| Objective: To observe the changes of clinical symptoms and related indexes of renal function in patients with early DKD treated with Cong Gui Yi Shen capsule,and evaluate the clinical efficacy of cistanche guiyi kidney capsule in treating DKD.And through animal experimental research,To observe the effects of Cong Gui Yi Shen Capsule on expression of intracellular adhesion molecule-1(ICAM-1)and renal tissue B-lymphoblastoma-2(Bcl-2),Bax,and Cystein-dependent aspartate specfic programed(Caspase-3)of early DKD model rats,To explore the mechanism of early DKD treatment by Cong Gui Yi Shen Capsule and provide new laboratory basis for Traditional Chinese Medicine treatment of DKD.Methods: 1.clinical research:From June 2017 to June 2018,60 patients with early diabetic kidney disease were selected from the outpatient and inpatient departments of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.They were divided into two groups according to the principle of randomized control.In each of the 30 cases in the treatment group and the control group,the control group was given Losartan Potassium(100mg qd).The treatment group added Cistanche Guiyi kidney capsules(0.4g/pill,4 pills at a time,Tid)on the basis of the control group.At the same time,the two groups of patients were instructed to actively control diet and exercise and other diabetes health education.The total treatment is 24 weeks.In addition to recording basic information such as age,gender,etc.,two groups of renal deficiency blood stasis traditional chinese medicine syndromes,fasting plasma glucose(FPG),hemoglobin A1c(Hb A1c),Blood ulrea nitrogen(BUN),serum creatmne(Scr),urine micro-albumin(m ALB)must be calculated before and after treatment.Changes in indicators such as intercellular adhesion molecule-1(ICAM-1).Objective to evaluate the clinical efficacy of cistanche guiyenan capsule in the treatment of early diabetic nephropathy.2.Animal experiments:65 healthy SD rats,after 1 week of normal breeding,were randomly selected as blank groups and continued to be fed with ordinary feed.The remaining 55 were fed with high-fat feed for the experimental group.After 4 weeks of feeding,the abdominal cavity was injected with STZ to establish a model of type 2 diabetic kidney disease(DKD)(4 deaths in 3 days and 6 deaths in the later period),and 42 rats that successfully molded were given high-fat feed.Feeding,according to the principle of random distribution,they were divided into 10 rats in the western medicine group,10 in the high-dose group of CGYSC capsule,There were 9 rats in the low dose group and 8 rats in the model group.Each group was given intragastric administration of different doses and drugs for 12 weeks.Observe the expression of FPG,Hb A1 c,BUN,Scr,ICAM-1,Bcl-2,Bax,Caspase-3 proteins.Results: 1 Clinical Study: 1.1 After 8 weeks of treatment,the total effective rate of the treatment group and the control group was 79.3% and 56.3%.The treatment group was significantly better than the control group,and the difference was statistically significant(P<0.05).1.2 Before treatment,there was no significant difference in TCM syndrome scores between the two groups(P>0.05).After 6 months of treatment,TCM syndrome scores in the treatment group decreased,There was statistically significant difference(P<0.05).In the control group,the syndrome score was lower than before,but there was no statistical significance(P>0.05).And the treatment group was significantly better than the control group(P<0.05).1.3 FPG,2h PG and Hb A1c: FPG、2h PG and Hb A1 c in the two groups were lower than that before treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the FPG level in the treatment group was lower than that in the control group,and the difference was statistically significant(P<0.05).Compared with the control group,2h PG and Hb A1 c in the treatment group were lower than those in the control group,but the difference was not statistically significant(P>0.05).1.4 Scr,BUN,m ALB and ACR: Before treatment,there was no significant difference in Scr,BUN,m ALB and ACR between the two groups(P>0.05).After treatment,Scr,BUN,m ALB and ACR in the treatment group and the control group were significantly lower than before,There was statistically significant difference(P<0.05).Compared with the control group,Scr,BUN,m ALB and ACR were significantly decreased in the treatment group(P<0.05).1.5 serum ICAM-1: Before treatment,there was no significant difference in serum ICAM-1 between the two groups(P>0.05).After treatment,serum ICAM-1 in both the treatment group and the control group was lower than that before treatment,with statistically significant difference(P<0.05).Compared with the control group,serum ICAM-1 in the treatment group was significantly lower,with statistically significant difference(P<0.05).2 Animal experiments: 2.1 changes in general conditions of rats: in the experiment,the blank group of rats had smooth hair color,good mental