| With the changes in diet and lifestyle,more and more patients suffer from diabetes,and the most common microvascular complication of diabetes—diabetic nephropathy,the incidence of which is also increasing,seriously endangering public health,delaying the development of diabetic nephropathy is imminent.This study evaluated the clinical efficacy of tonifying qi and warming kidney to remove stasis method in the treatment of yang deficiency syndrome of diabetic nephropathy through prospective before-and-after control test.On the basis of previous studies,the rat model of yang-deficiency syndrome of diabetic nephropathy was constructed to observe the key factors of RAAS system and the pathological changes of kidney tissues,and to discuss the mechanism and clinical efficacy of tonifying qi and warming kidney to remove stasis method in the treatment of yang deficiency syndrome of diabetic nephropathy.Objective:To evaluate the clinical efficacy of the tonifying qi and warming kidney to remove stasis method to treat patients with spleen-kidney yang deficiency syndrome according to the syndrome differentiation of traditional Chinese medicine and stage of Mogensen Ⅳdiabetic nephropathy.To observe the effect of tonifying qi and warming kidney to remove stasis method on the key factors of RAAS system in rats with yang deficiency syndrome of diabetic nephropathy,and to obtain the mechanism of its action in the treatment of diabetic nephropathy.Methods:Clinical trial:adopt the method of prospective before-and-after itself,Chinese medicine syndrome differentiation of spleen and kidney yang deficiency syndrome,stage belongs to Mogensen IV of diabetic nephropathy patients for 8 weeks of tonifying qi and warming kidney to remove stasis intervention treatment,observation of TCM symptoms,24 hours urinary protein quantitative,fasting blood glucose and renal function indexes of judging tonifying qi and warming kidney to remove stasis method of clinical curative effect for the treatment of diabetic spleen-kidney yang deficiency syndrome.Animal experiment:Selected on the basis of preliminary experiment,60 SD rats,only 10 were randomly divided into normal group and model group only 50,using high fat diet+chain urea with cephalosporins(streptozotocin,STZ)single intraperitoneal injection,the method of constructing rat model of diabetic nephropathy,yang deficiency syndrome types for 12 weeks after experiment in building success,the model group rats were randomly divided into 5 groups:yang deficiency syndrome model control group,valsartan group,good temperature kidney fights Chinese medicine group(low,middle and high dose),each group of 10 rats,to fill the stomach 8 weeks after testing rats fasting blood glucose,24 hours urinary protein,renal function,blood lipids and other quantitative indicators;ELISA method to detect the rat T4,cGMP,testosterone,Ang Ⅱ factor content changes;Protein levels of ACE2,ACE,AT1 and Mas in rat kidney were detected by Western blot.HE staining,PAS staining and Masson staining were used to observe the renal histopathology of rats.Results:Clinical trial:a total of 20 patients completed the study,compared with before treatment,after treatment of TCM symptom integral is reduced,the total effective rate was 85%,the difference was statistically significant(P<0.01),and chills,cold limbs,waist and knee acid urine turbidity,god exhausted lazy reduce symptoms integral,it had statistically significant(P<0.01),the night to urinate,loose stools,men’s or women’s sexual impotence more indifference,white complexion symptoms integral is reduced,the difference was statistically significant(P<0.05),limb swelling,less food,stay symptoms integral differences had no statistical significance(P>0.05);Compared with before treatment,24 hours urinary protein quantification was reduced after treatment,with statistically significant difference(P<0.05),and the total effective rate was 66.67%.Compared with before treatment,fasting blood glucose decreased after treatment,and the difference was statistically significant(P<0.05).There were no statistically significant differences in serum creatinine,blood urea nitrogen,blood uric acid and glycosylated hemoglobin after treatment compared with before treatment(P>0.05).No adverse reactions and no shedding and exit occurred during the treatment.Animal experiment:the experiment results show that by STZ mold maker yang deficiency syndrome in rats model of diabetic nephropathy is successful,compared