in the population of this study.2 Compared with NDRD group,patients in the DN group has longer course of diabetes,worse renal function,and higher incidence of anemia,hyperhomocysteinemia,and hyperphosphatemia.3 Among the TCM syndromes,in the DN group,the deficiency of liver and kidney yin and deficiency of both qi and yin are the most common,blood stasis and damp-heat are the most common in standard syndrome.In the NDRD group,the spleen and kidney yang deficiency and qi-yin deficiency are the most common,damp-heat and damp-turbid are the most common in standard syndrome.4 The most common pathological type of NDRD is membranous nephropathy,followed by mesangial proliferative glomerulonephritis and Ig A nephropathy.The degree of renal lesion was different between the two groups.The degree of renal lesion in DN group was more severe than that in NDRD group.Spherical sclerosis and small vessel lesion(with or without sclerosis and inflammatory cell infiltration)were mild in NDRD group.5 Logistic regression analysis found that the course of diabetes,glomerular filtration rate and hemoglobin were independent risk factors for NDRD.6 Further analysis and evaluation by ROC curve showed that when the glomerular filtration rate is greater than 58.9ml/min/m~2 and(or)hemoglobin exceeds 117g/L,the risk of developing NDRD is significantly increased.Conversely,when the glomerular filtration rate is less than 58.9ml/min/m~2 and(or)hemoglobin is less than 117g/L,the risk of developing DN is significantly increased.