糖尿病肾病中医证型与TWEAK等炎症因子相关性研究
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摘要
目的
1、观察糖尿病肾病患者中医证候特点。
2、探讨糖尿病肾病患者各中医证型与临床分期及相关理化指标的相关性。
3、观察糖尿病肾病患者炎症指标的变化特征。
4、观察TWEAK在糖尿病肾病中的表达变化,探讨糖尿病肾病、中医证型与炎症之间的关系。
方法
1、临床研究
回顾性分析2012年9月-2013年3月广州中医药大学附属深圳市中医院和宝安区中医院的糖尿病肾病152名,通过建立数据库,整理分析患者的临床证型、理化指标等,并依据2007年中华中医药学会肾病分会制定的《糖尿病肾病诊断、辨证分型及疗效评定标准》和《Mogensen糖尿病肾脏分期标准》,分别对所收集的糖尿病肾病病例进行中医辨证及西医诊断分期,应用SPSS统计软件,分析糖尿病肾病患者中医证型与西医理化指标、临床资料、糖尿病肾病分期的相关性。
2、实验研究
利用酶联免疫吸附剂测定法(ELISA),检测所纳入的120名糖尿病肾病和30名健康组患者的血、尿TWEAK,血IL-1β及血IL-10等相关炎症指标,对比分析各中医证型间各炎症因子浓度差异,分析糖尿病肾病患者血、尿TWEAK,血IL-1β及血IL-10与中医辨证分型的相关性。
结果
1、临床研究
(1)糖尿病分期方面：频数分析结果提示152例糖尿病肾病患者,中医本证包括气阴两虚证最多见100例(65.79%),阴虚燥热证6例(3.94%),脾肾气虚证24例(15.79%),阴阳两虚证22例(14.47%),共152例；标证中湿热证16例(10.53%),寒湿证共34例(22.37%),瘀证共52例(34.21%),痰瘀证共8例(5.26%)。结合糖尿病肾病的西医临床分期：主证中阴虚燥热证Ⅰ-Ⅱ期2例,Ⅲ期2例,Ⅳ期2例；气阴两虚证Ⅰ-Ⅱ期16例,Ⅲ期30例,Ⅳ期54例；脾肾气虚证Ⅰ-Ⅱ期6例,Ⅲ期8例,Ⅳ期10例；阴阳两虚证Ⅰ-Ⅱ期4例,Ⅲ期4例,Ⅳ期12例,V期2例；标证中湿热证Ⅰ-Ⅱ期6例,Ⅲ期2例,Ⅳ期8例；寒湿证Ⅰ-Ⅱ期0例,Ⅲ期10例,Ⅳ期24例；瘀证Ⅰ-Ⅱ期4例,Ⅲ期20例,Ⅳ期28例；痰瘀证Ⅰ-Ⅱ期2例,Ⅲ期0例,Ⅳ期26例。结果提示中医辨证分型与糖尿病肾病分期存在相关性(P<0.05,r=0.522)。
(2)临床分析：在152例DN患者中,口干多饮及小便频数症状在中医多个证型(包括本证及标证)中是成对出现,其中阴虚燥热证4例(2.6%),气阴两虚证46例(30.3%),脾肾气虚证8例(5.2%),阴阳两虚证8例(5.2%),湿热证4例(2.6%),寒湿证16例(10.5%),瘀证8例(5.2%),痰瘀证8例(5.2%),而多食易饥在糖尿病肾病患者当中表现较少,阴虚燥热证2例(1.3%),气阴两虚证4例(2.6%),阴阳两虚证2例(1.3%)。结果提示中医辨证分型与糖尿病主要症状存在相关性(P<0.05,r=0.415)。
(3)并发症分析：在152例DN患者中,中医各个证型本证当中,冠心病(心电图改变)最多见52例(34.2%),然后依次是脑血管意外32例(21.1%),视网膜病变28例(18.4%),周围神经病变17例(11.2%),标证当中仍以冠心病(心电图改变)最多见40例(26.3%),然后依次是脑血管意外32例(21.1%),视网膜病变19例(12.5%),周围神经病变19例(12.5%)。结果提示中医辨证分型与糖尿病肾病并发症存在相关性(P<0.05,r=0.383)。
