Winter With The Capsule In Treating Type 2 Diabetes And Early Kidney Disease Clinical And Experimental Research

Diabetic nephropathy is increasing with the increase of incidence rate of type 2 diabetes,and is one the main death causes of diabetes. So, effective treatment of diabetic nephropathyis a medical problem to be solved. This article summarizes the cognition and general situationof diabetic nephropathy of traditional and modern medicine. This article not only discussesname, cause, pathomechanism and treatment of diabetic nephropathy of traditional Chinesemedicine, but involves diagnosis, mechanism and treatment of modern medicine. This articlesummarizes that the early pathomechanism of this disease is Yin vacuity dryness-heataccording to professor Gaopu clinical experiences and the therapeutic method is to nourishyin and clear heat for type 2 diabetes and early nephropathy. Due to long course of diseasesand long-term decoction, it is to distill raw herbs to make Donglian capsule. This articlediscusses the curative effect and mechanism of Donglian capsule treating type 2 diabetes andearly nephropathy.PartⅠClinical researchObjectives: To investigate the curative effect of Donglian capsule treating Yin vacuitydryness-heat type 2 diabetes and early nephropathy. Methods: 106 patients who were chosenaccording to certain criterion are randomly divided into two groups, i.e. treatment group andcontrol. Each group includes 53 patients. In treatment group, patients are given Dongliancapsules and basic treatment. By contrast, in control, patients are given metforminhydrochloride enteric-coated tablets and basic treatment. To observe the security and thechange of blood sugar, glycated hemoglobin, urinary albumin excretion rate, renal function,blood lipids and hemorheological parameters, etc. Results: There are 96 patients at last instatistics. Treatment group includes 49 patients and control includes 47 patients. Totaleffective rate is 53．06% in treatment group and42．55% in control. But there is no distinctstatistic difference between two groups (P>0．05) . Treatment group is better than control inrelieving symptoms and there is difference between two groups (P<0．05) . In both groups, theindexes of fasting plasma glucose(FPG), postchallenge plasma glucose (PPG) and glycated hemoglobin decrease. By contrast, control is better than treatment group (P<0．05) . Intreatment group, urinary albumin excretion rate(UAER), 24h urinary protein quantitative,creatinine, triglycerides, cholesterol and low density lipoprotein(LDL) are less than beforetreatment, UAER, creatinine and triglycerides are better than control(P<0．05,P<0．01) . Inboth groups, The whole blood viscosity (in high, middle and low shear), plasma viscosity areless than before treatment (P<0．01) . But there is distinct difference between two groups. Theindex of security has no difference between before and after treatment (P>0．05) . Conclusions:The effect is clear of Donglian capsule treating type 2 diabetes and early nephropathy.Donglian capsule can obviously relieve symptoms, lower blood sugar urine minim albuminand 24h urinary protein quantitative, inhibit nonenzymatic glucosylation of protein,ameliorate renal function, modulate blood lipid and blood rheologic change. Especially inrelieving symptoms, urine minim albumin, renal function, treatment group is better thancontrol. Donglian capsule is safe in clinics and has no side effects.PartⅡExperiment researchPurpose: To investigate the effect and mechanism of Donglian capsule treating ratsdiabetes model with early nephropathy induced with high fat diet and injected celiac STZ.Methods: In this experiment, 50 Rats are randomly divided into two groups: They are controlgroup , model group. Rats of model group are injected small celiac STZ and are bred withhigh fat diet to make diabetes model. Rats are randomly divided into four groups. They aremodel group ,western medicine group, large dose Donglian capsule group and small doseDonglian capsule group. In control group, rats are normally bred and were given the samequantitive water. In model group, rats are bred with high fat diet and were also given the samequantitive water. In western medicine group, rats are bred with high fat diet and were givenmetformin hydrochloride enteric-coated tablets 0．18g/Kg. Large dose Donglian capsule groupare bred with high fat diet and were given Donglian capsule 6．75g/Kg. Small dose Dongliancapsule group are bred with high fat diet and were given Donglian capsule 1．35g/Kg. In allgroups, rats are given one time a day for 12 weeks. It is to test many indexes in blood andkidney tissue. They includes body weight, renal weight and its index, urine minim albumin, blood sugar, renal function and liver function, hs-CRP, blood lipid, TGF-β1, collagenⅣ, IL-6,TNF-αand pathological observations of kidney(both in light microscope and electronmicroscope). Results: In model rats, body weight decreases and renal weight and its indexincrease. Large Donglian capsule and metformin can obviously low renal weight and its index,and better than model group(P<0．05,P<0．01) . In model rats, such indices as urine minimalbumin, blood sugar, hs-CRP, GPT, BUN, Cr, CHO,TG,HDL-C, TGF-β1, collagenⅣ, IL-6and TNF-αall increase. Large Donglian capsule and metformin can lower the level of urineminim albumin, GPT, BUN, Cr, CHO, TG, TGF-β1, collagenⅣ, IL-6 and TNF-α.. In theseaspects, there is significant difference from model group(P<0．05, P<0．01) . Pathologicalchanges become better in Large Donglian capsule and metformin groups, especially in LargeDonglian capsule group. Conclusions: Donglian capsule can lower blood sugar, GSP,microalbuminuria, BUN and creatinine, ameliorate the disturbance of lipid metabolism andrenal pathological change. The mechanism is correlative with the decrease of TGFβ1,ⅣC,inflammatory factors and inhibition of extracellular matrix accumulation.