Retrospective Analysis Of TCM Diagnosis And Treatment Characteristics And Prognostic Factors In Patients With Stage Ⅲ Type 2 Diabetic Nephropath

Objective:Through screening the medical records of patients with stage Ⅲ diabetic kidney disease in wards,statistical analysis of their general data,laboratory indices,TCM symptoms and medication,to explore the characteristics of symptoms,prognostic factors and TCM medication to provide reference for clinical treatment.It also explores the active ingredients and possible mechanisms of action of the core Chinese herbal combinations for the treatment by means of network pharmacology and bioinformatics analysis.Methods:to screen the electronic medical record information of patients who were hospitalized at Xiyuan Hospital from January 2017 to August 2022 and had their blood creatinine and UACR retested,to explore the possible prognostic impact on patients’conditions using ROC curve analysis and survival analysis,and to collect information on oral TCM prescriptions of those who improved during the single hospitalization retest,to explore the pattern of TCM and to obtain core TCM combinations.The active ingredients and their targets of action of the core TCM combinations were retrieved using the TCMSP database,and the target genes of DKD were retrieved using the Gene Cards,OMIM and DrugBank databases,and the two were intersected to obtain information on the targets of the core TCM combinations acting on diseases.Using STRING database to construct protein interaction networks,using Cytoscape software for cluster analysis to construct sub network functional groups,screening hub genes,and conducting GO function and KEGG pathway enrichment analysis.Screen core target genes based on the degree value,and use Autodock software to perform molecular docking on the main active ingredient core target genes.Results:The median NLR in the good prognosis group was 2.16 and the median NLR in the poor prognosis group was 2.77,with a statistically significant difference in NLR levels between the two groups.The best cut-off value of 2.38 for NLR by ROC curve analysis divided the patients into 2 groups and Kaplan-Meier survival analysis found a significant difference in the cumulative good prognosis rate between the 2 groups.Multi-factor Cox regression analysis found a statistically significant effect of patient NLR level on time to outcome event(HR=1.378,95%CI=1.099-1.728,P=0.006);and a statistically significant effect of patient blood uric acid level on time to outcome event(HR=1.009,95%CI=1.004-1.014,P<0.001).Among patients whose UACR improved during a single hospitalisation,those with high NLR levels showed a greater decrease in UACR and there was a correlation between the degree of UACR decrease and the degree of decrease in the patient’s blood uric acid.Dry mouth,fatigue,blurred vision,numbness in the limbs,foamy urine,dizziness and poor sleep were common symptoms in patients.Tongue and pulse are mostly manifested as dark red tongue,yellow and greasy fur,and stringy and slippery pulse.Syndrome types are mostly qi yin deficiency,phlegm stasis syndrome,endoretention of damp heat,lung stomach heat excess,yin deficiency and fire excess.The TCM medicines used in patients with good short-term prognosis were mostly distributed in the four categories of transporting the heart and kidney,cooling the blood and invigorating the blood,drying dampness and resolving phlegm,and nourishing yin and generating fluid,with the core herbal combinations being:Coptis chinensis,Cinnamon,dark plum,Red Peony and Poria.Network pharmacology and bioinformatics analysis show that the core herbal combination acts on key genes such as AKT1,CASP3,CXCL8,IL1B,IL6,etc.The main active ingredients include quercetin,β-sitosterol,dousterol and kaempferol,which act on the disease through multiple pathways such as response to lipopolysaccharide,cytokine activity,AGE-RAGE signaling pathway,etc.Molecular docking has found that active ingredients bind stably to multi target proteins.Conclusion:High NLR and blood uric acid levels are risk factors for poor prognosis in patients with stage Ⅲ DKD and may be a new indicator for prognostic assessment of the condition.The patient’s symptoms are often accompanied by insomnia,which can interact with the condition.The syndrome features include deficiency of qi and yin,fire heat,phlegm dampness,and blood stasis.The core TCM combinations are:Coptis chinensis,Cinnamon,dark plum,Red Peony and Poria.It can act on stage Ⅲ DKD through multi-component,multi-target and multi-pathway.