(4)理化指标分析：本研究结果显示：空腹胰岛素(INS),糖化血红蛋白(HbAlc),体重指数(BMI),尿蛋白(Upro),尿肌酐(Ucr),尿蛋白肌酐比值(Upro/Ucr),红细胞计数(RBC),肝功能(AST、ALB)、血脂(TG、LDL-C、 HDL-C)、甲状腺功能(FT3、FT4、TSH),肿瘤三项(CA199、AFP、CEA2)组各证比较无统计学差异(P>0.05)。
各组间差异显著的理化指标包括空腹血糖(FPG)、谷丙转氨酶(ALT)、血肌酐(Cr)、胱抑素C (Cys-C)、血总胆固醇(CHOL)、血红蛋白(HGB)等。其中,空腹血糖：脾肾气虚证与阴虚燥热证、湿热证、气阴两虚证有统计学差异(P<0.05),痰瘀证与其它各证型之间比较均有统计学差异(P<0.05)；血清谷丙转氨酶：寒湿证组最高,与各证均有统计学差异(P<0.05),阴虚燥热证及气阴两虚证数值也明显增高,与其它各证比较有统计学差异(P<0.05),阴虚燥热证与气阴两虚证比较无统计学差异(P>0.05)；血肌酐：阴阳两虚证明显高于其它组,与阴虚燥热证、瘀证比较有统计学差异(P<0.05),而阴虚燥热证明显低于其它组,与气阴两虚证、瘀证比较有统计学差异(P<0.05)；胱抑素C：阴阳两虚证也明显高于其它组；血总胆固醇：瘀证明显高于其它组,与非气阴两虚证、阴阳两虚证比较有统计学差异(P<0.05),气阴两虚证与脾肾气虚、湿热证比较有统计学差异(P<0.05)；红细胞计数：阴阳两虚证明显低于其它组,组间对比虽然差异无统计学意义,但是降低比较明显；血红蛋白：阴阳两虚证明显低于其它组,且与各证比较有统计学差异(P<0.05),阴虚燥热证明显高于其它组,与各证比较有统计学差异(P<0.05),气阴两虚证与非痰瘀证比较有统计学差异(P<0.05),痰瘀证与非气阴两虚证比较有统计学差异(P<0.05)；上述结果提示中医证型与FPG、 RBC、 HGB、 CHOL、 ALT、 Cr和Cys-C水平可能有关。
2、实验研究
实验结果显示：主证中：血、尿TWEAK,血IL-10浓度水平随中医证型病情进展逐步降低,其中阴虚燥热证组血、尿TWEAK,血IL-I0浓度明显高于其它组,与其它证型对比差异有统计学意义(P<0.05),按浓度排序依次为：阴虚燥热证>气阴两虚证>脾肾气虚证、阴阳两虚证,与健康组和糖尿病肾病病情进展(无蛋白尿组、少量蛋白尿组、大量蛋白尿组、肾功能不全组)表达水平一致；血清IL-1β检测结果提示：与正常对照组和其他证型组比较,湿热证组IL-1β浓度较高,差别具有统计学意义(P<0.05)。
结论
1、结果提示中医辨证分型与糖尿病肾病分期的相关性有统计学意义(P<0.05),具有相关性,说明伴随着患者糖尿病肾病病情加重,中医证型从阴虚燥热→气阴两虚→脾肾气虚→阴阳两虚证发展,中医证型发展也是病情加重的一个反映。中医辨证分型(包括本证和标证)与临床表现及并发症的相关性有统计学意义(P<0.05),我们认为糖尿病“三多一少”症及并发症在糖尿病肾病的中医辨证中可以做为衡量病情严重程度的指标。
2、糖尿病肾病的中医证型与理化指标FPG、HGB、CHOL、CREA和Cys-C差别有统计学意义,存在相关性。
3、各中医证型间的血、尿TWEAK.血IL-1β、血IL-10浓度存在差异,提示中医分型与此类血、尿炎症因子的表达分泌有关。提示湿热证、阴虚燥热证可能与炎症关系密切。利用炎症因子有望对中医证型的发生机制进行阐释。
Objecti ve
1、 To observe the TCM syndromes characteristics in patients with diabetic nephropathy(DN).
