To Explore The Relationship Between DKD Kidney-essence Deficiency Syndrome And Fibrosis Factors Based On The Theory Of "essential Damage To Collaterals"

Objective:The preliminary research shows that kidney essence deficiency syndrome is the most important syndrome type of DKD patients.The core trerapeutic method of tonifying kidney essence has achieved remarkable effect in the clinical treatment of DKD.The accuracy of TCM treatment based on syndrome differentiation directly affects the progression and prognosis of DKD.At present,the evaluation and diagnosis of kidney essence deficiency syndrome mainly relies on subjective judgments,lack of objective biological indicators,which hinders the application of tonifying kidney essence in clinical treatment.Klotho,which can antagonizes fibrosis to protect renal function,has a biological effect similar to "kidney essence".Previous studies found that under the guidance of "Kidney essence deficiency leading to collaterals'stagnation" theory,tonifying kidney essence method could regulate the expression of fibrotic indexes,such as TGF-?1.Therefore,this study aims to explore the correlation between kidney essence deficiency syndrome and fibrotic indexes of DKD,to seek the potential biological quantitative evaluation indexes of kidney essence deficiency syndrome,so as to provide objective basis for TCM syndrome differentiation and treatment of kidney essence deficiency syndrome of DKD.Method:Relying on the project of "Explore the correlation between mitochondrial damage and kidney deficiency syndrome in patients with diabetic kidney disease"(project No.2020-JYB-XJSJJ-062),we collected subjects who met the diagnostic criteria of diabetic kidney disease of stage ?-? and subjects who met the diagnostic criteria of diabetes mellitus.And the DKD group was further divided into kidney essence deficiency group and non-kidney essence deficiency group.We collect the general information,medical history,results of laboratory tests,serum samples of the patients,and serum levels of TGF-?1,Klotho,MMP-9 and TIMP-1 were assessed by Elisa.The general information,medical history,results of laboratory tests,as well as the levels of serum fibrotic indexes were compared between DM group and DKD group or kidney essence deficiency group and non-kidney essence deficiency group,to explore the relationship between kidney essence deficiency syndrome of DKD and fibrotic factors of TGF-?1,Klotho,MMP-9,TIMP-1.Result:In this study,we collected 56 subjects who met the diagnostic criteria of DKD of stage?-? and 29 subjects who met the diagnostic criteria of DM.And the DKD group was further divided into kidney essence deficiency group of 36 cases and non-kidney essence deficiency group of 20 cases.1.There was no difference between the group of DKD and DM in gender,age,BMI,medical history and other general information(P>0.05).Compared with DM group,the erythrocyte count of DKD patients was decreased(P<0.05),the hemoglobin level and estimated glomerular filtration rate were significantly decreased(P<0.01),the total cholesterol level was decreased(P<0.05),which is still higher than the normal range,and the blood urea nitrogen and serum creatinine were significantly increased(P<0.01).There was no difference in results of glycated hemoglobin,blood uric acid,triglycerides and other clinical examinations(P>0.05).2.Compared with DM group,serum level of TGF-?1 and TIMP-1 in DKD group were significantly increased(P<0.01),MMP-9/TIMP-1 was significantly decreased(P<0.01),and Klotho was decreased(P<0.05).There was no significant difference in MMP-9 level between the two groups(P>0.05).3.Compared with the group of non-kidney essence deficiency in DKD patients,the number of patients with previous medical history of hypertension was increased(P<0.05)in the group of kidney essence deficiency,and there was no difference in gender,age,BMI,family history and other general information between the two groups(P>0.05).Compared with the non-kidney essence deficiency group,erythrocyte count,hemoglobin level,eGFR were significantly decreased in patients of kidney essence deficiency group(P<0.01),and glycated hemoglobin level was also decreased(P<0.05),which is still higher than the normal range.And in patients of kidney essence deficiency group,the level of blood urea nitrogen,24-hour urinary total protein were significantly increased(P<0.01),serum creatinine was also increased(P<0.05).4.Compared with the non-kidney essence deficiency group,the kidney essence deficiency group had higher scores in phlegm syndrome(P<0.05).5.Serum level of TGF-?1 in kidney essence deficiency group was significantly higher than that in non-kidney essence deficiency group(P<0.01),and TIMP-1 was also higher(P<0.05).The serum level of Klotho in the kidney essence deficiency group was significantly lower than that in the non-kidney essence deficiency group(P<0.01),but there was no difference in MMP-9 and MMP-9/TIMP-1 between two groups(P>0.05).6.Serum level of TGF-?1 and Klotho were correlated with the occurrence of kidney essence deficiency syndrome,TGF-?1 was positively correlated with the score of kidney essence deficiency syndrome(r=0.426,P<0.01),and Klotho was negatively correlated with the score of kidney essence deficiency syndrome(r=-0.375,P<0.01).Conclusion:The score of kidney essence deficiency syndrome of DKD was positively correlated with TGF-?1 and negatively correlated with Klotho.TGF-?1 and Klotho may be involved in the pathogenesis of kidney essence deficiency syndrome of DKD.