Clinical Study On Oxidative Stress Of Early Diabetic Nephropathy Treated By Tonifying Kidney And Activating Blood Method

ObjectiveThe main purpose of this clinical study is to explore the therapeutic effect of the tonifying kidney and activating blood method on early diabetic nephropathy.The clinical therapeutic effect of the tonifying kidney and reducing blood glucose recipe was studied by comparing the levels of TCM syndromes score,the ratio of urinary Microalbumin to creatinine(ACR),urinary Microalbumin(UMA),urinary Microprotein excretion rate(UAER),urinary Microalbumin,and the levels of serum lipids(TC,TG,HDL,LDL).The possible action mechanism of the tonifying kidney and reducing blood glucose recipe on early diabetic nephropathy was explored by serum malondialdehyde(MDA),superoxide dismutase(SOD)and others,to provide more effective clinical evidence for the treatment of early diabetic nephropathy with the tonifying kidney and reducing blood glucose recipe.Methods72 patients with early diabetic nephropathy and in accordance with clinical observation case conditions were collected from the Department of Endocrinology both of The Second Hospital of Guangdong Province and Clifford Hospital during the period of April 2017 to January 2018.They were randomly divided into the control group and the treatment group according to the generated random table,36 cases in each group.The random table was generated by spss22.0.Both groups were given routine basic treatment of diabetic nephropathy,including low-salt and low-fat diabetic diet,active treatment on primary disease.Hypoglycemic treatment: strict control of blood glucose,and cure with oral hypoglycemic agents or insulin therapy for keeping patients' blood glucose normal(4.4-7.0mmol/L fasting blood glucose,postprandial blood glucose is less than 10mmol/L,part of the older patients can be broadened to less than 11mmol/L;HbA1c < 7%,some older,prone to hypoglycemia can be broadened to < 8%).Anti-hypertension therapy: people with high blood pressure should choose CCB class anti-hypertension drugs,avoid using ARB class anti-hypertension drugs other than losartan.So as not to interfere with experimental results,ion level and urine volume in the course of medication should be detected,and avoid hyperkalemia and oliguria.When necessary,the blood pressure was controlled below 130/80 mmHg by adding antihypertensive drugs other than CCB.The control group was treated with losartan(Hangzhou Mersadon Pharmaceutical Co.,Ltd.,Chinese Medicine Standard 20150607).The treatment group was treated with self-made prescription of nourishing kidney and lowering sugar(Epimedium 12 g,antlers 15 g,Huangjing 12 g,Astragalus complanatus 15 g,Chinese yam 30 g,kudzu 30 g,salvia miltiorrhiza 30 g,Radix et Rhizoma et Rhizoma et Rhizoma et al.).The same dosage of granules in Guangdong Dangfang Pharmaceutical Factory,1 dose daily,warm water dissolved to 300 ml,2 hours after breakfast warm clothes.4 Weeks as a course of treatment,observation of 3 courses of treatment,a total of 12 weeks).Observation indicators and methods: monitoring the following indicators,It included the effective evaluation index: TCM syndromes score,urinary microalbumin / creatinine ratio(ACR),urine microalbuminuria(UMA),urinary microalbuminexcretion rate(UAER),serum malondialdehyde(MDA),and superoxide dismutase(SOD).The primary monitoring indexes: fasting blood glucose(FPG),postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c),serum lipids(TC,TG,HDL,LDL).Clinical safety indicators: blood routine,electrolyte,renal function,liver function,routine stool,electrocardiogram and so on.The statistical method was used to analyze the difference between the indexes of the selected patients before and after treatment.Results1.There was a significant difference between the two groups in syndrome score(Mann-Whitney U=130.000,P<0.01).The total effective rate(remarkable + effective)was 17.65% in the control group,and 94.29% in the treatment group.There was a significant difference in the effective rate between the two groups by Fisher chi square test(P<0.01).Tonifying kidney and activating blood method in improving the clinical symptoms of patients has a significant effect.2.Before treatment,there was no significant difference in ACR,UMA,and UAER between the two groups(P>0.05),which was comparable.There was significant difference in ACR,UMA,and UAER between the two groups(P<0.01).There was no significant difference in ACR,UMA,and UAER in the control group before and after treatment(P>0.05).There was a significant difference in ACR,UMA,and UAER in the treatment group before and after treatment(P<0.01).3.Before treatment,there was no significant difference in MDA and SOD between the two groups(P>0.05),which was comparable.After treatment,there was significant difference in MDA and SOD between the two groups(P<0.01),while there was no significant difference in MDA and SOD in the control group(P>0.05).There was a significant difference in MDA and SOD in the treatment group(P<0.01).4.Before treatment,there was no significant difference in the levels of serum lipids(TC,TG,HDL,LDL)between the two groups(P>0.05),which is comparable.There was no significant difference in TC and TG between the two groups(P>0.05).There was significant difference in HDL and LDL between the two groups(P<0.01).There was no significant difference in TC,TG,LDL in the control group under before and after treatment(P>0.05),and there was significant difference in HDL in the control group under before and after treatment(P<0.01),there was significant difference in the levels of serum lipids in the treatment group after treatment(P<0.01).5.Before treatment,there was no significant difference in fasting blood glucose(FPG),postprandial blood glucose(2hPG)and HbA1 c between the two groups(P>0.05),which is comparable.There was significant difference in HbA1 c between the two groups after treatment(P<0.01),there was no significant difference in FPG and 2hPG between the two groups after treatment(P>0.05).There was no significant difference in FPG,2hPGs and HbA1 c between the two groups under before and after treatment in the control group(P>0.05).There was significant difference in HbA1 c under before and after treatment in the treatment group(P<0.01),and there was no significant difference in FPG and 2hPG after treatment in the treatment group(P>0.05).Conclusion1.The tonifying kidney and reducing blood glucose recipe can effectively reduce the syndrome score of patients,and improve the clinical symptoms of patients.2.the tonifying kidney and reducing blood glucose recipe combined with losartan can better reduce the urinary Microalbumin / creatinine ratio(ACR),24-hour urinary Microalbumin(UMA),and urinary Microalbumin excretion rate(UAER).3.Oxidative stress plays an important role in the occurrence and development of diabetic nephropathy.Oxidative stress is closely related to lipid disorder in DN patients.the tonifying kidney and reducing blood glucose recipe can effectively reduce serum malondialdehyde(MDA)and blood lipid levels,and increase the level of superoxide dismutase(SOD).The Chinese medicine method of invigorating kidney and activating blood circulation has obvious effect on anti-oxidation stress response,regulating the disorder of glucose and lipid metabolism,so as to protect the further development of renal function and have clinical significance for the prevention and treatment of DN.