2、 To explore the correlation between TCM syndromes、 different stages and physicochemical index in patients with DN.
3、 To observe the change of inflammatory markers in patients with DN.
4、 To observe the expression change of TWEAK in diabetic DN, to explore the relationship between diabetic nephropathy and inflammation
Methods
1、 Clinical studies
We have done retrospective analysis of152patients with DN from Shenzhen TCM Hospital and Baoan District TCM Hospital of Subsidiary TCM University of Guangzhou during2012.09-2013.03. Through the establishment of a database, analysis of DN stages clinical syndromes, physicochemical index. According to the2007China Association of Chinese medicine nephropathy branch had made the 《diabetic nephropathy diagnosis, syndrome differentiation and therapeutic effect evaluation standard》and《Mogensen diabetic kidney staging criteria》, The152patients were carried out TCM syndromes and Western medicine diagnosis staging, and then used SPSS statistical software to analyse the relationship between TCM types and physicochemical index、 DN stages、 clinical data of patients with diabetic nephropathy.
2、 Experimental Study
To study serum、urine inflammatory factors:TWEAK、IL-1β and IL-10by using Experimental study of enzyme linked immunosorbent assay (ELISA) method on120diabetic nephropathy patients and normal persons, and analyses the correlation between patients with diabetic nephropathy and normal human serum and urine concentration and diabetic nephropathy
syndromes of TCM.
Results
1、 Clinical studies
The study selected152cases according to the general condition of patients, symptoms, signs, physicochemical index and diabetic nephropathy stage were compared and analysed the correlation of TCM types and clinical data、 physicochemical index, diabetic nephropathy stage, as follows:
(1) General data analysis:152cases of patients with diabetic nephropathy,77cases were male,34to81years of age, mean age was64.64±12.56years old, average disease course was11.56±5.38years;75cases were female, aged38years to84years, mean age was63.55±10.94years, average disease course was10.16±6.36months.
(2) The distribution of TCM types:The frequency analysis showed that:Qi-Yin deficiency was the major type,100cases (65.79%), yin deficiency dryness-heat was6cases (3.94%), Qi deficiency of spleen and kidney was24cases (15.79%), yin-yang deficiency was22cases (14.47%), cold-dampness、 Damp-heat、 blood stasis、 Phlegm and blood stasis, respectively was16cases (10.53%)、34cases (22.37%)、8cases (34.21%) and8cases (5.26%). In yin deficiency dryness-heat of the main type, there were2cases was Ⅰ-Ⅱ stage,2cases was Ⅲstage,2cases was Ⅳ stage; In Qi-Yin deficiency, there were16cases was Ⅰ-Ⅱ stage,30cases was Ⅲ stage,54cases was Ⅳ stage; In Qi deficiency of spleen and kidney, there were6cases was Ⅰ-Ⅱ stage,8cases was Ⅲstage,10cases was Ⅳ stage; In yin-yang deficiency, there were4cases was Ⅰ-Ⅱ stage,4cases was Ⅲstage,12cases was Ⅳ stage; In Damp-heat type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively6cases,2cases,8cases. In cold-dampness type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲ stage, and Ⅳstage were respectively0cases,10cases,24cases. In blood stasis type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively4cases,20cases,28cases. In Phlegm and blood stasis type of the concurrently type,Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively2cases,0cases,26cases.
