Distribution of Traditional Chinese Medicine syndromes in diabetic kidney disease chronic kidney disease 1-5: a correlation study

doi:10.19852/j.cnki.jtcm.20230802.007

Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (3): 572-580.DOI: 10.19852/j.cnki.jtcm.20230802.007

• Original articles • Previous Articles Next Articles

Distribution of Traditional Chinese Medicine syndromes in diabetic kidney disease chronic kidney disease 1-5: a correlation study

LI Shuang¹, DUAN Shuwei¹, DONG Zheyi¹, QU Yilun¹, LUO Yayong², KE Jianghua², WANG Conghui¹, PENG Yangzhi³, ZHOU Xuefeng¹, CHEN Xiangmei¹()

1 Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National 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, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
3 Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China; Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China

Received:2022-12-27 Accepted:2023-05-25 Online:2024-06-15 Published:2023-08-02
Contact: Prof. CHEN Xiangmei, Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National 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 Telephone: +86-10-66935462
Supported by:
Beijing Science and Technology Plan Project: Study on Multidimensional Precise Diagnosis and Treatment Technology and Clinical Transformation of Type 2 Diabetic Nephropathy(Z221100007422121);Beijing Science and Technology Plan Project: Correlation between Clinical Phenotype and Pathological Diagnosis of Type 2 Diabetic Nephropathy(D171100002817002);State Key Research and Development Program: Study on the Core Pathogenesis and Clinical Evolution of Damp-heat Symptom in Diabetic Nephropathy(2018YFC1704203);National Key R&D Program of China(2018YFC1704200);Natural Science Foundation of China: Mechanism of Organ Immune Injury and Basic Research of Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment(32141005)

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Abstract

Abstract:

OBJECTIVE: To analyze the distribution of Traditional Chinese medicine (TCM) syndromes in patients with diabetic kidney disease (DKD) and its related factors.

METHODS: We enrolled 435 patients with DKD, who were not undergoing dialysis, admitted to the Department of Nephrology, First Medical Center, Chinese PLA General Hospital from April 2020 to August 2021. Analysis of their TCM syndromes and related factors was carried out.

RESULTS: The 435 patients included 109, 117, 86, and 123 chronic kidney disease (CKD) 1-2, CKD3, CKD4, and CKD5 cases, respectively. With the progression of CKD1-5, the proportion of Yin deficiency and dry heat syndrome, and that of Qi and Yin deficiency syndrome showed a downward trend, whereas the proportion of spleen-kidney Yang deficiency, blood deficiency, blood stasis, water stagnation, and phlegm turbidity syndromes showed an upward trend; the differences were statistically significant (P < 0.05). Multivariate logistic regression analysis showed that Yin deficiency and dry heat syndrome was positively correlated with hemoglobin [odds ratio (OR) = 1.022, P = 0.005], albumin (OR = 1.058, P = 0.006), and estimated glomerular filtration rate (eGFR) (OR = 1.020, P < 0.001) but negatively correlated with male sex (OR = 0.277, P = 0.004). Qi and Yin deficiency syndrome was positively correlated with albumin (OR = 1.056, P < 0.001) and eGFR (OR = 1.008, P = 0.022) but negatively correlated with age (OR = 0.977, P = 0.023). Liver-kidney Yin deficiency syndrome was positively correlated with age (OR = 1.028, P = 0.021) and glycosylated hemoglobin (OR = 1.223, P = 0.007) but negatively correlated with total cholesterol (OR = 0.792, P = 0.006). Spleen-kidney Yang deficiency syndrome was negatively correlated with hemoglobin (OR = 0.977, P < 0.001), albumin (OR = 0.891, P < 0.001), and eGFR (OR = 0.978, P < 0.001) but positively correlated with high density lipoprotein (OR = 3.376, P = 0.001).

CONCLUSION: With CKD1-5 progression, TCM syndromes changed from Yin deficiency and dry heat syndrome to syndrome of deficiency of both Qi and Yin, liver-kidney Yin, and spleen-kidney Yang deficiency syndromes. TCM syndromes were correlated with laboratory test results.

