| Objective : To observe the changes of clinical syndromes of traditional Chinese Medicine and related laboratory indexes in patients with deficiency of Qi and Yin and deficiency and blood stasis by intervention of Tangshenkang granule in diabetic kidney disease(DKD)and analyze the effect of Tangshenkang granule on the cytoskeleton protein of DKD urinary α-actinin-4,Synaptopodin,so as to explore the mechanism of Tangshenkang granule in treating DKD patients with deficiency of qi and yin and blood stasis.Method: From October 2016 to January 2018,70 DKD patients with Qi and Yin deficiency and blood stasis syndrome were selected from Department of Renal Medicine and Endocrinology Department of Anhui traditional Chinese Medicine Hospital.They were randomly divided into Tangshenkang group and control group(35cases each).In addition,20 healthy persons from the physical examination in our hospital were the normal group.In the course of treatment,2 cases were lost in Tangshenkang group,4 cases were lost in control group,and 64 cases finally completed in this study.Patients in both groups were given routine treatment(Lowering Blood pressure and regulating Blood glucose and Lipid,etc.),Tangshenkang group was treated with Tangshenkang granules(3 times a day,1 bag at a time),both groups were treated for 8 weeks.To compare the changes of clinical efficacy and Traditional Chinese Medcine syndromes score before and after treatment,to observe the changes of urinary microalbumin / urinary creatinine ratio in two groups before and after treatment,and to observe the changes of 24 hours urinary protein,renal function and blood glucose.At the same time,the difference of urine α-actinin-4 and Synaptopodin was observed between the two groups before and after treatment.In the normal group,the urineα-actinin-4 and Synaptopodin was only detected,and the curative effect was evaluated and statistically analyzed according to the experimental results.Results: The curative effect of Tangshenkang group was significantly better than that of control group(P < 0.05),and the traditional Chinese Medcine syndromes of Qi and Yin deficiency and blood stasis syndrome were significantly better than that of control group(P < 0.05).There was no significant difference in Traditional Chinese Medcine syndromes between the two groups before treatment(P > 0.05);The scores of Traditional Chinese Medcine syndromes in Tangshenkang group decreased significantly after 4 weeks and 8 weeks of treatment,there were significant differences(P < 0.05 or P< 0.01);The scores of traditional Chinese Medcine syndromes in the control group decreased slightly after 4 weeks of treatment,but there was no significant difference(P > 0.05);while that in the control group decreased after 8 weeks of treatment,there were significant differences(P< 0.05);After 8 weeks of treatment,the decrease of score in both groups was more significant than that after 4 weeks of treatment(P < 0.05 or P< 0.01),and the decrease of score in Tangshenkang group was significantly higher than that in control group(P < 0.01).After 4 weeks and 8 weeks of treatment,the UACR and24 h UPr in Tangshenkang group was significantly lower than that before treatment(P <0.05 or P < 0.01);The UACR and 24 h UPr in the control group decreased after 4 weeks of treatment,but there was no significant difference between the two groups(P > 0.05),and the UACR and 24 h UPr in the control group decreased significantly after 8 weeks compared with that before treatment(P < 0.05);After 4 weeks and 8 weeks of treatment,the level of UACR and 24 h UPr in the Tangshenkang group was significantly lower than that in the control group(P < 0.05 or P < 0.01).There were no significant changes in BUN、Scr and e GFR before and after treatment between the two groups(P >0.05).The FPG、2h PG and Hb A1 c in the two groups were lower than before,but there was no significant difference between the two groups(P > 0.05).Before treatment,the levels of urine α-actinin-4 and Synaptopodin in the two groups were significantly higher than those in the normal group(P < 0.01);but there was no significant difference in the level of α-actinin-4 and Synaptopodin between the Tangshenkang group and the control group(P > 0.05).After treatment,the levels of α-actinin-4 and Synaptopodin in urine in Tangshenkang group were significantly lower than those before treatment(P < 0.05),while in control group,the levels of α-actinin-4 and Synaptopodin in urine were improved compared with those before treatment,but there was no statistical significance(P > 0.05).Conclusion: Tangshenkang granule can obviously relieve the clinical symptoms of DKD patients with Qi and Yin deficiency and blood stasis syndrome and reduce proteinuria.The levels of α-actinin-4 and Synaptopodin in urine in DKD patients were significantly different from those in healthy controls,indicating that abnormal expression of urinary cytoskeleton protein was involved in the pathogenesis and development of DKD.Tangshenkang granule can effectively reduce the level ofα-actinin-4 and Synaptopodin,which may be one of the mechanisms of Tangshenkang granule to alleviate the clinical efficacy of DKD. |
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