(3) The Clinical syndromes:The frequency analysis showed that:Dry mouth polydipsia and frequent urination symptom in TCM Different Syndromes (including the main and concurrently syndromes) which appear in pairs, there was4cases(2.6%) in yin deficiency dryness-heat; Qi-Yin ficiency were46cases (30.3%), Qi deficiency of spleen and kidney were8cases (5.2%), yin-yang deficiency were8cases (5.2%), cold-dampness. Damp-heat、 blood stasis. Phlegm and blood stasis, respectively was4cases (2.6%)、16cases (10.5%)、8cases (5.26%) and8cases (5.26%).
(4)152cases of patients with diabetic nephropathy:In the main syndromes of all TCM Syndromes, The coronary disease,52cases (34.2%) was the major type, strokes was32cases (21.1%), retina disease was28cases (18.4%), round neuropathy was17cases (11.2%), Samely, In the concurrently type The coronary disease,40cases (26.3%) was also the major type, then the strokes, retina disease, round neuropathy were respectively32cases (21.1%),19cases (12.5%),19cases (12.5%)。
(5) Physicochemical indicators:Physicochemical indicators:The results showed that physicochemical indexes of INS, HbAlc, BMI, RBC, Upro, Ucr, Upro/Ucr, AST, ALB, TG, LDL-C, HDL-C、 FT3, FT4, TSH, CA199, AFP and CEA2in groups of differential TCM types have no difference (P>0.05)。
Physicochemical indicators of a significant difference between groups including fasting blood glucose (FPG), alanine aminotransferase (ALT), serum creatinine (Cr), Cystatin C (Cys-C), serum total cholesterol (CHOL), hemoglobin (HGB) etc. The FPG of Qi deficiency of spleen and kidney type was significantly lower than yin deficiency dryness-heat. Damp-heat and kidney and Qi-Yin deficiency (P<0.05), Phlegm and blood stasis was significantly lower than the other types (P<0.05); The ALT of cold-dampness type was significantly higher than the other types (P<0.05), Yin deficiency dryness-heat and Qi-Yin deficiency higher than the other syndromes (P<0.05), but no cold-dampness type (P<0.05); but the two types have no difference (P>0.05); The CREA of yin-yang deficiency type was significantly higher than yin deficiency dryness-heat and blood stasis (P<0.05), Yin deficiency dryness-hea was significantly lower than Qi-Yin deficiency and blood stasis types (P<0.05); The CREA of blood stasis type was significantly higher than the other syndromes, but no Qi-Yin deficiency and yin-yang deficiency (P<0.05), Qi-Yin deficiency syndromes was significantly lower than Qi deficiency of spleen and kidney and Damp-heat types; The HGB of yin-yang deficiency type was significantly lower than the other syndromes (P<0.05), It has significantly difference between Qi-Yin deficiency and no Phlegm and blood stasis (P<0.05), It has significantly difference between Phlegm and blood stasis and no Qi-Yin deficiency (P<0.05), These results may suggest that TCM types have relevant with FPG、RBC、 HGB、 CHOL、 CREA and Cys-C.
2、 Experimental Study
In the study, The experimental results showed that:The blood and urine TWEAK、 blood IL-β、blood IL-10of yin deficiency dryness-heat of LN patients were significantly higher than the other types (P<0.05), In the main types, The blood and urine TWEAK、blood IL-1β、blood IL-10become lower and lower with the development of TCM types, such as yin deficiency dryness-heat>Qi-Yin deficiency>Qi deficiency of spleen and kidney and yin-yang deficiency, It was same with the development of DN(the normal persons, DN without albumen、 DN with a small amount albumen、 DN with a great amount albumen DN with CRF). Conclusion
1、 It has correlation between clinical symptoms、 complications DN、 stage and TCM syndromes in patients with DN.
2、 It has correlation between the TCM syndromes and FPG、 HGB、 CHOL、 Cr、 Cys-C.
3、 There are some difference of blood and urine TWEAK、 blood IL-β、blood IL-10expressing between normal persons and DN patients, It point out that has correlation between TCM syndromes and secretion expression of these blood、 urine inflammation factors. It has close relationship between Damp-heat type、 yin deficiency dryness-heat and inflammation, we may can use inflammation factors technology to reveal the mechanism of TCM syndromes.
