Study On The Relationship Between Cystatin C And Diabetic Nephropathy With Syndrome Differentiation Of TCM

Objective:1.To explore the the intrinsic link between CysC and syndrome differentiation of TCM in DN patients,which may be provide some reference for syndrome differentiation of DN,Which provided theoretical basis and clinical proofs for the combination treatment of DN by TCM and Western Medicine.2.To explore the value of serum CysC in the early diagnosis of Diabetic Nephropathy.Methods:According to the diabetes diagnostic criteria of type2diabetes, the inclusion criteria and exclusion criteria, the study selected87patients hospitalized in the Endocrinology of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from June2012to February2013.We calculated the glomerular filtration rate of the patients, and in accordance with the CKD stages in 《Clinical practice guidelines for chronic kidney disease and dialysis》(K/DOQI)written by the Organization of the American Kidney Foundation (NKF)in2002for staging.We collected the general information of the patient’s at the time of admission, the determination of serum CysC (CysC), serum creatinine (SCr), urinary albumin (m-Alb), urine creatinine (Urine creatinine), glycosylated hemoglobin (HbAlc),and calculated the urinary albumin/urine creatinine (UACR).According to symptoms,signs,coating on the tongue and pulse,we divided87DN patients into yin asthenia and dryness-heat group,Yin deficiency of liver and kidney,qi-yin deficiency group,qi deficiency of spleen and kidney group, yang deficiency of spleen and kidney group.Researched the relationship between the TCM Syndromes and serum CysC. Carried ROC analysis,calculated their area under the curve and compared the sensitivity and specificity of CysC,UACR and Um-Alb for early diagnosis of diabetic nephropathy.We carried ROC analysis,calculated their area under the curve and compared the diagnostic value of CysC UACR and Um-Alb for early diagnosis of diabetic nephropathy.Results:1.The distribution characteristics of the principal syndrome in87case of patients with DKD were as follows:10cases of yin asthenia and dryness-heat group,accounting for11%;12cases of Yin deficiency of liver and kidney.accounting for14%;36cases of qi-yin deficiency group,accounting for42%;13cases of qi deficiency of spleen and kidney group, accounting for15%;16cases of yang deficiency of spleen and kidney group,accounting for18%.2.Comparing the ages of each TCM Principal syndromes,yang deficiency of spleen and kidney syndrome in DKD patients was the highest;Yin deficiency of liver and kidney syndrome was the lowest.The difference of pairwise comparison between the groups was statistically significant (P<0.05).Comparing the course of disease of each TCM principal syndromes,yang deficiency of spleen and kidney syndrome in DKD patients was the longest;Followed by qi deficiency of spleen and kidney syndrome.The shortest course of disease was the Yin deficiency of liver and kidney group.3.Comparing the TCM symptoms with Serum CysC levels,the highest level of Serum CysC was yang deficiency of spleen and kidney syndrome group, the lowest level of Serum CysC was Yin deficiency of liver and kidney group. The difference of pairwise comparison between the groups was statistically significant (P<0.05).4.Comparing the area under the curve of receiver-operating characteric curve of CysC,Urinary micro albumin and urinary albumin-to-creatinine ratio was CysC> Urinary micro albumin>urinary albumin-to-creatinine ratio.5.There was a significant correlation between CysC and diabetic nephropathy CKD staging, UACR staging. And the the difference of serum CysC level in each staging was statistically significant (P<0.05).6.there is no correlation between the level of serum CysC and gender (P=0.256), and in terms of gender, the difference was not statistically significant (P>0.05).7.There were positive linear correlation between serum CysC and SCr, BUN, UA, alphal-MG (P<0.05). There were not exist linear correlation between serum CysC and the duration, BMI, HbAlc.(P>0.05). Conclusion: 1.Along with the increase of the extension of the course and growth of the age,the principal syndrome types developed from yin asthenia and dryness-heat syndrome to Yin deficiency of liver and kidney syndrome and to qi deficiency of spleen and kidney syndrome and to qi-yin deficiency and to yang deficiency of spleen and kidney syndrome.Then we could infer that the evolution of TCM syndrome types was:yin deficiency—qi deficiency—qi-yin deficiency—yang deficiency.2.Along with the rising of serum CysC levels,the principal syndrome types developed from Yin deficiency of liver and kidney syndrome and yin asthenia and dryness-heat syndrome to qi-yin deficiency and to yang deficiency of spleen and kidney syndrome, the CysC level or could be used as a reference indicator of the TCM Syndrome Types.3.The CysC level was not influenced by age, gender, body mass index or glycosylated hemoglobin levels.4.There was linear regression correlation between serum CysC level with UACR, SCr, Um-Alb.This study also showed that, CysC together with Um-Alb and UACR could be used to evaluate the level of kidney function. The CysC level was influenced by glomerular filtration rate, and could better reflect the level of glomerular filtration rate.5.Serum CysC level or could be used to assess the DN stage and UACR installments.6.The Serum CysC level together with Um-Alb and UACR could be used to detect early kidney damage, which is a sensitive indicator that can early reflect glomerular damage, there was some reference value to the occurrence and development and prognosis of DN. The diagnostic value of early diagnosis and accuracy of DN of serum CysC level was higher than Um-Alb, UACR.