Characteristics Of Traditional Chinese Medicine Symptom And Its Regression And Correlation With Urinary Protein In Patients With Stage â…¢ Diabetic Nephropathy

Characteristics of Traditional Chinese Medicine Symptom and its Regression and Correlation with Urinary Protein in Patients with StageⅢDiabetic Nephropathy【Background/Aims】This article is divided into three parts. At first, we reviewed the clinical features of early stage diabetic nephropathy (DN) and the mechanisms of Chinese herbal medicine. The clinical characteristics of early stage DN include glomerular injury and renal tubular damage. As the clinical manifestations, the elevation of urinary albumin (UAlb), is related to glomerular injury, while the elevation of urinary retinal binding protein (URBP), urinary cystatin C (UCysC) and urinary N-acetyl-β-D-glucosaminidase (UNAG) is correlated with renal tubular damage respectively. Chinese herbal medicine could delay the progression of glomerulosclerosis in DN by ameliorating the harmful factors of these pathological changes, such as glycometabolism disorder, podocyte injury, intra-renal hemodynamics abnormality, fibrogenic cytokines over-expression, oxidative stress inflammatory reaction and so on. The second, we overviewed the clinical research on the treatment of DN with Chinese herbal medicine. Two aspects below are demonstrated, one is the basic cognitions of famous experts at Traditional Chinese Medicine (TCM) about the etiopathogenisis and pathogensis in DN and their personal experience about treatment based on syndrome differentiation, another is the clinical observation on the treatment of DN with the characteristic prescriptions and Chinese herbs in TCM. It is also expounded, for early stage DN patients especially, the clinical symptoms are improved through reducing urinary protein and ameliorating renal functions. The third, as a focal point in this article, it is reported that characteristics of TCM symptom and its regression and correlation with urinary protein in patients with stageⅢDN. The aim of this study is to anlyze the characteristics of TCM syndrome and its dependence and correlation with urinary protein in patients with stageⅢDN, for the sake of providing a basis for clarifying the rules of TCM syndrome differentiation in DN.【Methods】In third part of this article, adopting traditional epidemiological retrospective method, the TCM syndrome and urinary protein related indexes, including 24h urinary protein (Upro), UAlb, URBP, UCysC, UNAG, etc, were collected from 54 patients with stageⅢDN, and a multiple factor regression analysis between them was conducted.【Results】75.9% of patients with stageⅢDN had clinical characteristics of Qi-Yin deficiency type. The elevation of Upro with the factors as swift digestion with rapid hungering, lassitude and lack of strength, weakness of waist and knees was correlated. And the elevation of UAlb with the factors as dry mouth with desire to drink, etc, the elevation of URBP with the factors as numbness of extremities, shortness of breath, etc, the elevation of UCysC with the factors as clear urine in large amounts, etc, and the elevation of UNAG with the factors as frequent micturition, were correlated respectively as well. Levels of UAlb in patients of Qi-Yin deficiency type were significantly higher than those in patients of non-Qi-Yin deficiency type (P<0.05). UAlb was correlated with UCysC positively (r=0.656, P<0.01).【Conclusion】For stageⅢDN patients, Qi-Yin deficiency is the major clinical characteristic of TCM. The TCM symptoms, as independent factors closely related to urinary protein, were swift digestion with rapid hungering, lassitude and lack of strength, weakness of waist and knees, dry mouth with desire to drink, numbness of extremities, shortness of breath, clear urine in large amounts, frequent micturition and so on. Shen and Pi are the major organs related to appearance of urinary protein. And Pi-Shen deficiency is the basic pathogenesis. Level of UAlb, which is associated with Qi-Yin deficiency type, could be taken as one of objective syndrome factors for the syndrome type. Level of UNAG and UCysC, which is related to Shen-Qi deficiency type, also is the objective syndrome factors for the syndrome type.