1、观察糖尿病肾病患者中医证候特点。
2、探讨糖尿病肾病患者各中医证型与临床分期及相关理化指标的相关性。
3、观察糖尿病肾病患者炎症指标的变化特征。
4、观察TWEAK在糖尿病肾病中的表达变化,探讨糖尿病肾病、中医证型与炎症之间的关系。
方法
1、临床研究
回顾性分析2012年9月-2013年3月广州中医药大学附属深圳市中医院和宝安区中医院的糖尿病肾病152名,通过建立数据库,整理分析患者的临床证型、理化指标等,并依据2007年中华中医药学会肾病分会制定的《糖尿病肾病诊断、辨证分型及疗效评定标准》和《Mogensen糖尿病肾脏分期标准》,分别对所收集的糖尿病肾病病例进行中医辨证及西医诊断分期,应用SPSS统计软件,分析糖尿病肾病患者中医证型与西医理化指标、临床资料、糖尿病肾病分期的相关性。
2、实验研究
利用酶联免疫吸附剂测定法(ELISA),检测所纳入的120名糖尿病肾病和30名健康组患者的血、尿TWEAK,血IL-1β及血IL-10等相关炎症指标,对比分析各中医证型间各炎症因子浓度差异,分析糖尿病肾病患者血、尿TWEAK,血IL-1β及血IL-10与中医辨证分型的相关性。
结果
1、临床研究
(1)糖尿病分期方面：频数分析结果提示152例糖尿病肾病患者,中医本证包括气阴两虚证最多见100例(65.79%),阴虚燥热证6例(3.94%),脾肾气虚证24例(15.79%),阴阳两虚证22例(14.47%),共152例；标证中湿热证16例(10.53%),寒湿证共34例(22.37%),瘀证共52例(34.21%),痰瘀证共8例(5.26%)。结合糖尿病肾病的西医临床分期：主证中阴虚燥热证Ⅰ-Ⅱ期2例,Ⅲ期2例,Ⅳ期2例；气阴两虚证Ⅰ-Ⅱ期16例,Ⅲ期30例,Ⅳ期54例；脾肾气虚证Ⅰ-Ⅱ期6例,Ⅲ期8例,Ⅳ期10例；阴阳两虚证Ⅰ-Ⅱ期4例,Ⅲ期4例,Ⅳ期12例,V期2例；标证中湿热证Ⅰ-Ⅱ期6例,Ⅲ期2例,Ⅳ期8例；寒湿证Ⅰ-Ⅱ期0例,Ⅲ期10例,Ⅳ期24例；瘀证Ⅰ-Ⅱ期4例,Ⅲ期20例,Ⅳ期28例；痰瘀证Ⅰ-Ⅱ期2例,Ⅲ期0例,Ⅳ期26例。结果提示中医辨证分型与糖尿病肾病分期存在相关性(P<0.05,r=0.522)。
(2)临床分析：在152例DN患者中,口干多饮及小便频数症状在中医多个证型(包括本证及标证)中是成对出现,其中阴虚燥热证4例(2.6%),气阴两虚证46例(30.3%),脾肾气虚证8例(5.2%),阴阳两虚证8例(5.2%),湿热证4例(2.6%),寒湿证16例(10.5%),瘀证8例(5.2%),痰瘀证8例(5.2%),而多食易饥在糖尿病肾病患者当中表现较少,阴虚燥热证2例(1.3%),气阴两虚证4例(2.6%),阴阳两虚证2例(1.3%)。结果提示中医辨证分型与糖尿病主要症状存在相关性(P<0.05,r=0.415)。
(3)并发症分析：在152例DN患者中,中医各个证型本证当中,冠心病(心电图改变)最多见52例(34.2%),然后依次是脑血管意外32例(21.1%),视网膜病变28例(18.4%),周围神经病变17例(11.2%),标证当中仍以冠心病(心电图改变)最多见40例(26.3%),然后依次是脑血管意外32例(21.1%),视网膜病变19例(12.5%),周围神经病变19例(12.5%)。结果提示中医辨证分型与糖尿病肾病并发症存在相关性(P<0.05,r=0.383)。
