| Part 1 Literature reviewSearching and reviewing relevant literatures on diabetic nephropathy at home and abroad in the past 10 years,understanding the pathogenesis,staging,diagnosis and treatment of diabetic nephropathy in modern medicine,as well as the etiology,pathogenesis,syndrome characteristics and special prescriptions of diabetic nephropathy in traditional Chinese medicine.The knowledge of specialty drugs,so as to have a comprehensive understanding of diabetic nephropathy.Part 2 Characteristics of syndromes in stage Ⅲ and Ⅳ of diabetic nephropathyObjectFor 100 patients with stage Ⅲ-Ⅳ diabetic nephropathy,statistical analysis of their general data,laboratory examinations and TCM syndromes was carried out to explore the characteristics of stage Ⅲ-Ⅳ syndromes of diabetic nephropathy,and lay the foundation for future clinical medication.MethodsThe source of the cases were patients who were hospitalized in the endocrinology ward of Guang’anmen Hospital from January 2018 to December 2020.According to their clinical diagnosis,100 patients with stage Ⅲ-Ⅳ diabetic nephropathy were selected,targeting their gender,age,course of diabetes,and course of diabetic nephropathy.,Blood pressure,fasting blood glucose,postprandial blood glucose,glycosylated hemoglobin,creatinine,urea,urine microalbumin,urine microalbumin-creatinine ratio,24-hour urine protein quantification,triglycerides,cholesterol,low-density lipoprotein,high-density lipoprotein And the corresponding symptoms are studied,and the syndrome characteristics of patients with diabetic nephropathy stage Ⅲ-Ⅳ are analyzed.ResultsA total of 100 patients were collected in this study,including 60 males(60.0%)and 40 females(40.0%);a total of 75 patients with stage Ⅲ,including 48 males(64.0%)and 27 females(36.0%)There are 25 patients with stage Ⅳ,including 12 males(48.0%)and 13 females(52.0%).There was no significant difference in gender composition between the two groups.Among the 100 patients collected in this study,the oldest was 79 years old and the youngest was 37 years old;there were 75 patients in the stage Ⅲ patient group,of which the oldest was 79 years old and the youngest was 37 years old;there were 25 patients in stage Ⅳ,of which The oldest is 79 years old and the youngest is 42 years old.The ages of patients with stage Ⅲ and stage Ⅳ are concentrated in the two age groups of 45-64 and over 64 years old.In this study,the course of DM in patients with stage Ⅲ diabetic nephropathy was 9.42±6.60 years,and the course of DM in patients with stage Ⅳ diabetic nephropathy was 13.21±7.15 years,which was statistically significant.This study found that the ratio of total cholesterol and urine microalbumin to creatinine in diabetic nephropathy stage Ⅲ and stage Ⅳ are statistically different,and both stage Ⅳ are higher than stage Ⅲ.Shortness of breath and laziness are the most common symptoms of diabetic nephropathy stage Ⅲ and Ⅳ.Fatigue,fatigue,frequent urination foam,heart palpitations,spontaneous sweating and other Qi deficiency syndromes occur frequently between the two groups,and the difference is not significant.The more frequent tongues in stage Ⅲ and Ⅳ of diabetic nephropathy are:dark purple tongue with ecchymosis,dark tongue,and pale tongue;in the third stage of diabetic nephropathy,the more frequent tongue textures are:dark purple tongue with ecchymosis,dark tongue,Pale tongue;The most frequent appearance of tongue quality in stage Ⅳ of diabetic nephropathy is:dark purple tongue with ecchymosis,dark tongue,and pale tongue.The most frequent tongue coatings in diabetic nephropathy stage Ⅲ and Ⅳ are:thin coating,less fur,and white and greasy coating;diabetic nephropathy stage Ⅲ has more tongue coatings:thin and white coating,less coating,and white and greasy coating;diabetic nephropathy stage Ⅳ The most frequent appearance of the tongue is as follows:thin and white fur,white and greasy fur,and less fur.The more frequent pulse conditions in diabetic nephropathy stage Ⅲ and Ⅳ are:astringent pulse,slippery pulse,and pulse string;the more frequent pulse conditions in diabetic nephropathy stage Ⅲ are:astringent pulse,slippery pulse,and pulse string;diabetic nephropathy appears in stage Ⅳ The most frequent pulse conditions are:astringent pulse,slippery pulse string,and pulse string.in conclusionThe incidence of diabetic nephropathy stage Ⅲ and stage Ⅳ is the same between men and women.Patients with diabetic nephropathy stage Ⅲ and stage Ⅳ diabetic nephropathy are concentrated in the middle-aged and elderly people.With the prolongation of the course of diabetes,the disorder of glucose and lipid metabolism in patients worsens,and the renal function damage is aggravated.In this clinical work,for patients with diabetic nephropathy,laboratory