| Objective To explore the influence of tripterygium wilfordii on urine podocyte injury and the mechanism in patients with diabetic kidney disease (DKD).Methods 40 patients were collected from the patients who were hospitalized in Endocrinology Department and Urology Department in the affiliated Hospital of Medical College of Qingdao University from November 2009 to April 2010. All the patients had normal serum creatinine, serum creatinine<126μmol/L, and their 24-hour urinary microalbuminuria was above 300mg. The patients were divided into 4 groups randomly. The 4 groups were control group (DN group), positive control group (DI group), treatment group (DT group) and combined treatment group (DTI group). Blood glucose, blood pressure was controlled, and other supported therapies were actively given to patients in DN group. Other groups were given the same treatment to DN group, in addition,1 mg/(kg-d) tripterygium wilfordii was given to patients in DT group, and Irbesartan Tablets was given to patients in DI group with the dosage of 150mg/d. The patients in DTI group were given 1 mg/(kg-d) tripterygium wilfordii and 150mg/d Irbesartan Tablets. The course of the treatment was 12 weeks in all patients. Monitor the serum creatinine, usea nitrogen, liver function, blood sugar, blood fat, blood routine examination and 24-hour urinary protein of all the patients after 12 weeks. Detect the podocytes in urine sediments by indirect immunofluorescence before and after their treatment. Detect the concentration of connective tissue growth factor (CTGF), transfer growth factor betal-1 (TGF-β1), osteopontin (OPN), bone morphogenetic proteins 7 (BMP-7) in urine by enzyme-linked immunosorbent assay (ELISA).Results The number of podocyte in all patients decreased after our treatment(P< 0.01). Comparing with DN group, the number of podocytes in other groups was much fewer (P<0.05 to DT and DI group, P<0.01 to DTI group). Comparison among DT, DI, and DTI groups was no statistical significant (P>0.05). The concentration of CTGF, TGF-β1, and OPN in urine in all patients decreased after our treatment(the CTGF concentration in urine in DN group decreased after our treatment than before,P<0.05; the difference among other groups was statistical significant, P<0.01). Comparing with DN group after our treatment, the concentration of CTGF, TGF-β1, and OPN in urine in all patients after our treatment decreased prominently (P<0.05 to DI group; P<0.01 to other groups). Comparing with DI group after our treatment, the concentration of CTGF, TGF-β1, and OPN in urine in DT, DTI group decreased(P<0.05, P<0.01); and DTI group decreased prominently than DT group(P<0.05). The concentration of BMP-7 in urine in all patients increased after our treatment (P<0.01); Comparing with DN group after our treatment, the concentration of BMP-7 in urine in all patients after our treatment increased prominently (P<0.05 to DI group; P<0.01 to other groups). Comparing with DI group after our treatment, the concentration of BMP-7 in urine in DT, DTI group increased(P<0.05, P<0.01); and DTI group increased prominently than DT group(P< 0.05).Conclusions Tripterygium wilfordii can reduce the injury of podocytes in kidney by inhibiting macrophage infiltration, inhibiting inflammatory reaction and suppressing the kidney fibrosis. The effect of podocytes protection is remarkable when using tripterygium wilfordii combined with Irbesartan Tablets. |
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