(4)理化指标分析：本研究结果显示：空腹胰岛素(INS),糖化血红蛋白(HbAlc),体重指数(BMI),尿蛋白(Upro),尿肌酐(Ucr),尿蛋白肌酐比值(Upro/Ucr),红细胞计数(RBC),肝功能(AST、ALB)、血脂(TG、LDL-C、 HDL-C)、甲状腺功能(FT3、FT4、TSH),肿瘤三项(CA199、AFP、CEA2)组各证比较无统计学差异(P>0.05)。
各组间差异显著的理化指标包括空腹血糖(FPG)、谷丙转氨酶(ALT)、血肌酐(Cr)、胱抑素C (Cys-C)、血总胆固醇(CHOL)、血红蛋白(HGB)等。其中,空腹血糖：脾肾气虚证与阴虚燥热证、湿热证、气阴两虚证有统计学差异(P<0.05),痰瘀证与其它各证型之间比较均有统计学差异(P<0.05)；血清谷丙转氨酶：寒湿证组最高,与各证均有统计学差异(P<0.05),阴虚燥热证及气阴两虚证数值也明显增高,与其它各证比较有统计学差异(P<0.05),阴虚燥热证与气阴两虚证比较无统计学差异(P>0.05)；血肌酐：阴阳两虚证明显高于其它组,与阴虚燥热证、瘀证比较有统计学差异(P<0.05),而阴虚燥热证明显低于其它组,与气阴两虚证、瘀证比较有统计学差异(P<0.05)；胱抑素C：阴阳两虚证也明显高于其它组；血总胆固醇：瘀证明显高于其它组,与非气阴两虚证、阴阳两虚证比较有统计学差异(P<0.05),气阴两虚证与脾肾气虚、湿热证比较有统计学差异(P<0.05)；红细胞计数：阴阳两虚证明显低于其它组,组间对比虽然差异无统计学意义,但是降低比较明显；血红蛋白：阴阳两虚证明显低于其它组,且与各证比较有统计学差异(P<0.05),阴虚燥热证明显高于其它组,与各证比较有统计学差异(P<0.05),气阴两虚证与非痰瘀证比较有统计学差异(P<0.05),痰瘀证与非气阴两虚证比较有统计学差异(P<0.05)；上述结果提示中医证型与FPG、 RBC、 HGB、 CHOL、 ALT、 Cr和Cys-C水平可能有关。
2、实验研究
实验结果显示：主证中：血、尿TWEAK,血IL-10浓度水平随中医证型病情进展逐步降低,其中阴虚燥热证组血、尿TWEAK,血IL-I0浓度明显高于其它组,与其它证型对比差异有统计学意义(P<0.05),按浓度排序依次为：阴虚燥热证>气阴两虚证>脾肾气虚证、阴阳两虚证,与健康组和糖尿病肾病病情进展(无蛋白尿组、少量蛋白尿组、大量蛋白尿组、肾功能不全组)表达水平一致；血清IL-1β检测结果提示：与正常对照组和其他证型组比较,湿热证组IL-1β浓度较高,差别具有统计学意义(P<0.05)。
结论
1、结果提示中医辨证分型与糖尿病肾病分期的相关性有统计学意义(P<0.05),具有相关性,说明伴随着患者糖尿病肾病病情加重,中医证型从阴虚燥热→气阴两虚→脾肾气虚→阴阳两虚证发展,中医证型发展也是病情加重的一个反映。中医辨证分型(包括本证和标证)与临床表现及并发症的相关性有统计学意义(P<0.05),我们认为糖尿病“三多一少”症及并发症在糖尿病肾病的中医辨证中可以做为衡量病情严重程度的指标。
2、糖尿病肾病的中医证型与理化指标FPG、HGB、CHOL、CREA和Cys-C差别有统计学意义,存在相关性。
3、各中医证型间的血、尿TWEAK.血IL-1β、血IL-10浓度存在差异,提示中医分型与此类血、尿炎症因子的表达分泌有关。提示湿热证、阴虚燥热证可能与炎症关系密切。利用炎症因子有望对中医证型的发生机制进行阐释。
Objecti ve
1、 To observe the TCM syndromes characteristics in patients with diabetic nephropathy(DN).