state,flexible movement,plump muscles,increased food intake,formed feces and normal urine volume.The rats in the model group were obviously polydipsia,polyphagia,polyuria,listlessness,yellowishness of hair,tiredness,lying and lazy movement,pale and wet tail and wet feces.After 5 weeks of STZ injection,a few rats gradually developed DM complications,such as abdominal mass,deafness,cataract and ulcer.The mental state of the rats improved after administration,and their water and food intake were better than those of the model group.2.2 weight of rats:Before treatment,compared with the blank group,the weight of rats in the other groups was significantly lower(P<0.05);after treatment,compared with the model group,the weight of rats in the western medicine group and the low-dose group of traditional Chinese medicine was significantly higher(P<0.05);the weight of rats in the high-dose group of traditional Chinese medicine was significantly higher than that in the model group(P<0.01),indicating that the high-dose Chinese medicine can improve the wasting symptoms of DKD.2.3 BUN and Scr of rats:Compared with the blank group,BUN and Scr of both model group and drug group were increased(P<0.05).Compared with the model group,the high dose group of traditional Chinese medicine and the western medicine group were significantly lower,and the difference was statistically significant(P<0.05).BUN and Scr decreased in low dose groups(P>0.05).2.4 influence on the 24 h urinary protein level of DKD rats: Compared with the blank group,the amount of urine protein in the model group and the treatment group was significantly increased at 24h(P<0.01).After 12 weeks of treatment,compared with the model group,the amount of urine protein in the western medicine group and the traditional Chinese medicine group at 24 h was significantly reduced(P<0.05).Compared with the western medicine group,there was no significant difference in the amount of urine protein in the high-dose group(P>0.05).There were significant differences in the amount of urine protein in the low dose groups(P<0.05).2.5 influence on serum ICAM-1 level of DKD rats:Compared with the blank group,the serum ICAM-1 level of DKD rats in the model group and each treatment group was significantly increased(P<0.05).Compared with the model group,the ICAM-1 level in the medium dose and low dose groups of traditional Chinese medicine decreased,but there was no statistical significance(P>0.05).Serum ICAM-1 level was significantly decreased in the western medicine group and the high-dose Chinese medicine group(P<0.05).2.6 pathological morphology of the rat kidney(HE staining): the renal structure of the blank group was basically normal,with intact basement membrane,no hyperplasia or fibrosis,clear capillary cavity and good openness.Inflammatory cell infiltration is rare in the renal stroma.There is no edema in the renal tubular epithelium.The renal tissue of model group showed obvious hypertrophy of glomeruli,slightly thickened basement membrane,obvious hyperplasia of mesangial area,and obvious narrowing of capillary lumen.The renal tubular epithelium is turbid and even necrotic,with erythematous granules in the cytoplasm,partial vacuolar degeneration,and mild interstitial fibrosis,and inflammatory cell infiltration in the renal interstitium.Compared with the model group,renal tubular epithelial cells in the treatment groups also showed degeneration and turbidity and swelling by HE staining,but inflammatory cell infiltration was significantly reduced.2.7 expression of Bcl-2,Bax and caspase-3 proteins in renal tissues(Western blot): Compared with the blank group,model group and treatment group Bax,Caspase-3 protein expression increased significantly,while the expressions of Bcl-2 protein were significantly decreased,with statistically significant differences(P<0.01).Compared with the model group,the expressions of Bax and caspase-3 protein in each group were significantly decreased,while the expression of Bcl-2 protein was increased(P<0.05).Compared with the western medicine group,the expression of Bcl-2 protein was significantly increased in the CGYSC(high)group,and the expression of Bax and caspase-3 protein was decreased,with statistically significant differences(P<0.05).Compared with western medicine group,there was no significant difference in the expression of Bcl-2,Bax and caspase-3 in CGYSC(low)group(P<0.05).Conclusions: 1 Cong Gui Yishen Capsule can improve the spleen and kidney syndromes in DKD patients,reduce FPG,Hb A1 c,and reduce BUN,Scr,m ALB,and improve the patient’s renal function.,so as to protect the patient’s kidney tissue.2 Cong Gui Yishen Capsule can promote cell apoptosis by reducing of Bax and Caspase-3 protein level,increase the level of the Bcl-2 protein of inhibiting cell apoptosis thereby reducing renal apoptosis and achieving the effect of protecting the kidneys. |
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