Study On Yiqi Tongluo Prescription Combined With Dapagliflozin Tablets In The Treatment Of Early Diabetic Nephropathy With Qi And Yin Deficiency

Objective : To observe the clinical efficacy and safety of Yiqi Tongluo decoction combined with dapagliflozin tablets in the treatment of early diabetic nephropathy(DN)with deficiency of both qi and yin,and to explore the clinical efficacy and safety of Yiqi Tongluo decoction combined with dapagliflozin tablets in patients with early DN with deficiency of both qi and yin.At the same time,by studying the action pathway of Yiqi Tongluo Decoction combined with Dapagliflozin Tablets on early DN patients with Qi and Yin deficiency,the potential molecular mechanism of renal protection was explained,which provided a scientific basis for the treatment of early DN with Qi and Yin deficiency.Methods : A total of 90 patients with early DN admitted to Yulin Hospital of Traditional Chinese Medicine were selected and diagnosed as qi and yin deficiency syndrome.The time of admission was from March 2022 to December 2022.According to the random number table method,they were randomly divided into control group(dapagliflozin tablet group),experimental group 1(Yiqi Tongluo recipe group)and experimental group 2(Yiqi Tongluo recipe combined with dapagliflozin tablet group),30 cases in each group.The general clinical data of the patients were statistically analyzed.The therapeutic effect,TCM syndrome score evaluation,diabetes index,renal function index,inflammation index and oxidative stress index before and after 12 weeks of treatment were compared and analyzed,and the safety was evaluated.To study the action pathway of Yiqi Tongluo Recipe combined with Dapagliflozin Tablets on early DN patients with Qi and Yin deficiency,and to explain the potential molecular mechanism of renal protection of Yiqi Tongluo Recipe combined with Dapagliflozin Tablets.Results :1.Clinical efficacy : After treatment,the total effective rate of the experimental group 2 was 86.68 %,which was significantly better than that of the control group 30 % and the experimental group 1 63.33 %(P < 0.05).2.Changes in TCM syndrome scores : Before treatment,the total scores of TCM syndromes in the three groups were similar(P > 0.05).After treatment,the total scores of TCM symptoms in the three groups were lower than those before treatment(P < 0.05).After treatment,the total score of TCM symptoms in the experimental group 2 was lower than that in the control group and the experimental group 1,and the difference was statistically significant(P < 0.05).3.Changes in diabetes indicators : Before treatment,the levels of FBG,GLU2,Hb A1 c and LDL-C in the three groups were similar(P > 0.05).The levels of FBG,GLU2,Hb A1 c and LDL-C in the three groups were lower than those before treatment(P < 0.05).After treatment,FBG,GLU2,Hb A1 c and LDL-C in the experimental group 2 were significantly lower than those in the control group and the experimental group 1(P < 0.05).4.Changes in renal function indicators : Before treatment,the levels of Cr,UA and MALB / Ucr in the three groups were similar(P > 0.05).The levels of Cr,UA and MALB / Ucr in the three groups were lower than those before treatment(P < 0.05).After treatment,Cr,UA and MALB / Ucr in the experimental group 2 were significantly lower than those in the control group and the experimental group 1(P < 0.05).5.Changes in inflammatory indicators : Before treatment,the levels of TNF-α and CRP in the three groups were similar(P > 0.05).The levels of TNF-α and CRP in the three groups were lower than those before treatment(P < 0.05).After treatment,the levels of TNF-α and CRP in experimental group 2 were significantly lower than those in control group and experimental group 1(P < 0.05).6.Changes in oxidative stress indicators : Before treatment,the SOD levels of the three groups were similar(P > 0.05).The SOD levels of the three groups were lower than those before treatment(P < 0.05).After treatment,SOD in the experimental group 2 was significantly lower than that in the control group and the experimental group 1(P < 0.05).7.Changes in mechanism-related indicators : Before treatment,the levels of mechanism indicators in the three groups were similar(P > 0.05).After treatment,the INS and HOMA-IR values in the experimental group 2 were significantly lower than those in the control group and the experimental group1(P < 0.05).The level of IGF-1 in the experimental group 2 was significantly lower than that in the control group and the experimental group 1,while the level of VEGF was significantly higher than that in the control group and the experimental group 1(P < 0.05).The level of PTX-3 in the experimental group 2 was significantly higher than that in the control group and the experimental group 1(P < 0.05).The levels of BAX and BCL-2 in the experimental group 2 were significantly lower than those in the control group and the experimental group 1(P < 0.05).The levels of TGF-β1,p38 MAPK and Caspase-3 m RNA in experimental group 2 were significantly lower than those in control group and experimental group 1(P < 0.05).8.Safety of the three groups of patients : During the treatment of the three groups of patients,no obvious adverse reactions occurred.Conclusion : Yiqi Tongluo Decoction combined with Dapagliflozin Tablets has a significant clinical effect in the treatment of early DN with deficiency of both qi and yin,which can significantly reduce blood glucose level and improve renal function.Its mechanism may be related to the maintenance of normal glucose and lipid metabolism,inhibition of inflammatory response,oxidative stress,TGF-β 1 / p38 MAPK signaling pathway and other mechanisms.