Treatment And Mechanism Research Of Shenqi Dihuang Combined With Danggui Shaoyao Decoction On Early Dibetic Kidney Disease

Object:To observe the clinical efficacy and safety of Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction in the treatment of early diabetic kidney disease(Qi and Yin deficiency mixed with blood stasis type),and to explore its mechanism of action via network pharmacology.Methods:Sixty patients diagnosed with early DKD and with the clinical stage of microalbuminuria(A2)and the syndrome differentiation of Qi and Yin deficiency and blood stasis are collected from the department of Nephropathy in the First Affliated Hospital of Heilongjiang University of Chinese Medicine.According to random number table method,30 cases were divided into experimental group and control group,respectively.Based on routine treatment and lifestyle intervention,the experimental group was given Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction orally,and the control group was given Bailing capsule orally.The course of treatment was 8 weeks.The TCM syndrome scores of the two groups were observed before and after treatment.urinary albumin-to-creatine ratio(UACR),estimated glomerular filtration rate(eGFR),glycated hemoglobin(HbA1c),fasting plasma glucose(FPG),and blood lipid,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)etc.The results of the trial were analyzed,and a network pharmacology approach was applied to screen the pharmacological basis and potential targets through the "data collection-network analysis" method via TCMSP,GeneCards,OMIM,TTD,DrugBank database,building protein-protein interaction internet via STRING,GO and KEGG pathway analysis to preliminarily explore the mechanism of DKD treatment with Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction.Results:1.The post-treatment results of the TCM syndrome scores of both groups were lower than those before treatment in the same group(P<0.05),and the trial group had a better reduction in syndrome scores than the control group(P<0.01).2.The clinical efficacy rate of the trial group was better than that of the control group(P>0.05),and the efficacy rate of the TCM symptoms of the test group was better than that of the control group(P<0.05).3.The UACR was lower in both groups after treatment than before treatment in the same group(P<0.01),and the level of UACR reduction after treatment was better in the trial group than in the control group(P<0.01)4.The FPG,HbAlc,TC and TG levels in the trial and control groups were lower after treatment than before treatment in the same group(P<0.05),and the HbAlc levels in the trial group improved better than those in the control group after treatment(P<0.05).5.The NLR and PLR levels were lower in the test group after treatment than before treatment in the same group(P<0.01),and the NLR and PLR levels were lower in the test group than in the control group(P<0.01).6.During treatment,there were no obvious adverse reactions between the trial group and control group,and no significant differences in renal function and liver function indexes(P>0.05).7.A total of 84 active ingredients,14,639 DKD disease targets,198 drug target-disease target intersections,and quercetin,kaempferol,luteolin,isoflavones,and stigmasterol are the active substance bases of Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction for the treatment of DKD.Targets for intervention in DKD include MAPK1,HSP90AA1,RELA,AKT1,etc.Possible pathways are regulation of AGE-RAGE,IL-17,TNF signaling pathway,etc.Conclusions:1.Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction can ameliorate the symptoms in patients with early diabetic nephropathy(Qi-Yin deficiency with blood stasis type).2.Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction can ameliorate UACR,NLR,PLR,FPG,and HbAlc levels in patients with early diabetic nephropathy,and may delay disease progression in patients.3.After network pharmacological analysis,it was tentatively suggested that the targets of Shenqi Dihuang Decoction combined with Danggui Shaoyao Decoction to interfere with DKD may be based on MAPK1,HSP90AA1,RELA,AKT1 and other targets to regulate AGE-RAGE,IL-17,TNF signaling pathways,which are associated with advanced glycosylation end products,inflammatory factors,reactive oxygen species generation,and hypoxic adaptation,etc.