| [Background/Aims] The thesis is made up of3parts. Firstly, we reviewed the clinical implication of urinary protein markers in diabetic nephropathy (DN) and interventional effects of Chinese herbal medicine (CHM). In clinic, some urinary protein makers can dynamically and noninvasively reflect the degree of renal tubular injury in patients with DN. These urinary biomarkers of tubular damage are broadly divided into two categories. One is newfound, including kidney injury molecule-1(Kim-1), neutrophil getatinase-associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP) and cystatin C (CysC); the other one is classical, including β2-microglobulin (β2-MG), retinal binding protein (RBP) and N-acetyl-β-D-glucosaminidase (NAG). It is reported that, the increases in urinary protein markers are not only closely related to the damage of tubular epithelial cells in DN patients, but also can be ameliorated by treatment with the Chinese herbal compound preparations or the single CHM. Secondly, we overviewed the clinical research on treatment of proteinuria with traditional Chinese medicine (TCM) in DN patients. Recently there are3kinds of effective therapeutic uses of TCM for proteinuria in DN, including the syndrome differentiation and treatment, the specific prescription and medication and the single CHM and its extract. Finally, as a focal point in this thesis, we aimed to investigate the characteristics of TCM syndrome in DN patients at stage III and analyzed the regression between characteristics of TCM syndrome and urinary tubular proteins, and then, preliminarily elucidated the characteristics of TCM syndrome in DN patients and their relationship with renal tubular urinary proteins, for the sake of providing a clinical evidence for the objective diagnosis of TCM syndrome in DN patients at stage Ⅲ.[Methods] Based on the method of epidemiological retrospective study, we collected data of60DN patients at stage III and observed their clinical characteristics and TCM syndrome features, then analyzed the relationship between TCM symptom, such as dry mouth to drink, thirsty much drink, tiredness and asthenia, spontaneous perspiration and night sweat, shortness of breath and numbness of the limbs, and renal tubular urinary proteins, such as Kim-1, CysC, β2-MG, RBP and NAG in urine, using the Logistic regression analysis. [Results] In60DN patients at stage Ⅲ,85.0%of patients were older than45,63.3%of patients’body mass index (BMI) were greater than24kg/m2and61.7%of patients’blood pressure were higher than140mmHg (systolic blood pressure) and/or90mmHg (diastolic blood pressure). In TCM original syndrome,76.7%of patients belonged to Qi-Yin deficiency type. In TCM superficial syndrome,51.7%of patients belonged to blood stasis type. In addition,73.3%of patients belonged to composite type, of them,52.3%of patients belonged to Qi-Yin deficiency and blood stasis types. The levels of serum high density lipoprotein cholesterol (HDL-C) in patients with Qi-Yin deficiency type were significantly higher than those in patients with non-Qi-Yin deficiency type (P<0.05). The levels of serum triglyceride (TG) in patients with blood stasis type were significantly higher than those in patients with non-blood stasis type (P<0.05). We found the dependency relation between urinary β2-MG, RBP and dry mouth to drink, spontaneous perspiration and night sweat respectively in patients with Qi-Yin deficiency type. Moreover, we also detected the dependency relation between urinary RBP and numbness of limbs in patients with blood stasis type. The levels of urinary β2-MG in patients with Qi-Yin deficiency type were significantly higher than those in patients with non-Qi-Yin deficiency type (P<0.05). The levels of urinary RBP in patients with blood stasis type were significantly higher than those in patients with non-blood stasis type.[Conclusion] For60DN patients at stage Ⅲ in this study, the characteristics of pathogenesis and TCM syndrome are Qi-Yin deficiency and blood stasis, as well as Qi-Yin deficiency syndrome and blood stasis syndrome. The increases in urinary β2-MG and RBP may be the objective TCM syndrome elements in patients with Qi-Yin deficiency type or blood stasis type. Additionally, age, body mass index (BMI) and blood pressure are the risk factors for DN patients at stage Ⅲ respectively. The levels of serum HDL-C and TG may be the objective indexes, which can evaluate the effects of TCM treatment in DN patients at stage Ⅲ with Qi-Yin deficiency type or blood stasis type. |