Key words: diabetic nephropathies, syndrome and complex, hemoglobins, albumins, glomerular filtration rate, correlation of data

LI Shuang, DUAN Shuwei, DONG Zheyi, QU Yilun, LUO Yayong, KE Jianghua, WANG Conghui, PENG Yangzhi, ZHOU Xuefeng, CHEN Xiangmei. Distribution of Traditional Chinese Medicine syndromes in diabetic kidney disease chronic kidney disease 1-5: a correlation study[J]. Journal of Traditional Chinese Medicine, 2024, 44(3): 572-580.

Figures/Tables 9

References 26.

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TCM syndrome types/elements	TCM symptoms	Evaluation criteria
Yin deficiency and dry heat syndrome	Dry mouth and throat, easy to hunger and eat more, vexation and insomnia, urinary frequency constipation, irascibility, red face, red tongue with yellowish fur, pulse string number or slip number	Four of these are diagnosable
Syndrome of deficiency of both Qi and Yin	Turbid urine, tiredness, dry mouth and throat, dizzy dreams, feverish palms and soles, in suspense, thin tongue, little moss dry, Weak pulse.	Four of these are diagnosable
Liver-kidney Yin deficiency syndrome	Turbid urine, vertigo tinnitus, burning sensation of five centres, Pain of waist and knee, dry eyes, oliguresis, little red tongue moss, pulse of thread and schneller.	Four of these are diagnosable
Spleen-kidney Yang deficiency syndrome	Turbid urine, tired and cold, cold waist and knees, limb swelling, especially lower limbs, long or short urine, nocturia increased, morning diarrhea, pale tongue with fat tooth marks, delayed pulse sinking	Four of these are diagnosable
Blood deficiency syndrome	Pale or yellow face, pale lips and nails, dizziness, pale tongue, weak pulse.	Two of these are diagnosable
Heat syndrome	Thirst with a predilection for cold drink, eat more and get hungry, yellowish or reddish urine, dry stool, red tongue with yellow fur, rapid pulse	Two of these are diagnosable
Qi stagnation syndrome	Thoracolumbar breast tenderness, abdominal fullness and distention, easily irritated or annoyed, depression and sighing, wiry pulse	Two of these are diagnosable
Water stagnation syndrome	Edema, hydrothorax, ascites, heavy cumbersome limbs	Two of these are diagnosable
Damp-heat syndrome	Heavy cumbersome limbs, lack of appetite, a bitter or sticky mouth, sticky stools, red tongue coating yellow greasy, slippery and rapid pulse	Two of these are diagnosable
Blood stasis syndrome	Gloomy complexion, dark purple lips, scaly dry skin, stabbing and fixed pain, dark purple tongue, hesitant or irregular pulse	One of these are diagnosable
Phlegm turbidity syndrome	Nausea and vomiting, spit or cough up, oral mucositis, greasy and muddy moss, slippery pulse	Two of these are diagnosable

