Advances In Study Of Vascular Endothelial Dysfunction And Endothelial Function In Patients With IgA Nephropathy

This article is divided into two parts:literature survey and clinical invest igating.First, literature surveyVascular endothelial cells are an important part of the human body, and they play a very important role in the regulation of vascular tensity, maintenance of vascular structures and hemostasis. Numbers of studies have showed that vascular endothelial cell injury is an initial pathological change in varieties of cardiovascular diseases. Endothelial dysfunction is closely related to atherosclerosis, coronary heart disease, hypertension, diabetes and thrombosis. This article reviews the major pathogenesis of endothelial dysfunction in recent years, including oxidative stress, imbalanced release of vasoactive substances, abnormal expression of adhesion molecules, and vascular endothelial cell apoptosis. In addition, through the four pathogenesises mentioned above, this article reviews the protect ion of Chinese medicine in vascular endothel ial cells in order to provide reference for the application of Chinese medicine.Second, clinical investigationObjective1. To investigate the difference between IgA nephropathy and the healthy matched group in the degree of endothelial function;2.To analyze of the related factors of IgA nephropathy patients’endothelial dysfunction;3.To discuss the correlation between endothelial dysfunction and atherosclerosis index in IgA nephropathy patients;4. To explore the Chinese medicine dialectical typing of IgA nephropathy patients and the relativity with endothelial dysfunction.Method40 primary IgA nephropathy pat ients wi th biopsy-confirmed were analyzed, who were inpatient and outpatient in the China-Japan Friendship Hospital, and 40 healthy cases were took as the control group trough examination. Age, sex, BMI, heart rate, blood pressure, blood urea nitrogen (BUN), serum creatinine (Scr), uric acid(UA), glomerular filtration rate (GFR), total cholesterol (TC), triglycerides (TG), high density lipoprotein(HDL-C), low density lipoprotein(LDL-C), fasting blood glucose,24h urine protein quantification were recorded. Then FMD, baPWV, ABI and typing of TCM were also determined. SPSS version 17.0 software was used for statistical analysis.Results1. The FMD of IgA nephropathy patients(9.57 ±4.28)% is lower than the control group (11.39±3.72)%. There was significant difference (P<0.05).2. Bivariate correlation analysis of Clinical biochemical indexes and FMD showed:FMD was correlated with total cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure(P<0.05), and has a statistically significant correlation between total cholesterol (P<0.01). At the same time, blood urea nitrogen, creatinine, uric acid, glomerular filtration rate,24h urine protein, BMI and age had no statistically significant correlation with the FMD(P> 0.05).3.The FMD and baPWV、ABI had no statistically significant correlation in IgA nephropathy group(P>0.05).4. In the TCM syndromes of patients with IgA nephropathy, the frequency from more to less was Qi and Yin deficiency>Yin dcficicncy of liver and kidney>Yang deficiency of spleen and kidney= Qi deficiency of lung and spleen. The difference of FMD between Qi and Yin deficiency type and the control group was statistically significant (P<0.01).Conclusions1. In this investigation, compared with the control group, the FMD of IgA nephropathy patients is lower, suggesting that endothelial dysfunction situation may already exist in patients with IgA nephropathy compared with healthy people of the same age.2. Total cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure are the related factors of IgA nephropathy patients’endothelial dysfunction, and in this investigation, serum creatinine, blood urea nitrogen, uric acid, GFR,24-hour urine protein, BMI and age have no relativity with FMD in patients with IgA nephropathy.3. The FMD and baPWV, ABI may not be directly related in IgA nephropathy patients.4. In the TCM syndromes of patients with IgA nephropathy, the syndromes of Qi and Yin deficiency type is most closely related with FMD.