2、 To explore the correlation between TCM syndromes、 different stages and physicochemical index in patients with DN.
3、 To observe the change of inflammatory markers in patients with DN.
4、 To observe the expression change of TWEAK in diabetic DN, to explore the relationship between diabetic nephropathy and inflammation
Methods
1、 Clinical studies
We have done retrospective analysis of152patients with DN from Shenzhen TCM Hospital and Baoan District TCM Hospital of Subsidiary TCM University of Guangzhou during2012.09-2013.03. Through the establishment of a database, analysis of DN stages clinical syndromes, physicochemical index. According to the2007China Association of Chinese medicine nephropathy branch had made the 《diabetic nephropathy diagnosis, syndrome differentiation and therapeutic effect evaluation standard》and《Mogensen diabetic kidney staging criteria》, The152patients were carried out TCM syndromes and Western medicine diagnosis staging, and then used SPSS statistical software to analyse the relationship between TCM types and physicochemical index、 DN stages、 clinical data of patients with diabetic nephropathy.
2、 Experimental Study
To study serum、urine inflammatory factors:TWEAK、IL-1β and IL-10by using Experimental study of enzyme linked immunosorbent assay (ELISA) method on120diabetic nephropathy patients and normal persons, and analyses the correlation between patients with diabetic nephropathy and normal human serum and urine concentration and diabetic nephropathy
syndromes of TCM.
Results
1、 Clinical studies
The study selected152cases according to the general condition of patients, symptoms, signs, physicochemical index and diabetic nephropathy stage were compared and analysed the correlation of TCM types and clinical data、 physicochemical index, diabetic nephropathy stage, as follows:
(1) General data analysis:152cases of patients with diabetic nephropathy,77cases were male,34to81years of age, mean age was64.64±12.56years old, average disease course was11.56±5.38years;75cases were female, aged38years to84years, mean age was63.55±10.94years, average disease course was10.16±6.36months.
(2) The distribution of TCM types:The frequency analysis showed that:Qi-Yin deficiency was the major type,100cases (65.79%), yin deficiency dryness-heat was6cases (3.94%), Qi deficiency of spleen and kidney was24cases (15.79%), yin-yang deficiency was22cases (14.47%), cold-dampness、 Damp-heat、 blood stasis、 Phlegm and blood stasis, respectively was16cases (10.53%)、34cases (22.37%)、8cases (34.21%) and8cases (5.26%). In yin deficiency dryness-heat of the main type, there were2cases was Ⅰ-Ⅱ stage,2cases was Ⅲstage,2cases was Ⅳ stage; In Qi-Yin deficiency, there were16cases was Ⅰ-Ⅱ stage,30cases was Ⅲ stage,54cases was Ⅳ stage; In Qi deficiency of spleen and kidney, there were6cases was Ⅰ-Ⅱ stage,8cases was Ⅲstage,10cases was Ⅳ stage; In yin-yang deficiency, there were4cases was Ⅰ-Ⅱ stage,4cases was Ⅲstage,12cases was Ⅳ stage; In Damp-heat type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively6cases,2cases,8cases. In cold-dampness type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲ stage, and Ⅳstage were respectively0cases,10cases,24cases. In blood stasis type of the concurrently type, Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively4cases,20cases,28cases. In Phlegm and blood stasis type of the concurrently type,Ⅰ-Ⅱ stage, Ⅲstage, and Ⅳstage were respectively2cases,0cases,26cases.
