Therapeutic Effication Of Yangyin Huoxue Recipe On Lupus Nephritis And Its Effect On Serum Levels Of MMP-9, TIMP-1and MMP-9/TIMP-1

Background:Systemic lupus erythematosus(SLE)is a multifactorial participatory systemic autoimmune disease.Lupus nephritis(lupus nephritis,LN)is its most common complication,but also is the most common secondary glomerulonephritis of China.Chinese medicine treatment of LN plays a unique role in improving symptoms and efficacy,easing the disease,reducing the side effects of Western medicine treatment,et cetera.Extracellular matrix(ECM)hyperplasia is a pathological feature of many glomerulonephritis.The abnormal expression of ECM degradation system,matrixmetalloproteinase-9(MMP-9)and its endogenous specific inhibitor,tissue inhibitor matrixmetalloproteinases-1(TIMP-1),may be involved in renal inflammation and extracellular matrix hyperplasia.MMP-9/TIMP-1 system dysfunction may be the cause of the progress of LN.Objective:Assess the clinical effication of Yangyin Huoxue Recipe(Rhododendron,Cortex Moutan,Red Peony,Scrophulariaceae,Artemisia annua,Salvia,Chuanxiong,Sanqi,Madder,Hedyotis diffusa,Duchesnea,Scutellaria barbata)on patients with lupus nephritis.And discuss the influence of Yangyin Huoxue Recipe on the levels of MMP-9,TIMP-1 and MMP-9/TIMP-1.Methods:1.Forty-four patients from the first affiliated hospital of Soochow University with lupus nephritis were enrolled from August 2015 to August 2016 in this study.All the patients were divided into two groups: the Western medicine(WM)group(n=22)and the integrated traditional Chinese Medicine and Western Medicine(TCM-WM)group(n=22).And 10 healthy controls were given.The WM group was treated with basic treatment and hormone therapy.The TCM-WM group was treated with Yangyin HuoxueRecipe on the basis of Western medicine treatment;2.To evaluate the clinical effication of Yangyin Huoxue Recipe on patients with LN,we observed the changes of clinical indicators in the two groups before and after treatment.The laboratory inspection indexes were white blood cell count(WBC),hemoglobin(HB),platelet count(PLT),serumcreatinine(SCr),urea nitrogen(BUN),24-hour urine protein(24 h U-pro),erythrocyte sedimentation rate(ESR),complement 3(C3),immunoglobulin G(IgG),as well as the Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)-2000 index;3.We detected the changes of serum MMP-9,TIMP-1and MMP-9/TIMP-1 in the healthy control group,the WM group and the TCM-WM group by enzyme-linked immunosorbent assay(ABC-ELISA).MMP-9,TIMP-1,MMP-9/TIMP-1 in the healthy control group were compared with those of the WM group and TCM-WM group before and after treatment.MMP-9,TIMP-1 and MMP-9/TIMP-1 in the WM group were compared with those of WM-TCM group before and after treatment.And we investigated the significance of MMP-9,TIMP-1 and MMP-9/TIMP-1 in the patients with LN and the effication of Yangyin Huoxue Recipe on the levels of serum MMP-9,TIMP-1,and MMP-9/TIMP-1 of the patients with LN.Results:1.There were no significant differences in WBC,HB,PLT,SCr,BUN,24 h U-pro,ESR,C3,IgG and SLEDAI index between the two groups before and after treatment(P>0.05).The levels of SCr,BUN,24 h U-pro,ESR,IgG and SLEDAI index were significantly decreased in both groups after treatment;the levels of WBC,HB,PLT and C3 were significantly increased compared with those before treatment(P<0.01).After treatment,the levels of HB,PLT and C3 in the TCM-WM group were significantly higher than those in the WM group(P<0.01).After treatment,the levels of BUN,24 h U-pro,ESR,IgG and SLEDAI index were significantly decreased in TCM-WM group compared with those before treatment(P<0.01).There were no significant differences in WBC and SCr between the two groups after treatment(P>0.05);2.There was no significant difference in MMP-9,TIMP-1 and MMP-9/TIMP-1between the two groups before treatment(P>0.05).The levels of MMP-9,TIMP-1,MMP-9/TIMP-1 in the WM group and TCM-WM group were significantly higher than those in the healthy control group(P<0.01).MMP-9 and TIMP-1 were significantlydecreased both in the WM group and TCM-WM group(P<0.01).The level of MMP-9/TIMP-1 did not change after treatment in WM group(P>0.05),while that of TCM-WM group changed significantly(P<0.01).The levels of MMP-9,MMP-9/TIMP-1in the WM group and TCM-WM group were siginificantly lower after treatment(P<0.01).There was no significant difference in TIMP-1 between WM group and TCM-WM group after treatment.The levels of MMP-9 and TIMP-1 in the WM group and TCM-WM group were significantly higher than those in the healthy control group(P<0.05).The level of MMP-9/TIMP-1 in the WM group was higher than that in the healthy control group(P<0.05).There was no significant difference in MMP-9/TIMP-1between TCM-WM group and healthy control group after treatment(P>0.05).Conclusion:1.The clinical effication of Yangyin Huoxue Recipe combined with western medicine in treating LN was better than that of western medicine alone.2.The levels of serum MMP-9,TIMP-1,MMP-9/TIMP-1 in LN patients were higher than those in healthy people,which indicated that MMP-9 and TIMP-1 had a certain effect on the occurrence and development of LN.3.Yangyin Huoxue Recipe combined with western medicine could be an effective treatment of LN.This therapy can down-regulate the levels of MMP-9,TIMP-1 and MMP-9/TIMP-1 to those of the healthy people.It indicated that its mechanism may be related to the down-regulation the levels of MMP-9,TIMP-1 and MMP-9/TIMP-1 of LN patients by treating with Yangyin Huoxue Recipe.