TCM syndrome types/elements	TCM symptoms	Evaluation criteria
Yin deficiency and dry heat syndrome	Dry mouth and throat, easy to hunger and eat more, vexation and insomnia, urinary frequency constipation, irascibility, red face, red tongue with yellowish fur, pulse string number or slip number	Four of these are diagnosable
Syndrome of deficiency of both Qi and Yin	Turbid urine, tiredness, dry mouth and throat, dizzy dreams, feverish palms and soles, in suspense, thin tongue, little moss dry, Weak pulse.	Four of these are diagnosable
Liver-kidney Yin deficiency syndrome	Turbid urine, vertigo tinnitus, burning sensation of five centres, Pain of waist and knee, dry eyes, oliguresis, little red tongue moss, pulse of thread and schneller.	Four of these are diagnosable
Spleen-kidney Yang deficiency syndrome	Turbid urine, tired and cold, cold waist and knees, limb swelling, especially lower limbs, long or short urine, nocturia increased, morning diarrhea, pale tongue with fat tooth marks, delayed pulse sinking	Four of these are diagnosable
Blood deficiency syndrome	Pale or yellow face, pale lips and nails, dizziness, pale tongue, weak pulse.	Two of these are diagnosable
Heat syndrome	Thirst with a predilection for cold drink, eat more and get hungry, yellowish or reddish urine, dry stool, red tongue with yellow fur, rapid pulse	Two of these are diagnosable
Qi stagnation syndrome	Thoracolumbar breast tenderness, abdominal fullness and distention, easily irritated or annoyed, depression and sighing, wiry pulse	Two of these are diagnosable
Water stagnation syndrome	Edema, hydrothorax, ascites, heavy cumbersome limbs	Two of these are diagnosable
Damp-heat syndrome	Heavy cumbersome limbs, lack of appetite, a bitter or sticky mouth, sticky stools, red tongue coating yellow greasy, slippery and rapid pulse	Two of these are diagnosable
Blood stasis syndrome	Gloomy complexion, dark purple lips, scaly dry skin, stabbing and fixed pain, dark purple tongue, hesitant or irregular pulse	One of these are diagnosable
Phlegm turbidity syndrome	Nausea and vomiting, spit or cough up, oral mucositis, greasy and muddy moss, slippery pulse	Two of these are diagnosable

Item	CKD1-2 (n = 109)	CKD3 ( n = 117)	CKD4 ( n = 86)	CKD5 ( n = 123)	H/F/ χ²value	P value
Age (years)	52.00 (44.50, 62.00)	59.00 (52.25, 65.00)^a	57.50 (53.00, 65.00)^a	59.00 (51.00, 66.00)^a	20.780	<0.001
Gender [male (%)]	64 (58.72)	88 (75.21)	64 (74.42)	97 (78.86)	13.249	0.004
History of DM (months)	60.00 (13.50, 133.00)	120.00 (60.50, 192.00)^a	168.00 (81.00, 240.00)^a	180.00 (108.00, 240.00)^ab	61.946	<0.001
SBP (mm Hg)	135.50±19.28	137.72±22.00	150.01±21.92^ab	156.42±24.12^abc	23.480	<0.001
DBP (mm Hg)	79.00 (72.50, 89.50)	78.50 (70.00, 88.75)	81.00 (73.00, 90.25)	80.00 (73.00, 89.00)	2.926	0.403
BMI (kg/m²)	26.40 (23.90, 28.90)	26.57 (24.41, 29.08)	26.05 (24.10, 28.40)	25.70 (23.50, 28.10)	4.886	0.180
Hb (g/L)	129.65±20.78	124.92±23.19	108.22±21.02^ab	94.92±16.85^abc	80.270	<0.001
GHb (%)	6.70 (6.00, 7.85)	6.50 (6.00, 7.58)^a	6.60 (6.10, 8.00)^a	6.40 (5.70, 7.20)^ab	10.587	0.014
FBG (mmol/L)	5.68 (4.76, 7.20)	5.86 (4.85, 7.00)	6.00 (4.90, 8.76)	6.13 (4.81, 8.11)	2.347	0.504
Scr (umol/L)	75.00 (64.55, 83.20)	121.75 (107.93, 149.15)^a	230.85 (188.53, 261.28)^ab	427.1 (357.40, 538.20)^abc	402.359	<0.001
eGFR (mL·min^-1·1.73m^-2)	88.28 (70.90, 101.49)	43.95 (34.27, 50.57)^a	21.49 (17.50, 25.31)^ab	9.64 (7.14, 12.08)^abc	405.565	<0.001
BUN (mmol/L)	5.61 (4.48, 7.52)	8.09 (6.59, 9.94)^a	12.73 (10.67, 15.06)^ab	21.19 (16.96, 26.45)^abc	321.250	<0.001
TC (mmol/L)	4.63 (3.70, 5.94)	4.38 (3.49, 5.82)	4.43 (3.32, 5.84)	4.10 (3.27, 4.97)^a	12.116	0.007
TG (mmol/L)	1.94 (1.44, 2.74)	2.31 (1.45, 3.07)	2.02 (1.22, 2.89)	1.72 (1.20, 2.52)^b	11.693	0.009
HDL (mmol/L)	1.01 (0.88, 1.23)	0.93 (0.87, 1.12)^a	0.92 (0.77, 1.15)	0.89 (0.74, 1.16)^a	13.862	0.003
LDL (mmol/L)	2.96 (2.28, 3.98)	2.66 (1.84, 4.01)	2.63 (1.73, 3.91)	2.33 (1.80, 3.34)^a	10.755	0.013
UA (umol/L)	352.10 (291.85, 428.00)	395.15 (319.55.475.90)^a	395.65 (341.53, 480.65)^a	418.60 (337.00, 496.50)^a	19.236	<0.001
Alb (g/L)	36.00 (27.10, 39.85)	36.20 (28.08, 40.60)	35.05 (28.50, 38.53)	35.30 (31.10, 38.40)	1.249	0.741
TP (g/L)	58.50 (50.30, 64.95)	62.85 (52.03, 67.05)	61.70 (53.30, 67.33)	63.40 (57.10, 67.40)^a	14.834	0.002
24 h urinary protein (g/L)	2.18 (0.58, 5.33)	2.84 (0.65, 5.27)	4.76 (2.25, 7.36)^ab	5.22 (2.48, 7.58)^ab	46.415	<0.001