indicators such as total cholesterol,urine microalbumin and creatinine ratio should be monitored regularly for early detection and early treatment to prevent disease progression.Qi deficiency and blood stasis syndrome is the main type of diabetic nephropathy in stage Ⅲ and stage Ⅳ.It can be divided into heart qi deficiency,lung qi deficiency,spleen qi deficiency,kidney qi deficiency,heart and lung qi deficiency,heart spleen qi deficiency,heart and kidney qi deficiency,lung spleen qi deficiency,lung and kidney qi deficiency Qi deficiency,spleen and kidney deficiency with blood stasis syndrome.Among them,the urinary microalbumin-creatinine ratio of the syndrome of deficiency of kidney qi with blood stasis is higher,which is significantly greater than that of syndrome of deficiency of lung qi with blood stasis.The kidney is responsible for storing essence,which is the foundation of sealing.If the kidney qi is weak or not solid,the kidney will lose its sealing and the fine substances will leak out.In patients with heart and kidney qi deficiency and blood stasis,the level of creatinine was significantly higher than those with lung and spleen qi deficiency and blood stasis.Kidney stores essence and metabolizes kidney qi can promote the regulation of visceral qi,heart and kidney interaction,mental interaction,peace of the monarch,heart and kidney qi deficiency,weak qi,metabolism disorder of qi,blood,essence,body fluid,and endogenous turbidity.Increased creatinine.The most common syndrome of diabetic nephropathy stage Ⅲ and Ⅳ is deficiency of both qi and yin and blood stasis.The treatment is based on the method of replenishing qi,nourishing yin and promoting blood circulation.ConclusionThe incidence of diabetic nephropathy stage Ⅲ and stage Ⅳ is the same between men and women.Patients with diabetic nephropathy stage Ⅲ and stage Ⅳ diabetic nephropathy are concentrated in the middle-aged and elderly people.With the prolongation of the course of diabetes,the disorder of glucose and lipid metabolism in patients worsens,and the renal function damage is aggravated.In this clinical work,for patients with diabetic nephropathy,laboratory indicators such as total cholesterol,urine microalbumin and creatinine ratio should be monitored regularly for early detection and early treatment to prevent disease progression.Qi deficiency and blood stasis syndrome is the main type of diabetic nephropathy in stage Ⅲ and stage Ⅳ.It can be divided into heart qi deficiency,lung qi deficiency,spleen qi deficiency,kidney qi deficiency,heart and lung qi deficiency,heart spleen qi deficiency,heart and kidney qi deficiency,lung spleen qi deficiency,lung and kidney qi deficiency Qi deficiency,spleen and kidney deficiency with blood stasis syndrome.Among them,the urinary microalbumin-creatinine ratio of the syndrome of deficiency of kidney qi with blood stasis is higher,which is significantly greater than that of syndrome of deficiency of lung qi with blood stasis.The kidney is responsible for storing essence,which is the foundation of sealing.If the kidney qi is weak or not solid,the kidney will lose its sealing and the fine substances will leak out.In patients with heart and kidney qi deficiency and blood stasis,the level of creatinine was significantly higher than those with lung and spleen qi deficiency and blood stasis.Kidney stores essence and metabolizes kidney qi can promote the regulation of visceral qi,heart and kidney interaction,mental interaction,peace of the monarch,heart and kidney qi deficiency,weak qi,metabolism disorder of qi,blood,essence,body fluid,and endogenous turbidity.Increased creatinine.Part 4 Study on the Network Pharmacological Mechanism of YiqiHuoxue RecipeObjectTo explore the mechanism of action of YiqiHuoxueRecipe(Astragalus,white bass,chuanxiong,almond,burdock seed)in the treatment of DKD,and provide theoretical support for guiding clinical yellow.MethodsObtain the active ingredients of YiqiHuoxue Recipe from the traditional Chinese medicine systems pharmacology database and analysis platform(TCMSP)and the traditional Chinese medicine integrated database(TCMID).Obtain effective targets of YiqiHuoxue Recipe through Swiss TargetPredition,herbal ingredients targets database(HIT),and collect DKD therapeutic targets from therapeutic target database(TTD),DrugBank,and DisGeNet After mapping the disease and the drug target,the"Yiqihuoxuefang-DKD Common Target Data Set" is obtained,which is imported into the String(Version 11.0)database to obtain the potential eight-point relationship,and the "combined-score(Comprehensive score)≥0.9" as the screening criteria,import the selected information into Cytoscape 3.2.1 software,construct a protein-protein interaction(PPI)network,use Network