Correlation Between Cognitive Dysfunction And TCM Syndrome Types In Patients With CKD Stages 3-5 Based On Kidney-brain Correlation

Purpose:Based on the close relationship of "kidney brain correlation" in the theory of visceral signs of traditional Chinese medicine,this paper evaluated the cognitive function of chronic kidney disease stage 3 to 5 not undergoing dialysis(CKD3-5ND)patients,explored the correlation between cognitive dysfunction and TCM Syndromes of CKD3-5ND patients,searched for the distribution of TCM Syndromes of cognitive dysfunction in CKD patients,and screened out the possible risk factors of cognitive dysfunction in CKD patients,so as to provide reference for TCM diagnosis Objective to provide a reference for the understanding,prevention and treatment of cognitive dysfunction of chronic kidney disease,provide a theoretical basis for the treatment of renal encephalopathy and improve the quality of life and prognosis of patients with CKD.Material and method:The combination of theoretical study and clinical study was used.1.Theoretical discussion According to the research methods of visceral image theory of traditional Chinese medicine,this article systematically sorts out the understanding of kidney and brain in TCM and modern medicine,and discusses the theory of kidney and brain from four aspects:historical origin,theoretical basis of traditional Chinese medicine,modern clinical and experimental research,and clinical application.2.Clinical research Using a cross-sectional study method,CKD3-5ND patients who were treated in the outpatient and ward of the Nephrology Department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2019 to December 2020 were selected as the research objects.The patients who met the inclusion criteria were enrolled.The Montreal Cognitive Assessment Scale(Mo CA)was used according to the Mo CA score,patients are divided into normal cognitive function group and cognitive impairment group.The self-designed case questionnaire(Appendix 1)was used to collect the general information of the patients,record the information of the four diagnostic methods of traditional Chinese medicine and carry out the syndrome differentiation,collect the relevant clinical indicators.Use Excel software to build a database,input questionnaire data,and use SPSS25.0 statistical software for data analysis,P < 0.05 was statistically significant.Results:1.There is correlation between kidney and brain in Yin and Yang,meridian,essence and mind;2.The treatment of encephalopathy from kidney has rich theoretical basis and clinical practice,which is correct and feasible.3.The average score of cognitive function of 147 CKD3-5ND patients in this study was 26±2,of which 61.22% had normal cognitive function and 38.78% had different degrees of cognitive dysfunction.There was significant difference in Mo CA score among CKD3,CKD4 and CKD5 groups(H=31.844,P=0.000 <0.05).Pairwise comparison between groups showed that there was no significant difference in Mo CA score between CKD3 and CKD4(P>0.05).There was significant difference in Mo CA scores between CKD 3 and CKD 5,CKD 4 and CKD 5 groups(P=0.000?P=0.007<0.05),CKD 5 patients are more likely to have cognitive dysfunction.4.There were significant differences in age,education years,red blood cell count,hemoglobin,alanine aminotransferase,aspartate aminotransferase,blood phosphorus,urea,creatinine,Cystatin C,e GFR and parathyroid hormone between the two groups(P < 0.05).There were no statistically significant differences in sex,history of diabetes mellitus,history of hypertension,history of coronary heart disease,BMI,platelet count,serum albumin,total bilirubin,direct bilirubin,alkaline phosphatase,glutamyl transpeptidase,triglycerides,cholesterol,LDL,serum sodium,potassium,serum calcium,uric acid,C-reactive protein,fibrinogen,24-h urinary protein quantification,glycated hemoglobin study significance(P>0.05).5.The results of the binary logistic regression analysis showed that after adjusting for the associated risk factors,only age,years of education and hemoglobin were significantly associated with the occurrence of CKD patients with CI(P=0.005,P=0.029,P=0.002),advanced age(OR=1.060,95% CI: 1.018-1.1047)was a risk factor for the occurrence of CKD patients with CI,years of Education(OR=0.820,95% CI: 0.686-0.979),hemoglobin(OR=0.955,95% CI: 0.928-0.983)as protective factors.6.The frequencies of TCM syndromes in patients with CKD 3-5 were 47.6% of spleen and kidney qi deficiency syndrome > 22.4% of Yin and yang deficiency > 13.6% of Qi Yin two deficiency > 11.6% of spleen and kidney yang deficiency > 4.8% of liver and kidney yin deficiency.The frequency of facultative syndrome was 38.2% for dampness opacity syndrome > 31.3% for blood stasis syndrome > 28.6% for no facultative syndrome > 12.2%for dampness heat syndrome > and 11.6% for hydroqi syndrome.7.In the cognitively normal group,most patients suffered from spleen and kidney qi deficiency(54.5%),followed by Qi Yin two deficiency(17.8%).In the cognitive dysfunction group,Yin Yang two deficiency syndrome was the main one(40.4%),followed by spleen kidney qi deficiency(36.8%).Among facultative cases,in the normal cognitive function group,there are mostly dampness and turbidity syndrome(36.7%)or no combination(34.4%).The cognitive dysfunction group had more facultative blood stasis syndrome(57.9%)or wet turbidity syndrome(40.3%).The Mo CA scores were lower in patients with Yin Yang two deficiency syndromes and lower in patients with blood stasis syndromes,with statistically significant differences(z=-3.429,P=0.001;Z=-3.429,P=0.001).Conclusion:1." Kidney brain correlation " theory has a rich theoretical basis and clinical practice,which provides a basis for clinical treatment of encephalopathy from kidney theory as well as the practical use of kidney brain correlation theory.2.The incidence of CI was approximately 38.78% in CKD3-5ND patients,and patients with CKD5 had lower cognitive function scores.3.Advanced age,low education level and low Hb are risk factors for CI in CKD patients,and early screening with interventions targeting these factors should be performed to reduce the incidence of CI in CKD patients.4.Yin Yang deficiency syndrome is the main syndrome type of CI in CKD3-5ND,followed by spleen kidney qi deficiency syndrome.On the facultative basis,the syndrome of blood stasis is predominant,followed by the syndrome of dampness and turbidity.5.The pathogenesis of cognitive dysfunction in CKD patients is the obstruction of brain know-how by Yin and yang deficiency of spleen and kidney,as well as phlegm and stasis.