Item	CKD1-2 (n = 109)	CKD3 ( n = 117)	CKD4 ( n = 86)	CKD5 ( n = 123)	H/F/ χ²value	P value
Age (years)	52.00 (44.50, 62.00)	59.00 (52.25, 65.00)^a	57.50 (53.00, 65.00)^a	59.00 (51.00, 66.00)^a	20.780	<0.001
Gender [male (%)]	64 (58.72)	88 (75.21)	64 (74.42)	97 (78.86)	13.249	0.004
History of DM (months)	60.00 (13.50, 133.00)	120.00 (60.50, 192.00)^a	168.00 (81.00, 240.00)^a	180.00 (108.00, 240.00)^ab	61.946	<0.001
SBP (mm Hg)	135.50±19.28	137.72±22.00	150.01±21.92^ab	156.42±24.12^abc	23.480	<0.001
DBP (mm Hg)	79.00 (72.50, 89.50)	78.50 (70.00, 88.75)	81.00 (73.00, 90.25)	80.00 (73.00, 89.00)	2.926	0.403
BMI (kg/m²)	26.40 (23.90, 28.90)	26.57 (24.41, 29.08)	26.05 (24.10, 28.40)	25.70 (23.50, 28.10)	4.886	0.180
Hb (g/L)	129.65±20.78	124.92±23.19	108.22±21.02^ab	94.92±16.85^abc	80.270	<0.001
GHb (%)	6.70 (6.00, 7.85)	6.50 (6.00, 7.58)^a	6.60 (6.10, 8.00)^a	6.40 (5.70, 7.20)^ab	10.587	0.014
FBG (mmol/L)	5.68 (4.76, 7.20)	5.86 (4.85, 7.00)	6.00 (4.90, 8.76)	6.13 (4.81, 8.11)	2.347	0.504
Scr (umol/L)	75.00 (64.55, 83.20)	121.75 (107.93, 149.15)^a	230.85 (188.53, 261.28)^ab	427.1 (357.40, 538.20)^abc	402.359	<0.001
eGFR (mL·min^-1·1.73m^-2)	88.28 (70.90, 101.49)	43.95 (34.27, 50.57)^a	21.49 (17.50, 25.31)^ab	9.64 (7.14, 12.08)^abc	405.565	<0.001
BUN (mmol/L)	5.61 (4.48, 7.52)	8.09 (6.59, 9.94)^a	12.73 (10.67, 15.06)^ab	21.19 (16.96, 26.45)^abc	321.250	<0.001
TC (mmol/L)	4.63 (3.70, 5.94)	4.38 (3.49, 5.82)	4.43 (3.32, 5.84)	4.10 (3.27, 4.97)^a	12.116	0.007
TG (mmol/L)	1.94 (1.44, 2.74)	2.31 (1.45, 3.07)	2.02 (1.22, 2.89)	1.72 (1.20, 2.52)^b	11.693	0.009
HDL (mmol/L)	1.01 (0.88, 1.23)	0.93 (0.87, 1.12)^a	0.92 (0.77, 1.15)	0.89 (0.74, 1.16)^a	13.862	0.003
LDL (mmol/L)	2.96 (2.28, 3.98)	2.66 (1.84, 4.01)	2.63 (1.73, 3.91)	2.33 (1.80, 3.34)^a	10.755	0.013
UA (umol/L)	352.10 (291.85, 428.00)	395.15 (319.55.475.90)^a	395.65 (341.53, 480.65)^a	418.60 (337.00, 496.50)^a	19.236	<0.001
Alb (g/L)	36.00 (27.10, 39.85)	36.20 (28.08, 40.60)	35.05 (28.50, 38.53)	35.30 (31.10, 38.40)	1.249	0.741
TP (g/L)	58.50 (50.30, 64.95)	62.85 (52.03, 67.05)	61.70 (53.30, 67.33)	63.40 (57.10, 67.40)^a	14.834	0.002
24 h urinary protein (g/L)	2.18 (0.58, 5.33)	2.84 (0.65, 5.27)	4.76 (2.25, 7.36)^ab	5.22 (2.48, 7.58)^ab	46.415	<0.001

