The Study Of The Risk Factors And The Distribution Of The Syndrome Types Of Traditional Chinese Medicine Of The Chronic Kidney Disease Stage 3-5 Combined With Arteriosclerotic Cardiovascular Disease

Objective:By researching the prevalence of arteriosclerotic cardiovascular disease(ASCVD)in the patients with chronic kidney disease(CKD)which are between three and five stage,and analyzing the risk factors and the distribution of the syndrome types of traditional Chinese Medicine(TCM syndrome types)to better achieve the early prophylaxis and treatment of CKD patients with ASCVD.Methods:The research method of single-center and cross-sectional study was conducted to select538 non-dialysis patients of CKD stage 3 to CKD stage 5(CKD3-5).All of these patients were hospitalized in the Department of Nephrology of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from March 2019 to December 2020.And they were divided into the ASCVD group(ASCVD group)and non-ASCVD group(no ASCVD group),according to whether they were combined with ASCVD or not.There were 296 patients in ASCVD group and 242 patients in no ASCVD group.To collect these data retrospectively,which not only included age,gender,height,weight,history of smoking and drinking,past medical history and other general information,but also contained hemoglobin(HGB),mean corpuscular hemoglobin concentration(MCHC),blood urea nitrogen(BUN),serum creatinine(Scr),serum albumin(ALB),serum total protein(TP),alkaline phosphatase(ALP),fasting plasma glucose(FPG),total cholesterol(TC),serum phosphorus(P)and other laboratory indicators.In addition,the study also gathered the four diagnostic materials of TCM.SPSS21.0 software was used to analyze these data,and the differences in various indicators between the two groups were compared to explore the risk factors of ASCVD in non-dialysis patients with CKD3-5.The TCM syndrome types was classified by Diagnosis,syndrome differentiation and curative effect evaluation of chronic renal failure.The distribution characteristics of TCM Syndrome types of patients in CKD3-5,and the relationship between TCM syndrome types and related laboratory indexes were analyzed preliminarily through the information gathered above.Results:1.A total of 538 patients were enrolled in this study.Among them,296 patients(55.1%)had ASCVD.2.The prevalence of ASCVD in 538 patients with CKD3-5 increased with the decrease of renal function:52%(96/185)in CKD3,53%(86/162)in CKD4 and 60%(114/191)in CKD5.But by rank sum test,there was no significant difference in the prevalence of ASCVD with the progression of kidney disease.(Z=-1.525,P=0.127).3.For the patients of CKD3-5,there were significant differences in age,BMI,systolic blood pressure(SBP),diastolic blood pressure(DBP),history of diabetes(DM),history of hypertension(HTN),smoking history and other general information between ASCVD group and no ASCVD group(P<0.05).There were significant differences in serum HGB,serum potassium,FPG,TP,ALB,TC and other laboratory indexes(P<0.05).Multivariate regression analysis showed that age,body mass index(BMI),history of DM,history of HTN and history of smoking were associated with the increased risk of ASCVD in CKD3-5 patients(P<0.05),meanwhile,increased serum potassium ion and MCHC were associated with the decreased risk of ASCVD(P<0.05).4.There were 185 patients with CKD3.There were significant differences in age,SBP level,history of DM,history of hypertension and other general information between ASCVD group and no ASCVD group(P<0.05).There were significant differences in serum Scr,MCHC and other laboratory indicators(P<0.05).Multivariate regression analysis showed that age,SBP and previous history of DM were associated with the increased risk of ASCVD in CKD3patients(P<0.05).5.There were 162 patients with CKD4.There were significant differences in age,DBP and other general information between ASCVD group and no ASCVD group(P<0.05).There were significant differences in serum potassium,serum P,TC,low density lipoprotein cholesterol,urinary microalbumin and other laboratory indicators(P<0.05).Multivariate regression analysis showed that the increase of serum P and age were associated with the increased risk of ASCVD in CKD4 patients(P<0.05);6.There were 191 patients with CKD5.There were significant differences in age,BMI,DBP,history of DM and other general information between ASCVD group and no ASCVD group(P<0.05).There were significant differences in serum Scr,ALB,FAR(FIB/ALB)and other laboratory indicators between two groups(P<0.05).Multivariate regression analysis showed that age,BMI and previous DM history were associated with the increased risk of ASCVD in CKD5 patients(P<0.05),and elevated serum potassium could reduce the risk of ASCVD in CKD5 patients(P<0.05).7.The distribution of TCM deficiency syndrome types in 538 CKD3-5 patients were as follows:146 cases(27.1%)of the Qi deficiency of spleen and kidney,134 cases(24.9%)of the deficiency of both Qi,95 cases(17.7%)of the Yin deficiency of liver and kidney,84cases(15.6%)of the deficiency of both Yin and Yang and 79 cases(14.7%)of the Yang deficiency of spleen and kidney.By chi square test,there was significant difference in the overall distribution of deficiency syndromes in CKD3-5(c~2=19.478,P=0.013).The distribution of TCM syndrome types in the secondary excess syndromes were as follows:204 cases of(37.9%)of damp-turbid syndrome,158 cases(29.4%)of damp heat syndrome,114 cases(21.2%)of blood-stasis syndrome and 62 cases of(11.5%)of heat-toxin syndrome.By chi square test,there was no significant difference in the distribution of the secondary excess in CKD3-5(c~2=7.836,P=0.25).8.There were some