The Correlation Between TCM Syndromes, TWEAK And Other Inflammatory Factors In Diabetic Nephropathy

Objecti ve1、 To observe the TCM syndromes characteristics in patients with diabetic nephropathy(DN).2、 To explore the correlation between TCM syndromes、 different stages and physicochemical index in patients with DN.3、 To observe the change of inflammatory markers in patients with DN.4、 To observe the expression change of TWEAK in diabetic DN, to explore the relationship between diabetic nephropathy and inflammationMethods1、 Clinical studiesWe have done retrospective analysis of152patients with DN from Shenzhen TCM Hospital and Baoan District TCM Hospital of Subsidiary TCM University of Guangzhou during2012.09-2013.03. Through the establishment of a database, analysis of DN stages clinical syndromes, physicochemical index. According to the2007China Association of Chinese medicine nephropathy branch had made the 《diabetic nephropathy diagnosis, syndrome differentiation and therapeutic effect evaluation standard》and《Mogensen diabetic kidney staging criteria》, The152patients were carried out TCM syndromes and Western medicine diagnosis staging, and then used SPSS statistical software to analyse the relationship between TCM types and physicochemical index、 DN stages、 clinical data of patients with diabetic nephropathy.2、 Experimental StudyTo study serum、urine inflammatory factors:TWEAK、IL-1β and IL-10by using Experimental study of enzyme linked immunosorbent assay (ELISA) method on120diabetic nephropathy patients and normal persons, and analyses the correlation between patients with diabetic nephropathy and normal human serum and urine concentration and diabetic nephropathy syndromes of TCM.Results1、 Clinical studiesThe study selected152cases according to the general condition of patients, symptoms, signs, physicochemical index and diabetic nephropathy stage were compared and analysed the correlation of TCM types and clinical data、 physicochemical index, diabetic nephropathy stage, as follows:(1) General data analysis:152cases of patients with diabetic nephropathy,77cases were male,34to81years of age, mean age was64.64±12.56years old, average disease course was11.56±5.38years;75cases were female, aged38years to84years, mean age was63.55±10.94years, average disease course was10.16±6.36months.(2) The distribution of TCM types:The frequency analysis showed that:Qi-Yin deficiency was the major type,100cases (65.79%), yin deficiency dryness-heat was6cases (3.94%), Qi deficiency of spleen and kidney was24cases (15.79%), yin-yang deficiency was22cases (14.47%), cold-dampness、 Damp-heat、 blood stasis、 Phlegm and blood stasis, respectively was16cases (10.53%)、34cases (22.37%)、8cases (34.21%) and8cases (5.26%). In yin deficiency dryness-heat of the main type, there were2cases was Ⅰ-Ⅱ stage,2cases was Ⅲstage,2cases was Ⅳ stage; In Qi-Yin deficiency, there were16cases was Ⅰ-Ⅱ stage,30cases was Ⅲ stage,54cases was Ⅳ stage; In Qi deficiency of spleen and kidney, there were6cases was Ⅰ-Ⅱ stage,8cases was Ⅲstage,10cases was Ⅳ stage; In yin-yang deficiency, there were4cases was Ⅰ-Ⅱ stage,4cases was Ⅲstage,12cases was Ⅳ stage; In Damp-heat type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively6cases,2cases,8cases. In cold-dampness type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲ stage, and Ⅳstage were respectively0cases,10cases,24cases. In blood stasis type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively4cases,20cases,28cases. In Phlegm and blood stasis type of the concurrently type,Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively2cases,0cases,26cases.