Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Biomed J. 2023 Feb;46(1):170-178. doi: 10.1016/j.bj.2022.02.001. Epub 2022 Feb 12.
To apply non-invasive Automatic Tongue Diagnosis System (ATDS) in analyzing tongue features in patients with chronic kidney disease (CKD).
This was a cross-sectional, case-controlled observational study. Patients with CKD who met the inclusion and exclusion criteria were enrolled and divided into the following groups according to renal function and dialysis status: non-dialysis CKD group; end-stage renal disease (ESRD) group; and control group. Tongue images were captured and eight tongue features-shape, color, fur thickness, saliva, fissure, ecchymosis, teeth marks, and red dots-were imaged and analyzed by ATDS.
117 participants (57 men, 60 women) were enrolled in the study, which included 16 in control group, 38 in non-dialysis CKD group, and 63 in ESRD group. We demonstrated significant differences in the fur thickness (p = 0.045), color (p = 0.005), amounts of ecchymosis (p = 0.010), teeth marks (p = 0.016), and red dot (p < 0.001) among three groups. The areas under receiver operating characteristic curve for the amount of ecchymosis was 0.757 ± 0.055 (95% confidence interval, 0.648-0866; p < 0.001). Additionally, with increase in ecchymosis by one point, the risk of CKD dialysis rose by 1.523 times (95% confidence interval, 1.198-1.936; p = 0.001). After hemodialysis, the amount of saliva (p = 0.038), the area of saliva (p = 0.048) and the number of red dots (p = 0.040) were decreased significantly among patients with ESRD. On the contrary, the percentage of coating (p = 0.002) and area of coating (p = 0.026) were increased significantly after hemodialysis.
Blood deficiency and stasis with qi deficiency or blood heat syndrome (Zheng pattern) is common in patients with CKD. The risk of CKD dialysis increases with increasing ecchymosis. Hemodialysis can affect saliva, tongue coating, and relieve heat syndrome among ESRD patients.
应用非侵入性自动舌诊系统（ATDS）分析慢性肾脏病（CKD）患者的舌象特征。
这是一项横断面、病例对照观察性研究。符合纳入和排除标准的 CKD 患者被纳入研究，并根据肾功能和透析状态分为以下几组：非透析 CKD 组；终末期肾病（ESRD）组；对照组。通过 ATDS 采集舌象并对 8 种舌象特征-形态、颜色、舌苔厚度、唾液、裂纹、瘀斑、齿痕和红点-进行成像和分析。
研究共纳入 117 名参与者（57 名男性，60 名女性），其中对照组 16 名，非透析 CKD 组 38 名，ESRD 组 63 名。我们发现三组间舌苔厚度（p=0.045）、颜色（p=0.005）、瘀斑量（p=0.010）、齿痕（p=0.016）和红点（p<0.001）存在显著差异。瘀斑量的受试者工作特征曲线下面积为 0.757±0.055（95%置信区间，0.648-0.866；p<0.001）。此外，瘀斑每增加 1 分，CKD 透析的风险增加 1.523 倍（95%置信区间，1.198-1.936；p=0.001）。血液透析后，ESRD 患者的唾液量（p=0.038）、唾液面积（p=0.048）和红点数量（p=0.040）明显减少，而舌苔百分比（p=0.002）和舌苔面积（p=0.026）明显增加。
CKD 患者以气血两虚、血瘀或血热证（证型）为主。瘀斑增多与 CKD 透析风险增加相关。血液透析可影响 ESRD 患者的唾液、舌苔，并缓解热证。
