Clinical Study On The Correlation Between Internal Heat Syndrome And MHR And NLR In Stage Ⅲ-Ⅴ Diabetic Nephropath

Diabetic kidney disease(DKD)is one of the most common microvascular complications of type 2 diabetes mellitus.It is one of the main causes of end-stage renal disease,which not only endangers public health,but also seriously affects the social and economic development in China.Traditional Chinese Medicine(TCM)has unique advantages in treating and delaying the progression of DKD.TCM practitioners have different understandings of the etiology and pathogenesis of DKD.Although most of them still take Yin deficiency as the main framework for syndrome differentiation,based on modern clinical observation and laboratory research,many TCM nephropathy experts have proposed that "internal heat" is one of the key pathological factors in the occurrence and development of DKD,and it has similarities with the inflammatory state of DKD.This has positive guiding significance for the clinical treatment and delaying of DKD based on the perspective of inflammatory mechanism.The ratio of peripheral blood monocyte count to high-density lipoprotein cholesterol concentration(MHR)and peripheral blood neutrophil count to lymphocyte count(NLR)are potential indicators of systemic inflammation,which change significantly in the event of kidney inflammation and may be of some value in the judgment of the disease progression of DKD.Objective:To observe the correlation of internal heat syndrome and MHR and NLR in patients with DKD.Methods:The 173 patients with DKD were included according to the inclusion criteria,their general data,medical history data,laboratory indicators and TCM syndrome data were collected.The correlation of MHR and NLR with internal heat syndrome and renal function was analyzed using the SPSS 26.0 statistical software package,and the factors influencing MHR,NLR and glomerular filtration rate estimates were analyzed.Results:(1)Internal heat syndrome is one of the main syndrome types of stage Ⅲ-Ⅴ DKD.Internal heat syndrome accounted for 42.9%of stage Ⅲ,38.2%of stage Ⅳ,37.1%of stage Ⅴ.(2)MHR and NLR increase gradually with the progression of DKD(p<0.01),NLR was positively correlated with BUN,Scr,SUA,and 24hUTP(r=0.410,p<0.01;r=0.433,p<0.01;r=0.143,p<0.01;r=0.301,p<0.01),NLR was negativly associated with eGFR(r=-0.440,p<0.01),MHR and NLR are the influencing factors with a negative correlation on eGFR(OR(95%Cl)=-35.698(-64.708-(-6.688)),p<0.05;OR(95%CI)=-5.561(-9.778-(-1.345)),p<0.05).(3)The MHR and NLR were higher in the internal heat syndrome group(p<0.01).Internal heat syndrome showed a positive correlation with MHR and NLR(r=0.584,p<0.01;r=0.347,p<0.01).Intermal heat syndrom is a influencing factor with a positive correlation on MHR and NLR(95%CI=0.225(0.172-0.279),p<0.01;OR(95%CI)=1.387(0.787-1.988),p<0.01).Conclusion:Internal heat syndrome is an important syndrome of DKD.It occupies an important position in stage Ⅲ-Ⅴ DKD.It may be one of the key pathological factors to promote the progression of DKD.MHR and NLR are associated with reduced renal function,which may become new indicators of inflammation of DKD,which may be of certain value in clinical judgment of the progression of DKD.Internal heat syndrome is related to the increase of MHR and NLR,indicating that the internal heat syndrome of DKD coincides with the state of inflammation.From the perspective of clinical inflammation of DKD,it provides a basis for treating and delaying the progression of DKD from the perspective of heat.