correlation between TCM deficiency syndromes and laboratory indexes in CKD3-5 patients.In the comparison of serum HGB,the deficiency of both Yin and Yang was less than the Qi deficiency of spleen and kidney,the deficiency of both Qi and Yin and the Yin deficiency of liver and kidney,meanwhile,the Yang deficiency of spleen and kidney was less than the Qi deficiency of spleen and kidney and the Yin deficiency of liver and kidney.In the comparison of serum BUN,the deficiency of both Yin and Yang was higher than the Qi deficiency of spleen and kidney and the Yin deficiency of liver and kidney.All these above differences were statistically significant(P<0.05).In the comparison of serum calcium,the deficiency of both Yin and Yang was lower than the other four deficiency,and In the comparison of serum P,the deficiency of both Yin and Yang was higher than the other four deficiency,but only the comparison between the deficiency of both Yin and Yang and the Yin deficiency of liver and kidney was significant(P<0.05).There were also some correlation between the secondary excess syndromes and laboratory indexes.In the comparison of serum PT and P,the damp-heat syndrome was high than phlegm-turbid syndrome,which showed a statistically significant difference between two types.9.In CKD3-5 patients,there was significant difference between ASCVD group and no ASCVD group in the overall distribution of the deficiency syndromes(c~2=17.790,P=0.001),and there was no significant difference in the overall distribution of the secondary excess syndromes(c~2=3.537,P=0.316);10.The distribution of the deficiency in 296 patients with ASCVD in CKD3-5 were as follows:85 cases(28.7%)of the deficiency of Qi and Yin,68 cases(23.0%)of the Qi deficiency of spleen and kidney,55 cases(18.6%)of the deficiency of both Yin and Yang,47 cases(15.9%)of the Yang deficiency of spleen and kidney and 41 cases(13.9%)of the Yin deficiency of liver and kidney.By chi square test,there was no significant difference in the overall distribution of CKD3-5 in each stage(c~2=6.319,P=0.612).The distribution of the secondary excess syndromes were as follows:102 cases(34.5%)of the damp-turbid,90 cases(30.4%)of the damp-heat syndrome,68 cases(23.0%)of the blood-stasis syndrome,36 cases(12.2%)of the heat-toxin syndrome.By chi square test,there was no significant difference in the distribution of standard evidence of CKD3-5 stages(c~2=3.961,P=0.682).11.According to the analysis of the correlation between the deficiency syndromes and laboratory indicators in patients with ASCVD in CKD3-5,in the comparison of MCHC,the Yang deficiency of spleen and kidney was less than the Qi deficiency of spleen and kidney,meanwhile,the deficiency of both Yin and yang was less than the Qi deficiency of spleen and kidney,the deficiency of Qi and Yin and the Yin deficiency of liver and kidney.In the comparison of potassium ion,the deficiency of both Yin and Yang was higher than the Yin deficiency of liver and kidney and the deficiency of both Qi and Yin..All these above differences were statistically significant(P<0.05).There was no statistically significant difference between the the secondary excess and the laboratory indexes(P<0.05).Conclusion:1.CKD3-5 patients have a high prevalence of ASCVD,but in this study,the association between the prevalence of ASCVD and CKD progress has not been confirmed.2.Increased age,increased BMI,previous history of DM,previous history of hypertension,previous history of smoking,decreased serum potassium and decreased MCHC are the independent risk factors for ASCVD in CKD 3-5 patients.3.Increased age,increased SBP,and previous history of DM are independent risk factors for ASCVD in CKD3 patients.Increased age and serum P are independent risk factors for ASCVD in CKD4 patients.Increased age,increased BMI,previous history of DM and decreased serum potassium ion are the independent risk factors for ASCVD in CKD5 patients.4.In the 538 CKD3-5 patients of this study,the most common deficiency syndromes of the stage 3-4 is the the Qi deficiency of spleen and kidney,the most common deficiency syndromes of the stage 5 is the deficiency of both Qi and Yin.And there is a certain correlation between the distribution of this deficiency syndromes and CKD stage.The most common secondary excess is the damp-turbid syndrome in CKD3 and 4 stage.The most common secondary excess is the damp-heat syndrome in CKD5 stage.There is no obvious correlation between the distribution of the secondary excess syndromes and the stages of CKD.The distribution of this deficiency syndromes is related to the distribution of the secondary excess syndromes.The damp-heat syndrome is the most frequent in the Yang deficiency of spleen and kidney.And the other four types of deficiency syndrome are mostly accompanied by the damp-turbid.5.The deficiency of both yin and yang in CKD3-5 are more serious in accumulation of toxin,the disorders of calcium phosphate metabolism and anemia.The degree of phosphorus accumulation in serum in damp-heat are more serious than damp-turbid.6.For patients in CKD3-5,the distribution of this deficiency syndromes is related to the occurrence of ASCVD,while the secondary excess syndromes does not show any correlation.7.The main deficiency syndromes are the deficiency of both Qi and Yin for ASCVD in 296CKD3-5 patients.MCHC and serum potassium concentration are helpful to the differentiation of deficiency syndromes.The most common secondary excess is the damp-turbid syndrome in CKD3 and 4 stage.The most common secondary excess syndromes is the damp-heat syndrome in CKD5.There is no correlation between the laboratory indexes and the secondary excess syndromes.