The Effect Of Yishen Jiangtang Decoction On Serum HIF-1α And TNF-α For Treatment Of Stage Ⅳ Diabetic Nephropathy Patients With Deficiency Of Qi And Yin With Blood-Stasis Syndrome

Purpose:This paper tries to investigate the effect of Yishen Jiangtang Decoction on the serum HIF-la and TNF-a of diabetic nephropathy patients in stage IV with deficiency of Qi and Yin with blood stasis syndrome, and to analysis the relationship between the expression of HIF-la, TNF-a and diabetic nephropathy. Thereby, we can further explore the possible mechanism of the treatment of diabetic nephropathy with Yishen Jiangtang Decoction.Methods:The 60 diabetic nephropathy patients in stage IV with deficiency of Qi and Yin with blood stasis syndrome were randomly divided into experimental group and control group, 30 cases in each group. According to the international Diabetes Federation in 2005 released< diabetes nephropathy treatment guidelines> in type II diabetes global guidelines of kidney injury in the treatment of DKD scheme. The control group were treated with basic western medicine foundation treatment. The patients of experimental group, on the basis of basic treatment, were given traditional Chinese medicine Yishen Jiangtang Decoction,15ml each time,2 times a day. The course of treatment was 60 days. The data of serum HIF-1α、serum TNF-α、blood glucose、blood lipid、renal function、urinary albumin excretion rate (UAER) and other indicators before and after the experiments were collected and analyzed. And the change of the symptom integral was observed. At the same time,20 healthy persons were selected as healthy group. SPSS13.0 was used to conduct the stastic analyses of the curative effects of Yishen Jiangtang Decoction on diabetic nephropathy patients in stage IV with deficiency of Qi and Yin with blood stasis syndrome.Results:1.60 patients diagnosed with diabetic nephropathy have been included in the study. (30 cases in treatment group,30 cases in control group). The gender, age, course of disease, body mass index(BMI) and other baseline datas of the two groups were not significantly different from those before the treatment (P>0.05).2. After the treatment, the serum levels of HIF-la, TNF-a, TC, LDL,UAER and symptom integral were significantly decreased in the two groups. And the treatment groupwas significantly lower than the control group, there were significant differences between the two groups (P<0.05).3. Bivariate analysis:the serum HIF-la and TNF-a were positively correlated (P<0.01), and both were positively correlated with HbAlc and UAER (P<0.01). Partial correlation analysis:when the fixed variable was TNF-a, the levels of serum HIF-la and UAER were positively correlated with HbAlc (all P<0.01). And when the fixed variable was HIF-la, the serum TNF-a and UAER were positively correlated with HbAlc(all P<0.01).4. The serum levels of HIF-la and TNF-a in DKD group were significantly higher than that in healthy group, and the difference was statistically significant (P<0.01).5. The total effective rate of the two groups of TCM syndromes was 83.3% and 63.3%, respectively. And there was statistical difference between the two groups (P<0.05).6. The total effective rate of the two groups of clinical total curative effect was 86.6% and 53.3%, respectively. Comparatively speaking, the treatment group was better than the control group, with significant difference (P<0.01). So Yishen Jiangtang Decoction combined with western medicine foundation treatment of DKD is superior to that of simple western medicine.Conclusion:1. DKD patients with high expression of serum HIF-1α, suggesting that chronic renal hypoxia is one of the mechanisms that lead to DKD renal injury.2. DKD patients’levels of serum HIF-la and TNF-a are closely related. The higher the level of HIF-la expression, the higher the expression of TNF-a. It is speculated that there may be a "inflammation-inflammatory mediators-HIF-1α-inflammatory mediators-inflammation" in the process of DKD development. And the HIF-1α play an important role in the amplification of inflammation, so it is very important to inhibit the expression of HIF-la in DKD.3. Yishen Jiangtang Decoction can reduce the level of serum HIF-la and TNF-a in DKD patients. It may be considered that it can protect renal function by inhibiting the inflammatory reaction and improving the renal tissue hypoxia.4. Yishen Jiangtang decoction can significantly improve the clinical efficacy of diabetic nephropathy patients with deficiency of Qi and Yin with blood stasis syndrome. It is conducive to promote the rehabilitation of the patients, improve the quality of their life. And it is worthy of further popularization and Application.