Item	CKD1-2 (n = 109)	CKD3 (n = 117)	CKD4 (n = 86)	CKD5 (n = 123)	χ ² value	P value
Yin deficiency and dry heat syndrome	31 (28.44)	23 (19.56)	5 (5.81)	6 (4.88)	33.113	<0.001
Syndrome of deficiency of both Qi and Yin	39 (35.79)	40 (34.19)	22 (25.58)	25 (20.33)	8.952	0.030
Liver-kidney Yin deficiency syndrome	19 (17.43)	19 (16.24)	21 (24.42)	25 (20.33)	2.477	0.480
Spleen-kidney Yang deficiency syndrome	20 (18.35)	35 (29.92)	38 (32.49)	67 (54.47)	36.881	<0.001
Blood deficiency syndrome	35 (32.11)	45 (38.46)	53 (61.63)	86 (69.92)	44.338	<0.001
Blood stasis syndrome	88 (80.73)	103 (88.03)	79 (91.86)	119 (96.75)	16.460	0.001
Heat syndrome	40 (36.70)	44 (37.61)	26 (30.33)	28 (22.76)	7.761	0.051
Damp-heat syndrome	82 (75.23)	81 (69.23)	54 (62.79)	82 (66.66)	3.812	0.283
Water stagnation syndrome	25 (22.94)	35 (29.92)	39 (45.35)	52 (42.28)	15.257	0.002
Phlegm turbidity syndrome	45 (41.28)	68 (58.12)	48 (55.81)	97 (78.86)	34.663	<0.001
Qi stagnation syndrome	52 (47.71)	64 (54.70)	52 (60.47)	78 (63.42)	6.528	0.089

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TCM syndrome element	n	Yin deficiency and dry heat syndrome (n = 65)	Syndrome of deficiency of both Qi and Yin (n = 126)	Liver-kidney Yin deficiency syndrome (n = 84)	Spleen-kidney Yang deficiency syndrome (n = 160)	χ ² value	P value
Blood deficiency syndrome	219 (50.35)	7 (10.80)	51 (40.50)	42 (50.00)	119 (74.40)	82.595	<0.001
Heat syndrome	138 (31.70)	45 (69.20)	44 (34.90)	20 (23.80)	29 (18.10)	58.900	<0.001
Blood stasis syndrome	389 (89.40)	49 (75.40)	111 (88.10)	75 (89.30)	154 (96.30)	21.669	<0.001
Damp-heat syndrome	299 (68.74)	48 (73.80)	82 (65.10)	64 (76.20)	105 (65.60)	4.467	0.215
Water stagnation syndrome	151 (34.71)	10 (15.40)	9 (7.10)	14 (16.70)	118 (73.80)	172.632	<0.001
Phlegm turbidity syndrome	258 (59.31)	28 (43.10)	57 (45.20)	53 (63.10)	120 (75.00)	34.256	<0.001
Qi stagnation syndrome	246 (56.55)	31 (47.70)	61 (48.40)	50 (59.50)	104 (65.00)	10.423	0.015