Analyzer to analyze the network topology,and use "Dggree(degree of freedom)≥2 Double median,Closeness centrality(closeness centrality)≥median,Betweeness centrality(between number)≥ median"as the standard,the key targets are screened,and the "Yiqihuoxue Fang-Key Target-DKD" is constructed.The network is visualized according to the degree value.Import the key target information into the DAVID database,and perform gene ontology(GO)analysis and KEGG pathway enrichment analysis.Excel 2007 and omicshare tools were used to draw GO analysis bar chart and KEGG pathway enrichment analysis bubble chart respectively.ResultsA total of 5 active ingredients of YiqiHuoxue Recipe were retrieved through the database and platform.The potential active ingredients obtained from the TXMSP database were screened according to the criteria of "DL≥0.18" and "OB≥30%",and a total of 54 The active ingredients meet the screening criteria,including 20 active ingredients from Astragalus,7 active ingredients from Ligusticum chuanxiong,19 active ingredients from bitter almonds,8 active ingredients from burdock seeds,and 10 active ingredients were found through TCMID database and verified by SwissADME..196 targets of Astragalus,28 targets of Ligusticum chuanxiong,70 targets of bitter almonds,99 targets of Arctium burdock were obtained through TCMSP and Uniprot database,and 466 targets of white silkworm were predicted by SwissTargetPrediction database.A total of 124 eligible targets for stage III and IV diabetic nephropathy were obtained from DrugBank,DisGeNet,and GeneCards.After mapping the targets of YiqiHuoxue Recipe and the targets of stage III and IV diabetic nephropathy,124 potential common targets are obtained;124 potential target points are imported into String,and "combindscore">0.9 is updated and screened,and node 45 is obtained.149 pairs of target interaction relationship.The target results obtained from String are analyzed by Network Analyzer using Cytoscape,and the results are in line with "Degree" greater than or equal to the median(6),"BetweennessCentrality" greater than or equal to the median(0.007815),and "ClosenessCentrality" greater than or equal to the median(0.447917)There are 19 key targets for screening standard YiqiHuoxue Decoction in the treatment of early and mid-stage diabetic nephropathy.In this study,KEGG enrichment analysis was performed on 19 key targets of YiqiHuoxue Decoction in the treatment of early and mid-stage diabetic nephropathy.A total of 81 pathways were enriched,and 64 pathways were significant(P<0.01).GO enrichment analysis was performed on 19 key targets of YiqiHuoxue Recipe in the treatment of early and mid-stage diabetic nephropathy.After screening,53 meaningful(P<0.01)biological process results,6 cytological component results,molecular biology There are 11 learning function results.ConclusionYiqiHuoxue Recipe works through the synergistic effect of multiple medicines,multiple targets,and multiple pathways.YiqiHuoxue Recipe may act on targets such as STAT3 and PIK3CA.At the same time,its multi-link and multi-channel mechanism of action may be related to NF signaling pathway,Toll-like receptor signaling pathway,and HIF-1 signaling pathway to regulate human inflammation.,Related cell apoptosis and the activity of related cytokines.Part 4 The innovations,shortcomings and prospects of this researchDiabetic nephropathy is one of the common diabetic microvascular complications.Its onset is hidden,there is no obvious manifestation in the early stage,and it is irreversible to the late stage.It is the main cause of end-stage renal disease and death.Western medicine currently has no specific drugs to treat it.treatment.Exploring the characteristics of the symptoms of diabetic nephropathy stage Ⅲ andⅣ is of great significance for the early diagnosis of diabetic nephropathy and effectⅣe treatment as soon as possible.YiqiHuoxue Recipe is an empirical prescription created by Professor Ni Qing for the pathogenesis of qi deficiency and blood stasis in diabetic nephropathy stage Ⅲ-Ⅳ.It has been practiced for many years and the effect is remarkable.However,the ingredients of YiqiHuoxue Recipe are diverse,the process of action in the body is complicated,and the mechanism of action still lacks systematic research.In recent years,the development of network pharmacology has enabled the use of public databases,network visualization,network analysis and prediction methods to predict drug mechanisms,which is of great significance for clinical drug research.Due to the limited conditions in this study,the number of studied cases is small,and the characteristics of other syndromes of diabetic nephropathy need to be further studied. |
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