with normal group,model group rats appeared retardation,decreased activity,thin body,color dark,weight loss,food intake and water quantity increase sharply increased,waste,part of the eye cataracts,abdomen of rats appeared,restlessness,Chinese medicine dose group death 5,the rest of the group’s death 1.Compared with the normal group,fasting blood glucose and ACR in other groups increased,with statistically significant difference(P<0.05).Compared with the model group of yang deficiency syndrome,there was no statistically significant difference in fasting blood glucose in each group(P>0.05),ACR increased in the high dose group(P<0.05),and there was no statistically significant difference in ACR between the other groups(P>0.05).Compared with the normal group,Scr and BUN in other groups were increased(P<0.05).Compared with the model group of yang deficiency syndrome,Scr in each group was not statistically significant(P>0.05).Compared with the normal group,TC in each group increased(P<0.05),TG in the medium dose group increased(P<0.05),TC and TG in the medium dose group increased(P<0.05),and TC in the high dose group increased(P<0.05).Compared with the normal group,the levels of cGMP and T4 in other groups decreased(P<0.05).Compared with the yang deficiency syndrome model group,cGMP increased in the high dose group(P<0.05).There was no statistically significant difference in cGMP between the low dose and medium dose groups(P>0.05).Compared with the normal group,the content of testosterone in each group decreased(P<0.05),while the content of testosterone in each group increased(P<0.05)compared with the model group of yang deficiency syndrome.Compared with the normal group,the level of ACE protein in the model group of yang deficiency syndrome and the traditional Chinese medicine group decreased,with a statistically significant difference(P<0.05).Compared with the model group of yang deficiency syndrome,there was no statistically significant difference in the other groups(P>0.05).Compared with the normal group,the content of AngⅡ increased in each group(P<0.05),while the content of AngⅡ decreased in the medium and high dose groups(P<0.05)compared with the model group(P<0.05).Compared with the normal group,the level of AT1 protein in the model group of yang deficiency syndrome and the medium dose group of traditional Chinese medicine decreased,and the difference was statistically significant(P<0.05).Compared with the model group of yang deficiency syndrome,the level of AT1 protein in the western medicine group and the traditional Chinese medicine group increased,and the difference was statistically significant(P<0.05).Compared with the normal group,ACE2 protein level in the model group of yang deficiency syndrome decreased,with statistically significant difference(P<0.005).Compared with the model group of yang deficiency syndrome,ACE2 protein level in the low and high dose groups of traditional Chinese medicine increased,with statistically significant difference(P<0.05),while there was no statistically significant difference between the western medicine group and the medium dose group of traditional Chinese medicine(P>0.05).Compared with the normal group,the level of Mas protein in the yang deficiency syndrome model group increased,and the difference was statistically significant(P<0.05).Compared with the yang deficiency syndrome model group,the level of Mas protein in the western medicine group and the traditional Chinese medicine group decreased,and the difference was statistically significant(P<0.05).Conclusion:1.The method of tonifying qi and warming kidney to remove stasis can improve the clinical symptoms of patients with yang deficiency syndrome of diabetic nephropathy,reduce the 24-hour urine protein ration and fasting blood glucose,and have a definite clinical effect.2.To some extent,the tonifying qi and warming kidney to remove stasis method can improve the levels of cGMP,T4 and testosterone related to yang deficiency syndrome in diabetic nephropathy rats.By raising the level of ACE2 protein,it can promote the generation of Ang(1-7)and its combination with Mas protein,and up-regulate ACE2-Ang(1-7)-Mas axis,so as to play the role of kidney protection.By reducing AngⅡfactor content,inhibit AngⅡ and AT1,cut the ACE-AngⅡ-AT1 shaft expression,inhibition of AT1 protein of podocyte damage,improve diabetic kidney yang deficiency syndrome,has a good effect in high dose group. |
PDF Full Text Request