Item	Yin deficiency and dry heat syndrome (n = 65)	Syndrome of deficiency of both Qi and Yin (n = 126)	Liver-kidney Yin deficiency syndrome (n = 84)	Spleen-kidney Yang deficiency syndrome (n = 160)	H/χ²value	P value
Age (years)	53.00 (44.50, 60.00)	55.50 (46.75, 61.25)	60.00 (51.25, 66.00)^ab	59.00 (54.00, 66.00)^ab	30.170	<0.001
Gender [male, n (%)]	56 (86.2)	90 (71.4)	54 (64.3)	113 (70.6)	9.100	0.028
History of DM (months)	84.00 (30.00, 180.00)	96.00 (48.00, 180.50)	144.00 (87.00, 204.00)^ab	156.00 (84.00, 240.00)^ab	23.721	<0.001
SBP (mm Hg)	134.20±18.43	141.76±22.46^a	142.67±19.64^a	152.94±25.86^abc	12.586	<0.001
DBP (mm Hg)	79.80±11.04	81.48±11.94	78.33±12.1	82.12±13.04^c	2.076	0.103
BMI (kg/m²)	27.20 (25.05, 29.40)	26.44 (24.18, 28.2)	25.65 (23.81, 28.88)	25.9 (23.6, 28.7)	6.591	0.086
Hb (g/L)	135.00 (121.50, 151.50)	119.50 (103.00, 136.25)^a	115.50 (97.25, 130.00)^a	99.00 (85.00, 115.00)^abc	88.526	<0.001
GHb (%)	6.80 (6.05, 7.90)	6.50 (6.10, 7.50)	6.90 (6.00, 7.78)	6.30 (5.70, 7.30)^c	11.438	0.010
FBG (mmol/L)	5.60 (4.67, 6.73)	5.98 (5.12, 7.68)	5.95 (4.70, 7.52)	6.06 (4.83, 7.80)	2.591	0.459
Scr (umol/L)	104.60 (73.35, 150.70)	125.30 (83.65, 259.25)	179.65 (101.93, 314.38)^a	246.30 (125.10, 408.50)^ab	54.695	<0.001
eGFR (mL/min/1.73m²)	55.30 (34.63, 91.51)	42.97 (18.06, 71.35)^a	28.16 (13.43, 57.05)^a	18.51 (10.32, 41.55)^ab	59.780	<0.001
BUN (mg/dL)	6.81 (5.06, 9.73)	8.95 (5.96, 13.52)^a	9.98 (7.17, 17.44)^a	13.95 (8.81, 20.99)^abc	67.125	<0.001
TC (mmol/L)	4.09 (3.61, 5.13)	4.33 (3.46, 5.33)	4.03 (3.32, 4.87)	4.76 (3.57, 6.34)^c	11.323	0.010
TG (mmol/L)	2.28 (1.54, 3.02)	2.00 (1.34, 2.66)	2.07 (1.39, 2.79)	1.77 (1.24, 2.83)	4.267	0.234
HDL (mmol/L)	0.88 (0.75, 1.10)	0.93 (0.79, 1.15)	0.94 (0.78, 1.04)	1.02 (0.81, 1.31)^c	12.379	0.006
LDL (mmol/L)	2.58 (1.94, 3.17)	2.59 (1.86, 3.67)	2.33 (1.83, 3.19)	2.90 (1.92, 4.13)^c	8.277	0.041
UA (μmol/L)	389.46±103.19	402.76±111.83	408.15±115.10	389.97±105.85	0.694	0.556
Alb (g/L)	38.50 (31.65, 42.30)	37.70 (32.75, 40.98)	36.45 (30.95, 39.85)	31.40 (24.50, 36.50)^abc	62.821	<0.001
TP (g/L)	62.70 (56.95, 68, 65)	63.10 (57.33, 67.75)	63.85 (57.55, 66.97)	57.00 (48.30, 64.30)^abc	34.342	<0.001
24 h urinary protein (g/L)	1.53 (0.30, 5.20)	2.87 (0.98, 5.14)	3.62 (0.92, 6.20)	5.44 (2.51, 7.14)^abc	43.153	<0.001