(3) The Clinical syndromes:The frequency analysis showed that:Dry mouth polydipsia and frequent urination symptom in TCM Different Syndromes (including the main and concurrently syndromes) which appear in pairs, there was4cases(2.6%) in yin deficiency dryness-heat; Qi-Yin ficiency were46cases (30.3%), Qi deficiency of spleen and kidney were8cases (5.2%), yin-yang deficiency were8cases (5.2%), cold-dampness. Damp-heat、 blood stasis. Phlegm and blood stasis, respectively was4cases (2.6%)、16cases (10.5%)、8cases (5.26%) and8cases (5.26%).(4)152cases of patients with diabetic nephropathy:In the main syndromes of all TCM Syndromes, The coronary disease,52cases (34.2%) was the major type, strokes was32cases (21.1%), retina disease was28cases (18.4%), round neuropathy was17cases (11.2%), Samely, In the concurrently type The coronary disease,40cases (26.3%) was also the major type, then the strokes, retina disease, round neuropathy were respectively32cases (21.1%),19cases (12.5%),19cases (12.5%)。(5) Physicochemical indicators:Physicochemical indicators:The results showed that physicochemical indexes of INS, HbAlc, BMI, RBC, Upro, Ucr, Upro/Ucr, AST, ALB, TG, LDL-C, HDL-C、 FT3, FT4, TSH, CA199, AFP and CEA2in groups of differential TCM types have no difference (P>0.05)。Physicochemical indicators of a significant difference between groups including fasting blood glucose (FPG), alanine aminotransferase (ALT), serum creatinine (Cr), Cystatin C (Cys-C), serum total cholesterol (CHOL), hemoglobin (HGB) etc. The FPG of Qi deficiency of spleen and kidney type was significantly lower than yin deficiency dryness-heat. Damp-heat and kidney and Qi-Yin deficiency (P<0.05), Phlegm and blood stasis was significantly lower than the other types (P<0.05); The ALT of cold-dampness type was significantly higher than the other types (P<0.05), Yin deficiency dryness-heat and Qi-Yin deficiency higher than the other syndromes (P<0.05), but no cold-dampness type (P<0.05); but the two types have no difference (P>0.05); The CREA of yin-yang deficiency type was significantly higher than yin deficiency dryness-heat and blood stasis (P<0.05), Yin deficiency dryness-hea was significantly lower than Qi-Yin deficiency and blood stasis types (P<0.05); The CREA of blood stasis type was significantly higher than the other syndromes, but no Qi-Yin deficiency and yin-yang deficiency (P<0.05), Qi-Yin deficiency syndromes was significantly lower than Qi deficiency of spleen and kidney and Damp-heat types; The HGB of yin-yang deficiency type was significantly lower than the other syndromes (P<0.05), It has significantly difference between Qi-Yin deficiency and no Phlegm and blood stasis (P<0.05), It has significantly difference between Phlegm and blood stasis and no Qi-Yin deficiency (P<0.05), These results may suggest that TCM types have relevant with FPG、RBC、 HGB、 CHOL、 CREA and Cys-C.2、 Experimental StudyIn the study, The experimental results showed that:The blood and urine TWEAK、 blood IL-β、blood IL-10of yin deficiency dryness-heat of LN patients were significantly higher than the other types (P<0.05), In the main types, The blood and urine TWEAK、blood IL-1β、blood IL-10become lower and lower with the development of TCM types, such as yin deficiency dryness-heat>Qi-Yin deficiency>Qi deficiency of spleen and kidney and yin-yang deficiency, It was same with the development of DN(the normal persons, DN without albumen、 DN with a small amount albumen、 DN with a great amount albumen DN with CRF). Conclusion1、 It has correlation between clinical symptoms、 complications DN、 stage and TCM syndromes in patients with DN.2、 It has correlation between the TCM syndromes and FPG、 HGB、 CHOL、 Cr、 Cys-C.3、 There are some difference of blood and urine TWEAK、 blood IL-β、blood IL-10expressing between normal persons and DN patients, It point out that has correlation between TCM syndromes and secretion expression of these blood、 urine inflammation factors. It has close relationship between Damp-heat type、 yin deficiency dryness-heat and inflammation, we may can use inflammation factors technology to reveal the mechanism of TCM syndromes.