Effect Of Triptergium Wilfordii Polyglucoside On Level Of Serum TGF-β1, BMP7and Gremlin In Patients With Diabetic Nephropathy

Background and Purpose Diabetic nephropathy （DN） has become commondiseases endangering public health，tubular location in nephron and reabsorption decidethat tubular is vulnerable to be impacted fromdirect and indirect pathogenic factors.Tubular interstitial severity is important factors that determine the kidney survival, itsaffection even more important than the degree of glomerular lesions, so in recent years,tubulointerstitial damage was given widespread attention in the pathogenesis of DN.Inflammation, proteinuria and the expression of multiple cytokines involved intubulointerstitial pathological changes in DN. Transforming growth factor-β1(TGF-β1) is important fibrogenic factor, Bone morphogenetic protein-7(BMP-7) is antifibroticfactor by antagonistic TGF-β1, Gremlin is endogenous antagonist of BMP-7. It isimportant mechanism of renal fibrosis of BMP-7and Gremlin imbalance. This study isto observe the change of level of TGF-β1, BMP-7and Gremlin in patients with DNand the effects of tripterygium wilfordii polyglucosides (TW), learn more about themechanism of renal interstitial fibrosis in DN, and to explore TW prevention andtreatment of tubulointerstitial fibrosis and clinical medicine security.Methods53patients with the type2diabetic nephropathy on the basis of control bloodglucose were randomly divided into TW treatment group (60mg/d, n=28) andbenazepril treatment group (20mg/d, n=25). The changes of24hours urinary protein,NAG and serum TGF-β1, BMP-7, Gremlin were observed in patients with type2diabetic nephropathy respectively before the experiment and4weeks,12weeks,24 weeks. During follow-up adverse events was recorded.Results The level of serum TGF-β1, Gremlin was elevated and BMP-7decreased inDN than that in normal control group. Serum TGF-β1was negatively correlated toeGRF (r=0.216, p <0.05), but positively correlated to HbAlc (r=0.528, p <0.01) and24h urinary protein (r=0.851, p <0.01). The level of serum Gremlin was positivelycorrelated to TGF-β1(r=0.938, P <0.01) and HbAlc (r=0.629, P <0.01). The level ofserum BMP-7was negatively correlated to Gremlin (r=0.918, P <0.01) and24hurinary protein (r=-0.887, P <0.01). The level of urinary NAG and serum TGF-β1were significantly decreased and serum BMP-7was increased compared with baselinelevels in benazepril group. The level of urinary NAG follow-up decline significantly inTW group than benazepril group, but other index was no significantly reduced. Theincidence of adverse reactions was no significant difference between the two groups.Conclusion TW can improve tubular injury and reduce the urinary protein excretionand the concentrations of TGF-β1and Gremlin in serum, but increases the level ofserum BMP-7in patients with DN. Possible mechanism is that TW can inhibitinflammation and immune, protection podocytes, reduce urinary protein, improve renaltubular injury, inhibit the expression of TGF-β1and Gremlin, raise the expression ofBMP-7.