Study On The Diagnostic Criteria Of Phlegm-stasis Syndrome In Idiopathic Membranous Nephropath

Research backgroundStandardization is an important part of the modernization of traditional Chinese medicine,and standardized and perfect diagnostic criteria of TCM syndromes can help better carry out clinical diagnosis,treatment,and related scientific research.Idiopathic membranous nephropathy is a common glomerular disease,and its incidence has increased significantly in recent years,it is already the most common primary glomerular disease in the elderly over 65 years old.Traditional Chinese medicine thinks that IMN often shows both positive and deficiency syndrome at the same time,phlegm,dampness,blood stasis and toxin are the most common positive evidence in IMN,and the transformation of phlegm-dampness and blood stasis in kidney collaterals is an important factor leading to the complex pathogenesis and protracted disease of IMN.However,it is found that there is no quantitative and standardized diagnostic criteria for intermingled phlegm and blood stasis syndrome with IMN by reviewing previous studies,and the current guidelines and diagnostic criteria for kidney disease do not clearly put forward the intermingled phlegm and blood stasis syndrome of IMN,and there are many problems,such as disunity of diagnostic criteria,inconsistent description of symptoms,less objective expression of terms and so on.The lack of weight of diagnostic indicators and the low objectivity of diagnosis are not good for the clinical diagnosis,treatment and scientific research of intermingled phlegm and blood stasis syndrome of IMN.This study intends to build a quantitative and standardized clinical diagnostic criteria for intermingled phlegm and blood stasis syndrome with IMN by means of literature retrieval,consensus meeting,analytic hierarchy process and diagnostic test with the guidance of experts,It is expected to provide guidance for clinical and scientific research of IMN.Research methodsThis study intends to sort out the previous research literature on the diagnosis of intermingled phlegm and blood stasis syndrome with IMN by literature retrieval,extract the diagnostic items of intermingled phlegm and blood stasis syndrome with IMN,count the frequency and frequency of each item and construct the item pool,standardize the diagnostic items according to the reference books such as "terminology of traditional Chinese Medicine",screen the items in combination with consensus meetings and expert interviews,and then invite experts in this field from all over the country.Analytic hierarchy process(AHP)was used to collect expert group decision opinions to determine the weight assignment of each diagnostic index.Finally,diagnostic test was used to determine the diagnostic threshold combined with clinical expert opinions to establish the diagnostic criteria of intermingled phlegm and blood stasis syndrome with IMN.Research resultsOn the basis of previous literature retrieval,frequency statistics,build item pool and terminology standardization,diagnostic items were preliminarily screened by consensus meetings and expert interviews,then two rounds of AHP expert consultation sessions were held to collect the group decision-making opinions of 34 experts nationwide,and the weights of each diagnostic index were divided into high-level weights and low-level weights.The details are as follows:high-level weight:purple or dark tongue,petechiae on the tongue,swollen or varicose veins under the tongue,greasy fur,swelling of the limbs,heavy fatigue of the limbs.Lower weight:dark complexion,purple lips,skin ecchymosis,epigastric fullness,sticky mouth,sticky stool,chest tightness,slippery pulse,astringent pulse,string pulse,sunken pulse,osmosis pulse.The diagnostic test is carried out,combined with expert advice to determine the diagnostic index and establish diagnostic criteria:the diagnostic indexes are divided into two categories according to weight:Main index:1.Limb swelling,or limb tiredness;2.Greasy fur;3.The tongue is purple or dark,or the tongue has bruises,or sublingual collaterals are thickly distended,or purplish purple,purplish red,crimson purple,purplish black.Secondary index:1.Abdominal distension and fullness;2.Sticky mouth,or sticky stool;3.Dark complexion,or purple lips;4.Skin petechiae and petechiae;5.Slippery pulse or astringent pulse or string pulse.The diagnostic indexes are divided into three categories according to the content:Sputum related index:1.swollen limbs or body trapped;2.greasy fur;3.distention and fullness;4.sticky and greasy in mouth or viscous stool;Blood stasis related index:1.purple or dark tongue,petechia or ecchymosis of tongue or varicose sublingual veins or present in cyan purple,purple red,crimson purple,and purple black;2.dim complexion or dark purple lips;3.subcutaneous ecchymosis;Pulse:1.slippery pulse or stringy pulse or rough pulse.And then clear diagnostic conditions:1.In accordance with the diagnosis of idiopathic membranous nephropathy;2.There is at least one "sputum related index" and "Blood stasis related index" at the same time,and the cumulative score is≥9.Research conclusionThe diagnosis of intermingled phlegm and blood stasis syndrome with IMN is to diagnose the intermingled phlegm and blood stasis syndrome of TCM under the premise of modern medical diagnosis of IMN.