The Study Of Advanced Oxidation Protein Products In Patients With Diabetic Nephropathy By Methods Of Invigorating The Spleen And Kidney, Promoting Blood Circulation

ObjectiveTo research the advanced oxidation protein product(AOPP), exploring its relationship with advanced glycation end products(AGE), superoxide dismutase(SOD), high-sensitivity C-reactive protein(hsCRP), leukocytes interleukin-6(IL-6), N-acetyl-β-D-glucosaminidase(NAG) and lipids(tot-al cholesterol, TC, triglycerides, TG, high-density lipoprotein HDL, low-density lipoprotein HDL, low-density lipoprotein LDL) in patients with diabetic nephropathy, and the clinical significance of the Chinese medicine by methods of invigorating the spleen and kidney, promoting blood circulation.MethodsTo select 60 cases of patients with diabetic nephropathy in the urology department, Clifford Hospital of Guangzhou University of Chinese Medicine from September 2013 to September 2014. In accordance with internationally harmonized diagnostic criteria (Mogensen diagnostic staging criteria) and serum creatinine, they are divided into early diabetic nephropathy group (DN1 group) 22 cases:UAER sustained 20-200μg/min; clinical diabetic nephropathy group (DN2 group) 18 cases:UAER>200μg/min; end-stage diabetic nephropathy group (DN3 group) 20 cases:UAER>200μg/min and Cr>445μmol/L, and the other to select 15 healthy control group (NC) from physical examination of inpatient or outpatient. DN1, DN2, DN3 group use Chinese herbs to invigorate the spleen and kidney, promoting blood circulation on Treatment 4 weeks. The healthy group aren’t taken any treatment. To investigate the level of AOPP, AGE, SOD, hsCRP, IL-6, lipids (triglycerides, TG, total cholesterol, TC, high-density lipoprotein HDL, low-density lipo-protein HDL, low-density lipoprotein LDL), NAG in patients with diabetic nephropathy before and after the treatment, the same as the healthy group before treatment.Results(1) With the increase in UAER, the serum AOPP levels gradually increase among the groups were statistically significant(P<0.05). The levels of AOPP, AGE, hsCRP, IL-6, LDL in DN1 group are higher than the healthy control group(P <0.05). The level of SOD in DN1 is lower than the healthy control group(P <0.05). The levels of AOPP, AGE, hsCRP, IL-6, LDL in DN2 group are higher than DN1 group(P<0.05). The level of SOD in DN2 is lower than DN1 group(P<0.05). The levels of AOPP, AGE, hsCRP, IL-6, LDL in DN3 group are higher than DN2 group(P <0.05). The level of SOD in DN3 is lower than DN2 group(P<0.05). The levels of AOPP, AGE, hsCRP, IL-6, LDL in DN2 group are significantly higher than the healthy control group(P<0.01). The level of SOD in DN2 is significantly lower than the healthy control group (P<0.01). The levels of AOPP, AGE, hsCRP, IL-6, LDL in DN3 group are significantly higher than the healthy control group and DN1 group(P<0.01).The level of SOD in DN3 is significantly lower than the healthy control group and DN1 group (P<0.01). The level of NAG in DN1, DN2, DN3 group is significantly higher than the healthy control group(P<0.01). The levels of TG, TC, HDL in DN1, DN2, DN3 group show no significant difference with the healthy control group(P>0.05).(2) Serum AOPP and AGE, SOD, hsCRP, IL-6, TG, LDL, NAG are positive correlations between the two (AOPP and AGE is a positive correlation r=0.898, P <0.01;AOPP and SOD is a negative correlation r=-O.746, P<0.01;AOPP and hsCRP is a positive correlation r=0.803, P<0.01;AOPP and IL-6 is a positive correlation r=0.855, P<0.01;serum AOPP and TG is a positive correlation r =0.522, P<0.01;serum AOPP and LDL is a positive correlation r=0.782, P <0.01; serum AOPP and NAG is a positive correlation r=0.716, P<0.01). The serum AOPP, AGE, SOD, hsCRP, IL-6 are positive correlations with UAER(AOPP and UAER is a positive correlation r=0.847, P<0.01;AGE and UAER is a positive correlation r=0.826, P<0.01;SOD and UAER is a negative correlation r=-0.693, P <0.01;hsCRP and UAER is a positive correlation r=0.851, P<0.01;IL-6 is a positive correlation with UAER r=0.851, P<0.01). AOPP and TC, HDL have no correlation (P>0.05).(3) The level of serum SCr, BUN in DN1、DN2、DN3 group have significant differences after 4 weeks of treatment with before treatment(P<0.01); The level of serum AOPP, AGE, SOD in DN1、DN2、DN3 group have significant differences after 4 weeks of treatment with before treatment (P<0.01). The level of hsCRP, IL-6 in DN1 group after four weeks of treatment have significant differences before treatment (P<0.01). The level of hsCRP, IL-6 in DN2、DN3 group after four weeks of treatment have differences before treatment (P<0.05). The level of TG、LDL in DN1、DN2、DN3 group after treatment are decreased compared before, and have differences before treatment (P<0.05). The level of NAG in DN1 and DN2 group decreases after the treatment (P<0.05), whereas there is no significant change in the level of NAG in DN3 group after the treatment.Conclusion(1) The oxidative stress in DN patients is played an important role in the development of DN. Oxidative stress and micro-inflammatory state is closely related in DN patients. The serum AOPP may become an early predictor of joint detection in diabetic nephropathy of microvascular disease. With UAER to investigate together, it is helpful to diagnosis DN early. It is important to forbid protein oxidative damage and further strengthen cause of renal failure deterioration factors.(2) TCM against oxidative stress, lipid disorders, further delaying renal tubular damage and other effects are more effective by methods of invigorating the spleen and kidney, promoting blood circulation, in order to protect the function of kidney. TCM treatment has obvious advantages and clinical significances in preventing and treating DN.