Correlation Of Type 2 Diabetic Nephropathy Metabolic Syndrome With Visceral Adiposity Index And TCM Syndrome Elements

Objective: To explore the value and characteristics of VAI in diagnosing metabolic syndrome in CKD patients with type 2 diabetes mellitus and its related factors in CKD patients with type 2 diabetes mellitus and metabolic syndrome,so as to provide a new approach for the prevention of metabolic syndrome by integrated traditional Chinese and Western medicine.Methods: This study collected CKD patients(with or without T2DM)hospitalized in the Department of Nephrology,the First Medical Center of the Chinese People’s Liberation Army General Hospital from March 2021 to November 2021.The patient case data,information on the four diagnosis of traditional Chinese medicine,VAI indicators,etc.were collected,and statistical analysis was performed by binary Logistic regression,ROC curve analysis,and multiple linear regression.The study includes two parts:(1)to compare the value of seven indicators including visceral adiposity index(VAI)and body mass index(BMI),waist circumference(WC),visceral fat area(VFA),subcutaneous fat area(SFA),Chinese visceral adiposity index(CVAI),and lipid accumulation product(LAP)in identifying different standards of Met S in the CKD population based on the presence or absence of T2DM;(2)to identify CKD patients with T2 DM Correlative factors of VAI indexes,clinical indexes and TCM syndrome elements in metabolic syndrome.Results:(1)The first part of the study included 537 chronic kidney disease patients without dialysis.All patients were divided into 4 groups according to the presence or absence of T2 DM and gender.Among male patients,214 patients were CKD patients with T2 DM,and 158 patients were CKD patients without T2 DM.Among female patients,70 patients were CKD patients with T2 DM and CKD patients without T2 DM.95 cases.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were used to investigate the independent associations between seven obesity-and lipid-related indices and metabolic syndrome and their predictive power in different groups.According to the best cut-off value,VAI had the strongest correlation with Met S.In CKD patients with T2 DM,the OR values for men and women were 40.585(8.683-189.695)and5.076(1.247-20.657),respectively;in CKD patients without T2 DM Among them,the OR values for males and females were 7.514(3.757-15.027)and3.008(1.789-5.056),respectively.And VAI’s area under ROC(AUC)and Youden index are the highest among the 7 indices.In CKD patients,especially with T2 DM,VAI outperformed BMI,WC,VFA,SFA,CVAI,and LAP,showing the best predictive ability for metabolic syndrome in both sexes.(2)A total of 187 patients with type 2 diabetic nephropathy were included in the second part of the study,including 150 patients with metabolic syndrome and 37 patients without metabolic syndrome.Compared with patients without Met S,BMI,WC,VAI,platelets,and triglycerides in patients with Met S were significantly increased,and high-density lipoprotein was significantly decreased,and the difference between the two groups was statistically significant(P<0.001).In the univariate linear regression analysis,the clinical indicators(age,fasting blood glucose,total cholesterol)and TCM syndrome elements(phlegm turbidity syndrome,qi stagnation syndrome)with P value less than 0.05 were used as independent variables for multiple linear regression analysis.Because the calculation formula of VAI includes triglyceride and high-density lipoprotein,we did not include these two indicators when we included independent variables.The results showed that fasting blood glucose(P<0.001),phlegm turbidity syndrome(P=0.003),and Qi stagnation syndrome(P=0.021)were the related factors of VAI in CKD patients with T2 DM metabolic syndrome.Conclusions: Our study shows that VAI is an important risk factor for metabolic syndrome in Chinese patients with CKD and T2 DM.In CKD patients,especially with T2 DM,VAI was superior to BMI,WC,VFA,SFA,CVAI and LAP,showing the best diagnostic ability for metabolic syndrome in both sexes.Fasting blood sugar,phlegm turbidity syndrome,and qi stagnation syndrome are the related factors of VAI in people with CKD and T2 DM metabolic syndrome.