Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine

doi:10.19852/j.cnki.jtcm.20230404.004

Journal of Traditional Chinese Medicine ›› 2023, Vol. 43 ›› Issue (3): 588-593.DOI: 10.19852/j.cnki.jtcm.20230404.004

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Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine

QU Yilun¹, CHENG Haimei¹, WANG Qian¹, LI Shuang¹, DUAN Shuwei¹, FENG Zhe¹, LI Weizhen¹, JIANG Shuangshuang¹, YANG Hongtao², MAO Yonghui³, GENG Yanqiu⁴, LI Jijun⁵, LIU Yuning⁶, TIAN Jinzhou⁷, LIU Hongfang⁸, DONG Zheyi¹, CHEN Xiangmei¹()

1 Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
2 Department of Nephrology, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
3 Department of Nephrology, Beijing Hospital, Beijing 100730, China
4 Department of Nephrology, the Third Medical Center of PLA General Hospital, Beijing 100039, China
5 Department of Nephrology, the Forth Medical Center of PLA General Hospital, Beijing 100048, China
6 Department of Nephrology, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing 100700, China
7 Three Departments of Encephalopathy, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing 100700, China
8 Department of Endocrinology, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing 100700, China

Received:2022-03-25 Accepted:2022-06-15 Online:2023-04-04 Published:2023-04-04
Contact: DONG Zheyi,CHEN Xiangmei
About author:Dr. DONG Zheyi, Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
Prof. CHEN Xiangmei, Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China. xmchen301@126.com;
Supported by:
Study on the Core Pathogenesis and Clinical Evolution of Damp-heat Symptom in Diabetic Nephropathy(2018YFC1704203);Key Technologies and Varieties Development of New TCM Drugs Based on Big Data(2019Zx09201-005);Correlation between Clinical Phenotype and Pathological Diagnosis of Type 2 Diabetic Nephropathy(D171100002817002);Effect of miR-155 on Inhibition of Macrophage Autophagy by mTOR in Diabetic Nephropathy(81700629)

Abstract

Abstract:

OBJECTIVE: To study the clinical characteristics relating to differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD).

METHODS: The subjects were patients with type 2 diabetes mellitus (T2DM) complicated with chronic kidney disease (CKD). Western medical history data and Traditional Chinese Medicine (TCM) symptom pattern were collected, and logistic regression was used to analyze.

RESULTS: Blood deficiency pattern [odds ratio (OR) = 2.269, P = 0.017] and Qi stagnation pattern (OR = 1.999, P = 0.041) are independently related to DN.

CONCLUSIONS: TCM factors blood deficiency pattern and Qi stagnation pattern are relating to differential diagnosis of DN and NDRD.

Key words: diabetes mellitus, type 2, renal insufficiency, chronic, diabetic nephropathies, non-diabetic renal disease, syndrome complex

QU Yilun, CHENG Haimei, WANG Qian, LI Shuang, DUAN Shuwei, FENG Zhe, LI Weizhen, JIANG Shuangshuang, YANG Hongtao, MAO Yonghui, GENG Yanqiu, LI Jijun, LIU Yuning, TIAN Jinzhou, LIU Hongfang, DONG Zheyi, CHEN Xiangmei. Noninvasive identificational diagnosis of diabetic nephropathy and non-diabetic renal disease based on clinical characteristics of Traditional Chinese Medicine symptom pattern and conventional medicine[J]. Journal of Traditional Chinese Medicine, 2023, 43(3): 588-593.

Figures/Tables 4

References 20

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Index	DN group (n = 84)	NDRD group (n =76)	t/Z/χ²value	P value
Gender [male (%)]	64 (76.2)	50 (65.8)	2.107	0.147
Age [years, M (IQR)]	54.00 (15.00)	55.00 (12.00)	-0.757	0.449
Diabetes course [months, M (IQR)]	168.00 (96.00)	72.00 (100.50)	-6.881	<0.001
BMI [kg/m², M (IQR)]	25.93 (4.60)	26.86 (4.38)	-2.107	0.035
SBP (mm Hg, $\bar{x}±s$)	145±23	132±19	3.863	<0.001
DBP [mm Hg, M (IQR)]	81.00 (17.00)	80.50 (15.00)	-0.564	0.573
HbA1c (%)	7.55 (1.53)	6.65 (1.60)	-3.153	0.002
Hb (g/L. $\bar{x}±s$)	112±21	129±20	-5.176	<0.001
TG [mmol/L, M (IQR)]	1.66 (1.36)	2.43 (1.24)	-3.540	<0.001
LDL [mmol/L, M (IQR)]	2.72 (1.77)	3.16 (1.59)	-1.326	0.185
Alb (g/L, $\bar{x}±s$)	34±7	33±9	0.532	0.595
Scr [μmol/L, M (IQR)]	149.85 (102.6)	103.05 (75.93)	-3.466	0.001
UA (μmol/L, $\bar{x}±s$)	376±89	368±98	0.003	0.998
eGFR [mL/min/1.73m², M (IQR)]	51.87 (44.61)	77.96 (60.18)	-3.371	0.001
24h urine protein [g/24 h, M (IQR)]	3.64 (3.64)	2.56 (3.94)	-2.522	0.012
DR [yes (%)]	58 (69.0)	17 (22.4)	34.939	<0.001
CHD [yes (%)]	8 (9.5)	10 (13.2)	0.528	0.468
AS [yes (%)]	25 (30.1)	26 (34.2)	0.305	0.581
Fatty liver [yes (%)]	13 (15.5)	22 (28.9)	4.237	0.040

