The Intervention Effect Of Bupiyiqishengyang Principle On Inelammation Of Diabetic Nephropathy

Aims: To validate the therapeutic effects of Bupi-Yiqi-Shengyang (BYS) principle on diabetic nephropathy (DN) and to investigate the anti-inflammatory mechanisms underlying these effects that may provide scientific evidence for clinical application of this principle.Methods:1.Clinical study: Twenty-four patients with phase IV DN were randomly divided into treatment and control groups, which were given BYS and BianZheng-Shizhi(BS), respectively for 1 month. Blood glucose, ratio of urinary protein/creatinine Scr, urinary CRP, MCP-1 and MIF were measured.2.Experimental study: STZ rats were divided into six groups, including blank control, model control, high-dose BYS, low- dose BYS, MMF and Tripterygium Glucosides treatment groups. They were observed for 8 weeks and body weight, kidney weight, urine volume, blood glucose, urinary cr, Scr and urinary microalbumin were evaluated. CRP, MCP-1 and MIF were assayed by ELISA. CD68 expression on macrophages was measured using immunohistochemistry approach. MCP-expression in kidney was assayed by semi-quantitative RT-PCR.Results:1. Clinical study: There were no difference in the therapeutic effects on blood glucose and kidney functions between two treatment groups (P>0.05), including similar decrease in urinary protein/creatinine ratio (P<0.05), urinary CRP and MCP-1 (P<0.05).2. Experimental study: After BYS therapy, no obvious improvement was observed in the body weight, urine volume, blood glucose and serum creatinine compared with the model group, but the kidney weight and kidney index were decreased and UAE was significantly decreased by the end of weeks 6 and 8 in high-dose group (P<0.05). By the end of week 8 the urinary CRP, MCP-1 and MIF weredecreased (P<0.01). In the high-dose group, the expression of CD68on macrophages was significantly inhibited compared with the modelgroup (P<0.05). The mRNA expression of MCP-1 in kidney wasremarkably decreased in the high-dose group, but the value wassimilar to that in the blank control group.Conclusions: The clinical observation and experimental studyindicate that:1.BYS therapeutic principle may reduce urinary protein, CRP,MCP-1 and MIF to some extent in DN patients and STZ rats, inwhich the mRNA expressions of CD68 on mono-macrophages andMCP-1 in kidney were downregulated;2.Spleen deficiency is one of the major mechanisms for DNdevelopment and BYS is an important therapeutic principle, whoseunderlying mechanism by which it works for DN treatment may bethe suppression of inflammation;3. The clinical study indicates that the traditional Chinese medicine(TCM) approaches of differentiating diseases and symptoms showbasically similar effects in the treatment of DN. They areindispensable methods used in TCM practice.