Clinical Study On The Correlation Between Yang Deficiency Syndrome Of Diabetic Nephropathy And TNFR-1 And FGF-2

Diabetic nephropathy is a major microvascular complication of diabetes mellitus and has become a significant contributor to chronic kidney disease and end-stage renal disease in China.This imposes a significant burden on social,economic,and medical resources.Currently,Western medicine lacks effective treatment methods for this condition.However,Chinese medicine has unique advantages for the treatment of diabetic nephropathy.Through multi-path and multi-target treatment,it can improve symptoms,slow down the progression of the disease,and improve the quality of life for patients.The basic pathogenesis of thirst disorders is internal heat injuring yin and depleting qi.While modern medical practitioners tend to treat diabetic nephropathy from the perspective of internal heat,it has been found that Yang deficiency evidence is also common in clinical practice.As the disease progresses,the number of patients exhibiting Yang deficiency evidence gradually increases in the middle and late stages,with worsening Yang deficiency symptoms being a common feature.In a previous study,it was observed that TNFR-1 was not statistically significant in relation to internal heat evidence,but was associated with Yang deficiency evidence.The aim of this study is to further investigate the distribution of Yang deficiency evidence in diabetic nephropathy and its correlation with TNFR-1 and FGF-23.Objectives:1.To investigate the distribution pattern of Traditional Chinese Medicine(TCM)symptoms in patients with diabetic nephropathy,including the distribution pattern and characteristics of Yang deficiency evidence.2.To explore the correlation between Yang deficiency evidence and TNFR-1 and FGF-23 in patients with diabetic nephropathy.3.To investigate the correlation between TNFR-1,FGF-23 and renal function impairment in patients with diabetic kidney disease(DKD).4.To provide a basis for the clinical use of the Warm Yang method in improving and delaying the progression of disease and microinflammatory state in patients with DKD.Methods:1.Clinical data was collected from 173 patients with stage III-V diabetic nephropathy,including TCM evidence data and laboratory indexes.The distribution pattern of each TCM evidence element in different periods was observed,and the correlation between Yang deficiency evidence and important laboratory indexes was analyzed using statistical methods such as t-test,one-way ANOVA,and non-parametric tests.2.The study collected TNFR-1,FGF-23,and clinical data from 183 patients with stage III-V diabetic nephropathy.Statistical methods such as t-test,one-way ANOVA,and nonparametric tests were used to analyze the correlation between inflammatory factors and clinical indexes.The correlation between Yang deficiency evidence and inflammatory indexes was analyzed using statistical methods such as one-way and multi-factor logistic regression analysis.Results:1.Among the deficiency elements of diabetic kidney disease,Yin deficiency evidence was the most common in the early stage,while the proportion of Qi deficiency,Yang deficiency,and blood deficiency evidence gradually increased in the middle and late stages.The proportion of Yang deficiency evidence was the largest among the deficiency elements in the late stage.The proportion of internal heat evidence was the highest in the early and middle stages,but decreased in the late stage.The proportion of blood stasis evidence and phlegm-dampness evidence gradually increased in the early,middle,and late stages,with the proportion of phlegm-dampness evidence being the largest among the actual elements in the late stage.The proportion of Qi-dampness evidence was the highest in the early stage.The proportion of Qi-depression evidence gradually decreased in the middle and late stages,while the proportion of Yang deficiency evidence gradually increased as the disease progressed.2.The proportion of patients using insulin and three or more antihypertensive drugs was higher in the Yang deficiency group compared to the non-Yang deficiency group(P<0.05).Blood potassium,blood phosphorus,urea nitrogen,blood creatinine,and 24-hour urine protein levels were higher in the Yang deficiency group compared to the non-Yang deficiency group(P<0.05),while blood calcium,carbon dioxide binding capacity,total bilirubin,and estimated glomerular filtration rate decreased(P<0.05).3.Yang deficiency evidence was positively correlated with TNFR-1(P<0.05).TNFR1 was negatively correlated with hemoglobin,glomerular filtration rate,and positively correlated with triglycerides,blood creatinine,blood uric acid,and 24-hour urine protein(P<0.05).FGF-23 was negatively correlated with hemoglobin and glomerular filtration rate,and positively correlated with triglycerides,blood creatinine,blood uric acid,and 24-hour urine protein(P<0.05).Conclusion:1.As diabetic nephropathy progresses,the proportion of Yang deficiency evidence gradually increases in the middle and late stages,making it an important evidence type of diabetic nephropathy.2.Yang deficiency evidence in diabetic nephropathy is closely associated with reduced renal function.3.TNFR1 is closely related to Yang deficiency evidence in diabetic nephropathy,while TNFR-1 and FGF-23 are closely related to reduced renal function in patients with diabetic nephropathy.Hyperuricemia,hemoglobin,blood creatinine,and 24-hour urine protein are possible influencing factors of TNFR-1,while hemoglobin is a possible influencing factor of FGF-23.