Index	DN group (n = 84)	NDRD group (n =76)	t/Z/χ²value	P value
Gender [male (%)]	64 (76.2)	50 (65.8)	2.107	0.147
Age [years, M (IQR)]	54.00 (15.00)	55.00 (12.00)	-0.757	0.449
Diabetes course [months, M (IQR)]	168.00 (96.00)	72.00 (100.50)	-6.881	<0.001
BMI [kg/m², M (IQR)]	25.93 (4.60)	26.86 (4.38)	-2.107	0.035
SBP (mm Hg, $\bar{x}±s$)	145±23	132±19	3.863	<0.001
DBP [mm Hg, M (IQR)]	81.00 (17.00)	80.50 (15.00)	-0.564	0.573
HbA1c (%)	7.55 (1.53)	6.65 (1.60)	-3.153	0.002
Hb (g/L. $\bar{x}±s$)	112±21	129±20	-5.176	<0.001
TG [mmol/L, M (IQR)]	1.66 (1.36)	2.43 (1.24)	-3.540	<0.001
LDL [mmol/L, M (IQR)]	2.72 (1.77)	3.16 (1.59)	-1.326	0.185
Alb (g/L, $\bar{x}±s$)	34±7	33±9	0.532	0.595
Scr [μmol/L, M (IQR)]	149.85 (102.6)	103.05 (75.93)	-3.466	0.001
UA (μmol/L, $\bar{x}±s$)	376±89	368±98	0.003	0.998
eGFR [mL/min/1.73m², M (IQR)]	51.87 (44.61)	77.96 (60.18)	-3.371	0.001
24h urine protein [g/24 h, M (IQR)]	3.64 (3.64)	2.56 (3.94)	-2.522	0.012
DR [yes (%)]	58 (69.0)	17 (22.4)	34.939	<0.001
CHD [yes (%)]	8 (9.5)	10 (13.2)	0.528	0.468
AS [yes (%)]	25 (30.1)	26 (34.2)	0.305	0.581
Fatty liver [yes (%)]	13 (15.5)	22 (28.9)	4.237	0.040

TCM syndrome elements	DN group (n = 84)	NDRD group (n = 76)	χ²value	P value
Qi deficiency pattern	44 (52.4)	39 (51.3)	0.018	0.893
Blood deficiency pattern	49 (58.3)	29 (38.2)	6.501	0.011
Yin deficiency pattern	39 (46.4)	33 (43.4)	0.146	0.703
Yang deficiency pattern	38 (45.2)	37 (48.7)	0.190	0.663
Heat pattern	25 (29.8)	33 (43.4)	3.221	0.073
Qi stagnation pattern	46 (54.8)	27 (35.5)	5.951	0.015
Water stagnation pattern	29 (34.5)	22 (28.9)	0.571	0.450
Damp retention pattern]	40 (47.6)	38 (50.0)	0.091	0.764
Blood stasis pattern	69 (82.1)	60 (78.9)	0.261	0.610
Phlegm turbidity pattern	15 (17.9)	11 (14.5)	0.336	0.562
Heart deficiency pattern	68 (81.0)	62 (81.6)	0.010	0.919
Liver deficiency pattern	81 (96.4)	69 (90.8)	0.194	0.126
Spleen deficiency pattern	45 (53.6)	34 (44.7)	1.246	0.264
Lung deficiency pattern	54 (64.3)	51 (67.1)	0.141	0.708
Kidney deficiency pattern	77 (91.7)	70 (92.1)	0.010	0.919

TCM syndrome elements	DN group (n = 84)	NDRD group (n = 76)	χ²value	P value
Qi deficiency pattern	44 (52.4)	39 (51.3)	0.018	0.893
Blood deficiency pattern	49 (58.3)	29 (38.2)	6.501	0.011
Yin deficiency pattern	39 (46.4)	33 (43.4)	0.146	0.703
Yang deficiency pattern	38 (45.2)	37 (48.7)	0.190	0.663
Heat pattern	25 (29.8)	33 (43.4)	3.221	0.073
Qi stagnation pattern	46 (54.8)	27 (35.5)	5.951	0.015
Water stagnation pattern	29 (34.5)	22 (28.9)	0.571	0.450
Damp retention pattern]	40 (47.6)	38 (50.0)	0.091	0.764
Blood stasis pattern	69 (82.1)	60 (78.9)	0.261	0.610
Phlegm turbidity pattern	15 (17.9)	11 (14.5)	0.336	0.562
Heart deficiency pattern	68 (81.0)	62 (81.6)	0.010	0.919
Liver deficiency pattern	81 (96.4)	69 (90.8)	0.194	0.126
Spleen deficiency pattern	45 (53.6)	34 (44.7)	1.246	0.264
Lung deficiency pattern	54 (64.3)	51 (67.1)	0.141	0.708
Kidney deficiency pattern	77 (91.7)	70 (92.1)	0.010	0.919

Independent variable	Assignment method
Gender	female = 0, male = 1
Age (years)	<60 = 0，≥ 60 = 1
Blood deficiency pattern	no = 0, yes = 1
Heat pattern	no = 0, yes = 1
Qi stagnation pattern	no = 0, yes = 1
Liver deficiency pattern	no = 0, yes = 1

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References 20

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Item	B	SE	Wald	df	P	Exp (B)	95%CI
Item	B	SE	Wald	df	P	Exp (B)	Lower	Upper
Gender (1)	0.740	0.376	3.860	1	0.049	2.095	1.002	4.381
Blood deficiency pattern (1)	0.819	0.344	5.685	1	0.017	2.269	1.157	4.451
Qi stagnation pattern (1)	0.693	0.339	4.178	1	0.041	1.999	1.029	3.885
Constant	-1.132	0.407	7.726	1	0.005	0.322

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