Item	B	SE	Wald	df	P value	Exp(B)	95% CI
Item	B	SE	Wald	df	P value	Exp(B)	Lower	Upper
Gender (1)	-1.282	0.441	8.441	1	0.004	0.277	0.117	0.659
Hb (g/L)	0.022	0.008	8.064	1	0.005	1.022	1.007	1.038
Alb (g/L)	0.056	0.020	7.549	1	0.006	1.058	1.016	1.101
Egfr (mL·min^-1·1.73m^-2)	0.019	0.005	12.849	1	0.000	1.020	1.009	1.030
Constant	-7.134	1.016	49.318	1	0.000	0.001	-	-

[1]	WANG Yuhuang, ZHANG Le, ZHANG Zhengshan, YAO Zhi, LI Xiyao, SUN Luying, LIAO Xing. Characteristics and quality of clinical practice guidelines for diabetic kidney disease: a systematic review [J]. Journal of Traditional Chinese Medicine, 2024, 44(3): 609-619.
[2]	HUANG Hongmei, YANG Maojun, LI Ting, WANG Dandan, LI Ying, TANG Xiaochi, YUAN Lu, GU Shi, XU Yong. Neferine inhibits the progression of diabetic nephropathy by modulating the miR-17-5p/nuclear factor E2-related factor 2 axis [J]. Journal of Traditional Chinese Medicine, 2024, 44(1): 44-53.
[3]	PAN Longci, QI Chunhui, SHEN Xubo, HUANG Yixian, YANG Xinrong, SUN Xianjun. Traditional Chinese Medicine syndrome analysis on oxaliplatin-induced peripheral neuropathy and clinical efficacy of Bushen Yiqi formula (补肾益气方): a prospective randomized controlled study [J]. Journal of Traditional Chinese Medicine, 2023, 43(6): 1234-1242.
[4]	YE Yujuan, WEI Yuting, JIA Jing, YAN Xingke. Efficacy of needling Baihui (GV20), Neiguan (PC6), Shenmen (HT7) and Taichong (LR3) on cerebral cortical blood oxygen level in rats with insomnia [J]. Journal of Traditional Chinese Medicine, 2023, 43(3): 523-532.
[5]	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.
[6]	XIE Jing, BI Zheng, WANG Sihai, SHEN Guoming, FANG Zhaohui. Danzhi Jiangtang capsule (丹蛭降糖胶囊) reduces renal injury in rats with diabetes induced by high fat diet and streptozotocin via downregulating toll-like receptor 4-nuclear factor-κB pathway and apoptosis [J]. Journal of Traditional Chinese Medicine, 2023, 43(2): 312-321.
[7]	LI Wei, XIA Ping, SUN Wei, ZHAO Jing, LIU Qiong, GENG Lianyi, ZHOU Yao, GAO Kun. Effects of the Huangkui capsule (黄葵胶囊) on chronic kidney disease: a systematic review and Meta-analysis [J]. Journal of Traditional Chinese Medicine, 2023, 43(1): 6-13.
[8]	Zimeng SHANG, Zhengguang DU, Bei GUAN, Xingyu JI, Longchang CHEN, Yongji WANG, Yun MA. Correlation analysis between characteristics under gastroscope and image information of tongue in patients with chronic gastritis [J]. Journal of Traditional Chinese Medicine, 2022, 42(1): 102-107.
[9]	GUO Yangzhi, DU Juan, JIANG Min, GUO Wei. Full composition granules of Huanglian (Rhizoma Coptidis) decrease the serum monocyte chemotactic protein-1 and connective tissue growth factor levels and inhibit kidney nuclear factor-κB expression in rats with high-fat diet-induced diabetes [J]. Journal of Traditional Chinese Medicine, 2021, 41(3): 424-431.
[10]	HAN Jiarui, ZHANG Yage, SHI Xiujie, PENG Zining, XING Yufeng, PANG Xinxin. Tongluo Digui decoction(通络地龟汤) treats renal injury in diabetic rats by promoting autophagy of podocytes [J]. Journal of Traditional Chinese Medicine, 2021, 41(1): 125-132.
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[12]	Guo Jing, Chen Hongdong, Zhao Xiyan, Zhao Linhua, Tong Xiaolin. Diabetic kidney disease treated with a modified Shenzhuo formula derived from Traditional Chinese Medicine: a case report [J]. Journal of Traditional Chinese Medicine, 2017, 37(06): 854-861.
[13]	Tian Jiaxing, Zhao Linhua, Zhou Qiang, Liu Wenke, Chen Xinyan, Lian Fengmei, Tong Xiaolin. Efficacy of Shenzhuo formula on diabetic kidney disease:a retrospective study [J]. Journal of Traditional Chinese Medicine, 2015, 35(05): 528-536.
[14]	Jing Xu, Lu Bai, Erwei Ma, Qian Guo, Yuehua Wang, Muqing Zhang, Zhiqiang Chen. Correlativity between blood measures related to blood stasis blocking collaterals and gene expression of angiotensin-converting enzyme of renal cortex in diabetic rats and effect of stasis removing and collaterals dredging [J]. Journal of Traditional Chinese Medicine, 2014, 34(05): 597-603.
[15]	Wei Wu, Hua Geng, Zhaoru Liu, Hong Li, Zhangzhi Zhu. Effect of curcumin on rats/mice with diabetic nephropathy: a systematic review and Meta-analysis of randomized controlled trials [J]. Journal of Traditional Chinese Medicine, 2014, 34(04): 419-429.

