| ObjectivesThe paper aims to study the differences through the examination of four liver fibrosis indicators between the hemodialysis and non-dialysis group of patients who were diagnosed as chronic kidney disease stage5with primary glomerulonephritis, and were recognized as renal fibrosis of qi deficiency and blood stasis. To assess wheather the liver fibrosis indicators could be used as non-invasive renal fibrosis detection indicators.Use the metabolomics research technology of liquid chromatography mass spectrometry (LC-MS) to find out the potential biomarkers in blood of the patients with CKD stage5of the non-dialysis, and of the maintenance hemodialysis with primary glomerulonephritis. Secondly explore the probable differences between hemodialysis and non-dialysis patients of metabolomics, who were identified as chronic renal fibrosis with qi deficiency and blood stasis syndrome. And then search for its related biomarkers (group). Attempt to use the metabolomics technology to explore the essence, that is to say its related biomarkers or group of chronic kidney disease (CKD) stage5of chronic glomerulonephritis renal fibrosis combined with qi deficiency and blood stasis syndrome. Meanwhile, establish an objective and quantitative scientific expressive system of renal fibrosis QDBS of the TCM syndromes, and try to explore material basis of the "card" mentioned above in metabolomics.MethodsChose the patients from Guangdong provincial hospital of TCM during July of2012to March of2013, who were diagnosed as chronic kidney disease stage5with primary glomerulonephritis and renal fibrosis qi deficiency and blood stasis syndrome,30cases of non-dialysis as observation group, and32cases of maintenance hemodialysis group, and selected30cases of healthy controls in our hospital medical examination center. Analyzed statistically the differences of liver fibrosis indicators and the syndromes of QDBS in different groups. Firstly collected their blood and separated it to get blood plasma to do metabolomics research. And then used LC-MS to do metabolomics detection. First of all used the analyt software to collect data and get metabolic fingerprint contour map then through MarkerView software (version1.2, AB SCIEX) to analysis metabolomics data. So we can get all the quantitative information of the marker in each sample, next imported the data into SIMCA-P11.5software separately through unsupervised and supervised analysis methods, using principal component analysis and partial least squares discriminant analysis, and got contributions that different markers have to the sample clustering. At last from the perspective of clinical significance, identified different compounds between groups. The key procedure is to apply TOF using the exact mass of the compounds to search on HMDB, KEGG, Pubmed database et. al, where we can identify the possible potential marker, analysis the structure and function of potential biomarkers, combining with biological significance, and interpreted the potential biomarkers from mechanism, diagnose, treatment of the diseases.Result1. The four liver fibrosis indicators of CKD stage five primary glomerulonephritis QDBS syndrome hemodialysis group are higher than in the non-dialysis group, the difference was statistically significant; between the two groups of patients with QDBS symptom severity score, average score of hemodialysis group is slightly higher, with P=0.657>0.05, which means the difference was not statistically significant.2. The metabolomics potential biomarkers of CKD stage5with renal fibrosis QDBS in hemodialysis group, the lipids, inflammatory substances are much more compared with healthy group, whereas in hemodialysis group the substances mentioned above are the least, compared to the healthy group, with most of the differences statistically significant. Non-dialysis group of amino acids (lysyl leucine), carnitine substances than healthy people is significantly reduced, the difference was statistically significant. In the hemodialysis group, content of the substances mentioned above are the highest, and significantly different from the healthy group. Conclusion1. Patients diagnosed as CKD stage five primary glomerulonephritis, with renal fibrosis QDBS were divided into two groups, the hemodialysis group and non-dialysis group. We found that Four Liver Fibrosis Indicators in hemodialysis group were higher than the other.2. After hemodialysis, the acid-base disbalance, electrolyte metabolism disorders et al are corrected in the CKD5patients, which can’t change the nature of renal fibrosis and QDBS, and in hemodialysis patients with symptoms of QDBS therefore highlighter as water-dampness complexion is cleared. Such result gives us tips that clinically using Yiqihuoxue medication to improve hemodialysis patients symptoms of QDBS could be effective.3. Patients with CKD5with primary glomerular nephritis, renal fibrosis QDBS hemodialysis, blood metabolite profiles in non-dialysis and health among the three groups have significant difference. Lipids, inflammatory substances of non-dialysis patients are more than in healthy group; significant reduction in non-dialysis patients with amino acids, carnitine and other energy substances less than healthy people.4. The metabolomics result shows that CKD5patients with lipids abnormal, indicating that we can use drug or chinese herbal to adjust the lipid level. Whereas amino acid and energy materials is reduced that we can supply amino acid and carnitine to promot qi. |
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