(3) The Clinical syndromes:The frequency analysis showed that:Dry mouth polydipsia and frequent urination symptom in TCM Different Syndromes (including the main and concurrently syndromes) which appear in pairs, there was4cases(2.6%) in yin deficiency dryness-heat; Qi-Yin ficiency were46cases (30.3%), Qi deficiency of spleen and kidney were8cases (5.2%), yin-yang deficiency were8cases (5.2%), cold-dampness. Damp-heat、 blood stasis. Phlegm and blood stasis, respectively was4cases (2.6%)、16cases (10.5%)、8cases (5.26%) and8cases (5.26%).
(4)152cases of patients with diabetic nephropathy:In the main syndromes of all TCM Syndromes, The coronary disease,52cases (34.2%) was the major type, strokes was32cases (21.1%), retina disease was28cases (18.4%), round neuropathy was17cases (11.2%), Samely, In the concurrently type The coronary disease,40cases (26.3%) was also the major type, then the strokes, retina disease, round neuropathy were respectively32cases (21.1%),19cases (12.5%),19cases (12.5%)。
(5) Physicochemical indicators:Physicochemical indicators:The results showed that physicochemical indexes of INS, HbAlc, BMI, RBC, Upro, Ucr, Upro/Ucr, AST, ALB, TG, LDL-C, HDL-C、 FT3, FT4, TSH, CA199, AFP and CEA2in groups of differential TCM types have no difference (P>0.05)。
Physicochemical indicators of a significant difference between groups including fasting blood glucose (FPG), alanine aminotransferase (ALT), serum creatinine (Cr), Cystatin C (Cys-C), serum total cholesterol (CHOL), hemoglobin (HGB) etc. The FPG of Qi deficiency of spleen and kidney type was significantly lower than yin deficiency dryness-heat. Damp-heat and kidney and Qi-Yin deficiency (P<0.05), Phlegm and blood stasis was significantly lower than the other types (P<0.05); The ALT of cold-dampness type was significantly higher than the other types (P<0.05), Yin deficiency dryness-heat and Qi-Yin deficiency higher than the other syndromes (P<0.05), but no cold-dampness type (P<0.05); but the two types have no difference (P>0.05); The CREA of yin-yang deficiency type was significantly higher than yin deficiency dryness-heat and blood stasis (P<0.05), Yin deficiency dryness-hea was significantly lower than Qi-Yin deficiency and blood stasis types (P<0.05); The CREA of blood stasis type was significantly higher than the other syndromes, but no Qi-Yin deficiency and yin-yang deficiency (P<0.05), Qi-Yin deficiency syndromes was significantly lower than Qi deficiency of spleen and kidney and Damp-heat types; The HGB of yin-yang deficiency type was significantly lower than the other syndromes (P<0.05), It has significantly difference between Qi-Yin deficiency and no Phlegm and blood stasis (P<0.05), It has significantly difference between Phlegm and blood stasis and no Qi-Yin deficiency (P<0.05), These results may suggest that TCM types have relevant with FPG、RBC、 HGB、 CHOL、 CREA and Cys-C.
2、 Experimental Study
In the study, The experimental results showed that:The blood and urine TWEAK、 blood IL-β、blood IL-10of yin deficiency dryness-heat of LN patients were significantly higher than the other types (P<0.05), In the main types, The blood and urine TWEAK、blood IL-1β、blood IL-10become lower and lower with the development of TCM types, such as yin deficiency dryness-heat>Qi-Yin deficiency>Qi deficiency of spleen and kidney and yin-yang deficiency, It was same with the development of DN(the normal persons, DN without albumen、 DN with a small amount albumen、 DN with a great amount albumen DN with CRF). Conclusion
1、 It has correlation between clinical symptoms、 complications DN、 stage and TCM syndromes in patients with DN.
2、 It has correlation between the TCM syndromes and FPG、 HGB、 CHOL、 Cr、 Cys-C.
3、 There are some difference of blood and urine TWEAK、 blood IL-β、blood IL-10expressing between normal persons and DN patients, It point out that has correlation between TCM syndromes and secretion expression of these blood、 urine inflammation factors. It has close relationship between Damp-heat type、 yin deficiency dryness-heat and inflammation, we may can use inflammation factors technology to reveal the mechanism of TCM syndromes.
引文
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