Item		B	SE	Wald	df	P value	Exp (B)	95% CI
Item		B	SE	Wald	df	P value	Exp (B)	Lower	Upper
Age (years)		-0.024	0.010	5.198	1	0.023	0.977	0.957	0.997
eGFR (mL·min^-1·1.73m^-2)		0.008	0.003	5.225	1	0.022	1.008	1.001	1.015
Alb (g/L)	0.055		0.015	13.447	1	0.000	1.056	1.026	1.088
Constant	-1.812		0.865	4.389	1	0.036	0.163	-	-

Item		B	SE	Wald	df	P value	Exp (B)	95% CI
Item		B	SE	Wald	df	P value	Exp (B)	Lower	Upper
Age (years)		-0.024	0.010	5.198	1	0.023	0.977	0.957	0.997
eGFR (mL·min^-1·1.73m^-2)		0.008	0.003	5.225	1	0.022	1.008	1.001	1.015
Alb (g/L)	0.055		0.015	13.447	1	0.000	1.056	1.026	1.088
Constant	-1.812		0.865	4.389	1	0.036	0.163	-	-

Item		B	SE	Wald	df	P value	Exp(B)	95% CI
Item		B	SE	Wald	df	P value	Exp(B)	Lower	Upper
Age (years)		0.028	0.012	5.336	1	0.021	1.028	1.004	1.053
GHb (%)		0.201	0.074	7.314	1	0.007	1.223	1.057	1.414
TC (mmol/L)	-0.233		0.085	7.516	1	0.006	0.792	0.670	0.936
Constant	-3.391		0.964	12.368	1	0.000	0.034	-	-

Item		B	SE	Wald	df	P value	Exp(B)	95% CI
Item		B	SE	Wald	df	P value	Exp(B)	Lower	Upper
Age (years)		0.028	0.012	5.336	1	0.021	1.028	1.004	1.053
GHb (%)		0.201	0.074	7.314	1	0.007	1.223	1.057	1.414
TC (mmol/L)	-0.233		0.085	7.516	1	0.006	0.792	0.670	0.936
Constant	-3.391		0.964	12.368	1	0.000	0.034	-	-