Study On The Treatment Of IgA Nephropathy By Regulating SIRT1/HIF-1α Pathway With Modified Huangqi Chifeng Decoctio

OBJECTIVE:This experiment verifies the clinical efficacy of modified Huangqi Chifeng Decoction in the treatment of IgA nephropathy,and explored the regulatory effect of modified Huangqi Chifeng Decoction on SIRTl/HIF-1α pathway.METHODS:This experiment adopted a placebo-controlled,randomized,double-blind,single-center clinical trial design.Eighty patients with IgA nephropathy in CKD stages 1-2,with 24-hour urinary protein quantification between 1.0-2.5g,were randomly selected.Both the control group and the experimental group were treated with telmisartan as the Western medicine basic treatment.In addition,the experimental group was given treatment with Wei Huang Qi Chi Feng Tang on this basis.The experiment lasted for a total of 24 weeks.Patients’24-hour urine was collected at weeks 0,12,and 24 of the experiment to measure 24-hour urinary protein quantification.Blood creatinine,blood urea nitrogen,uric acid,albumin,aspartate aminotransferase,alanine aminotransferase,and hemoglobin levels were measured at weeks 0 and 24 of the experiment.The SIRT1,HIF-1α,TGF-β,TNFα,IL6,FN,LN,and VEGF contents were also detected using the ELISA method.RESULTS:①Efficacy of 24-hour urinary protein quantification:For intra-group comparison of 24-hour urinary protein,the 24-hour urinary protein content gradually decreased in both the control and experimental groups at 12 and 24 weeks compared to week 0,and the difference was statistically significant(P<0.05).For inter-group comparison of 24-hour urinary protein content at 12 and 24 weeks,the experimental group had a greater effect in reducing 24-hour urinary protein compared to the control group,and the difference was statistically significant(P<0.05).②Comparison of SIRT1 efficacy:For intra-group comparison,the SIRT1 content in both the experimental and control groups increased after treatment(P<0.01),and the difference was statistically significant.After treatment,the inter-group comparison between the control and experimental groups showed that the difference was statistically significant(P<0.01),and the up-regulation of SIRT1 in the experimental group was superior to that of the control group.③Comparison of HIF-1αefficacy:For intra-group comparison,the HIF-la content in both the experimental and control groups significantly decreased after treatment(P<0.01),and the difference was statistically significant.After treatment,the inter-group comparison between the control and experimental groups showed that the difference was statistically significant(P<0.05),and the down-regulation of HIF-1α in the experimental group was superior to that of the control group.④TNFα efficacy comparison:within-group comparison showed that the TNFα content in the experimental group and the control group significantly decreased after treatment(P<0.05),with a statistically significant difference.After treatment,there was no statistically significant difference in TNFa content between the control group and the experimental group(P>0.05).⑤IL6 efficacy comparison:within-group comparison showed that the IL6 content in the experimental group and the control group significantly decreased after treatment(P<0.01),with a statistically significant difference.After treatment,there was a statistically significant difference in IL6 content between the control group and the experimental group(P<0.05).⑥TGF-β efficacy comparison:within-group comparison showed that the TGF-β content in the experimental group and the control group significantly decreased after treatment(P<0.01),with a statistically significant difference.After treatment,there was no statistically significant difference in TGF-β content between the control group and the experimental group(P>0.05).The experimental group’s downregulation of TGF-β had a superior effect to the control group.⑦FN efficacy comparison:within-group comparison showed that the FN content decreased in the experimental group and the control group after treatment(P<0.05),with a statistically significant difference.After treatment,there was a statistically significant difference in FN content between the control group and the experimental group(P<0.01).The experimental group’s downregulation of FN had a superior effect to the control group.⑧LN efficacy comparison:within-group comparison showed that there was no statistically significant difference in the control group before and after treatment(P>0.05);the experimental group had a significant decrease in LN content after treatment(P<0.01),with a statistically significant difference.After treatment,there was a statistically significant difference between the control group and the experimental group(P<0.05).The experimental group’s downregulation of LN had a superior effect to the control group,and the control group had no downregulation effect on LN.⑨VEGF efficacy comparison:within-group comparison showed that the VEGF content in the experimental group and the control group significantly decreased after treatment(P<0.01),with a statistically significant difference.After treatment,there was no statistically significant difference in VEGF content between the control group and the experimental group(P>0.05).⑩Safety comparison:there were no significant changes in eGFR,HGB,ALT,and AST in the experimental and control groups before and after treatment(P>0.05).CONCLUSION:The addition of Huangqi Chifeng decoction can reduce the quantity of 24-hour albuminuria in IgA nephropathy patients,and it is safe without side effects.It may affect the SIRT1/HIF-1α pathway by up-regulating the expression of SIRT1 and down-regulating the expression of HIF-1α,and reduce the inflammatory reaction by down-regulating the expression of IL6 and TGF-β.Down-regulating the expressions of FN and LN can reduce the degree of fibrosis.