Clinical Observation Of Yishen Qingli Decoction On Regulating NGAL And Immunity Of Patients With Chronic Nephritis

Chronic glomerulonephritis(CGN)is an immune related glomerulonephritis.Many cytokines,inflammatory mediators and cell signaling pathways are involved in the process of immune damage.Neutrophil gelatinase associated lipocalin(NGAL),a new type of lipocalins,involved in many biochemical reactions.Most of the studies related to inflammation,tumors,embryonic development,cell differentiation,lipid metabolism,may be involved in the CGN immune inflammatory lesions,and correlated with the expression of a variety of immune inflammatory mediators and signal pathway.Traditional Chinese medicine(TCM)believes that the pathogenesis of this disease belongs to the virtual standard,kidney deficiency and damp heat.Yishen Qingli decoction by the tutor's clinical experience summed up for many years in treatment of chronic nephritis,the set of Spleen invigorating kidney,nourishing qi and nourishing Yin,clearing away the effect of heat and damp as a whole,The clinical curative effect is remarkable.The study is based on the study of the correlation between early renal damage markers NGAL and chronic glomerulonephritis laboratory indicators to investigate the expression of NGAL in CGN;And on the basis of previous animal experiments and some clinical efficacy studies completed to observe the clinical curative effect of Yishen Qingli decoction to further explore Yishen Qingli decoction effect on immune function and NGAL in patients with CGN and immune mechanism.Provide sufficient basis for the clinical feasibility of the drug.The main contents are as follows:First,The correlation between the early renal damage markers NGAL and the laboratory indexes of CGN.The concentration of NGAL in blood and urine was measured at random in 30 health examiners as a normal reference range.The serum and urine samples of two groups of patients with CGN were tested for NGAL,including 60 cases in each group,including 30 cases in the damp heat group and the non damp heat group.At the same time,the clinical score,24h urine protein,renal function,interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-a(TNF-a),and nuclear transcription factor(NF-?B)were recorded.The relationship between the level of NGAL and the related indexes was analyzed,and the changes of blood and urine NGAL levels in the damp heat group and non damp heat group were observed,and the relationship between damp heat and NGAL was discussed.The results showed:(1)the concentrations of serum and urine NGAL in the patients with chronic nephritis were higher than those in the healthy group,and the difference was statistically significant(P<0.05),The blood and urine NGAL were positively correlated with serum creatinine(Scr),blood urea nitrogen(BUN),24h urine protein(0<r<1 P<0.01),and negatively correlated with GFR(-1<r<0,P<0.01);(2)There was a positive correlation between NGAL and IL-6(0<r<1,P<0.01)in the patients with CGN(0<r<1,P<0.01),and there was no significant correlation with TNF-a,IL-10 and NF-?B(P>0.05);(3)The NGAL of blood and urine in CGN damp heat syndrome group were higher than those in non damp heat syndrome group,P<0.05,and there was no obvious linear correlation between blood and urine NGAL concentration and the scores of damp heat symptom(P>0.05).Conclusion:The level of blood and urine NGAL in patients with chronic nephritis can be increased,and the increase of urine NGAL is more obvious.NGAL is closely related to renal function and proteinuria,and NGAL can be used as a new predictor of renal function changes in CGN patients.When renal function decreased,NGAL in blood and urine increased,and NGAL was associated with inflammatory factor IL-6,which was involved in the immuno inflammatory injury of chronic nephritis.Second,The clinical research of the Yishen Qingli decoction in treating the kidney deficiency and dampness heat syndrome of CGN and regulating of NGAL and inflammatory factors.Select 60 patients with chronic nephritis kidney deficiency and damp heat into the standard were randomly divided into control group and treatment group with 30 cases in each group,the former treated with western medicine therapy,the latter given Yishen Qingli decoction combined with western medicine therapy for 1 months.The main TCM symptoms and signs changes,renal function,24h urinary protein quantitation,blood and urine NGAL,IL-10,IL-6,NF-?B,and TNF-?levels in two groups before and after treatment were observed respectively.To observe the clinical curative effect of Yishen Qingli decoction in treating CGN with syndrome of kidney deficiency and damp heat,clear,regulated factor and signal pathway of NGAL,immune and the effect on NGAL,immune regulation factor and signal pathway.The results showed:(1)The clinical efficiency of the treatment group and the efficiency of TCM syndrome were 86.67%and 93.33%respectively,were better than those in the control group which were 70%,80%,P<0.05.(2)Two groups of treatment can reduce Scr,BUN level,24 hours urinary protein quantitation,improve renal function,the treatment group decreased more significantly than the control group,P<0.05.(3)The levels of IL-10 and NF-?B in the control group were not significantly different,and the levels of P>0.05,blood and urine NGAL,IL-6,and TNF-? were decreased,P<0.05;The treatment group can significantly reduce the expression of TNF-?,IL-6,NF-?B and blood and urine NGAL,and increase the level of blood IL-10,the difference is more obvious than that of the control group,P<0.05.Conclusion:1.Yishen Qingli decoction can directly regulate the balance of pro-inflammatory and anti inflammatory factors,reduce the secretion of TNF-a and IL-6,and promote the secretion of IL-10,and reduce the inflammatory injury of the kidney.2.The clinical curative effect of Yishen Qingli Decoction in treating chronic nephritis significantly,the expression of the possible mechanism of immune regulation of NF-?B signaling pathway to regulate proinflammatory cytokines and anti-inflammatory cytokines balance;3.Yishen Qingli decoction can reduce the immune damage of renal tissue by reducing the NGAL level of blood and urine.It shows that the immune mechanism of chronic nephritis is related to the abnormal expression of NGAL.