Study On The Relationship Between Diabetic Nephropathy And Dyslipidemia And TCM Syndrome Research

Objectives:By studying the distribution characteristics of blood lipids in the early and clinical stage of DN and the correlation between blood lipid and laboratory indicators associated with DN, to explore the correlation between DN and dyslipidemia; By comparing the syndromes between DN with dyslipidemia and without dyslipidemia, and the correlations between the syndrome elements and blood lipid level, it can reveal the characteristics of syndromes in DN with dyslipidemia, moreover to provide the basis on diagnosis and treatment based on an overall analysis of symptoms and signs, as well as lay the foundation of objective assessment for developing multi-center clinical research.Methods:In this study, with the support from "11th five-year" National Key Technology Research and Development Program-the Study on the Comprehensive Protocol of Whole-course TCM Intervention for the Development of DN (project number:2006BAI04A03-2) and the subproject of major scientific and technological projects on technical platform of new drugs clinical evaluation(project number:2011ZX09302-006-01), the 385 cases were enrolled from outpatient and inpatient department of several institutions(Dongzhimen Hospital of Beijing, etc.). Collecting patients information including general information, laboratory indicators, symptoms and assessment of syndrome integral according to the questionare of the research.The difference of the blood lipid index between two groups, the correlations between blood lipid and indicators associated with DN, and TCM syndrome integral, and the correlation between syndromes and blood lipid index were analyzed according to statistics methods.Results:1 The distribution characteristics of blood lipids in the early and clinical stage of DN and the correlation between blood lipid and laboratory indicators associated with DNIn 385 patients with DN, the number of patients with dyslipidemia is 255, accounting for 66.2% of the total. In 192 patients with the early stage of DN, the number of patients with dyslipidemia is 127, accounting for 66.1%. In 193 patients with the clinical stage of DN, the number of patients with dyslipidemia is 128, accounting for 66.3%. There is no significant difference of the prevalence of dyslipidemia between the groups of the early stage of DN and the clinical stage of DN(P＞0.05). In 127 patients with the early stage of DN with dyslipidemia, the number of high TC is 34, accounting for 26.8%; the number of high TG is 52, accounting for 40.9%; the number of high TC+TG is 41, accounting for 32.3%. In 128 patients with the clinical stage of DN with dyslipidemia, the number of high TC is 28, accounting for 21.9%; the number of high TG is 45, accounting for 35.2%; the number of high TC+TG is 55, accounting for 43.0%. The constituent ratios of the dyslipidemia in the early stage of DN is high TG>high TC+TG>high TC, the constituent ratios of the dyslipidemia in the clinical stage of DN is high TC+TG> high TG>high TC.There is no significant difference between the groups of the early stage of DN and the clinical stage of DN on the gender, age and BMI(P＞0.05). There is significant difference between the groups of the early stage of DN and the clinical stage of DN on the course of disease(P＜0.05). Two groups of cholesterol, triglyceride, low density lipoprotein cholesterol levels have significant difference (P＜0.05), blood lipid levels in the clinical stage of DN group are higher than in the early stage of DN group; In the group of the early stage of DN, there is positive relationship between UAE and the level of TC, TG (P＜0.05); In the group of the early stage of DN, there is positive relationship between UAE and the level of TC, TG (P ＜0.05); In the group of the clinical stage of DN, there is positive relationship between 24-hour urinary protein quantity and the level of TC, TG (P＜0.05); there is positive relationship between serum creatinine and LDL-C level, there is positive relationship between blood urea nitrogen and TC level, there is negative relationship between estimated glomerular filtration rate and LDL-C level (P＜0.05).2 The distribution of syndrome elements in DN with dyslipidemia and the correlation of syndrome element and blood lipids indexSyndrome elements of 255 patients with DN with dyslipidemia in frequency order:qi deficiency syndrome> blood stasis syndrome> yin deficiency syndrome> yang deficiency syndrome> phlegm-dampness syndrome> damp-turbid syndrome> blood deficiency syndrome. Syndrome elements of 130 patients with DN without dyslipidemia in frequency order:qi deficiency syndrome> yin deficiency syndrome> blood stasis syndrome> yang deficiency syndrome> phlegm-dampness syndrome> damp-turbid syndrome> blood deficiency syndrome. Among them, Syndrome elements of 127 patients with the early stage of DN with dyslipidemia in frequency order:deficiency syndrome> blood stasis syndrome> yin deficiency syndrome> yang deficiency syndrome> phlegm-dampness syndrome> damp-turbid syndrome> blood deficiency syndrome; Syndrome elements of 65 patients with the early stage of DN without dyslipidemia in frequency order:qi deficiency syndrome> yin deficiency syndrome> blood stasis syndrome> yang deficiency syndrome> phlegm-dampness syndrome> damp-turbid syndrome> blood deficiency syndrome. Syndrome elements of 128 patients with the clinical stage of DN with dyslipidemia in frequency order:qi deficiency syndrome> blood stasis syndrome> yin deficiency syndrome> yang deficiency syndrome> damp-turbid syndrome> phlegm-dampness syndrome> blood deficiency syndrome; Syndrome elements of 65 patients with the clinical stage of DN without dyslipidemia in frequency order:qi deficiency syndrome> yin deficiency syndrome> blood stasis syndrome> yang deficiency syndrome> damp-turbid syndrome> phlegm-dampness syndrome> blood deficiency syndrome. There is significant difference between the groups of dyslipidemia and non-dyslipidemia on blood stasis syndrome and phlegm-dampness syndrome (P＜0.05). There is positive relationship between the integrals of blood stasis syndrome and TG level(P＜0.05), there is positive relationship between the integrals of damp-turbid syndrome and TG level(P＜0.05), there is positive relationship between the integrals of phlegm-dampness syndrome and TG level(P＜0.05).Conclusions:1 The prevalence of dyslipidemia in patients with DN is high, more than 60%.Dyslipidemia in the early stage of DN is given priority to high TG, with the progress of the course of the disease, the clinical stage of DN is given priority to mixed dyslipidemia. The cholesterol, triglyceride, low density lipoprotein cholesterol levels of the clinical stage of DN patients are significantly higher than that of patients with the early stage of DN. Whether the early stage or clinical stage of DN patients, there is relationship between renal function indexes and lipid index. It shows that with the progress of DN, urinary protein excretion increase, renal function gradually decline, the degree of dyslipidemia is aggravating which promotes the development of DN in turn. There is deteriorating relationship between DN and dyslipidemia.2 The main syndrome of DN with dyslipidemia is qi deficiency syndrome, yin deficiency syndrome, blood stasis syndrome、phlegm-dampness syndrome, blood stasis syndrome and phlegm-dampness syndrome are more obvious than that of the patients without dyslipidemia. There is relationship between the integrals of blood stasis syndrome、phlegm-dampness syndrome、damp-turbid syndrome and the blood lipid index level.This study belongs to the cross-sectional study, we didn’t continue to track the cases enrolled. But in order to do the full and complete understanding of the characteristics of the disease syndrome, it is very important to do the research about the dynamic changes of the disease syndrome. Therefore, we hope to do a multi-center, prospective, longitudinal cohort study in the future which can better explore the characteristics of the disease syndrome.