| Objective:1.To observe the differences in urinary podocyte marker protein Nephrotic protein(Nephrin)and Podocalyxin(PCX)between patients with Hyperhomocysteinemia(HHcy),Diabetic Kidney Disease(DKD)and qi-yin absence and serum stasis syndrome.It was confirmed that podocyte injury plays an important role in the pathogenesis of HHcy-DKD.2.To observe the intervention of Tangshenkang Pellets on urinary podocyte markers Nephrin and PCX in patients with HHcy-DKD qi-yin absence and serum stasis syndrome,and to explore the mechanism of Tangshenkang Pellets on HHcy-DKD.Methods:Sixty patients with HHcy-DKD qi-yin absence and serum stasis syndrome were selected from our department of Nephrology and Endocrinology from April 2019 to December 2019,and sixty patients were randomly separated into a remedy group and a contrast group of 30 cases each.Patients in both groups were given lifestyle intervention and basic western medicine remedy;patients in the remedy group were treated with Tangshenkang Pellets(3 times / day,1 bag / time)for 8 weeks.At the same time,20 healthy people were selected as the normal group.Observe the alterations in urine albumin / urinary creatinine ratio(UACR),24-hour urinary protein quantification(24h UPr),renal function,serum glucose,serum homocysteine(Hcy),urine PCX,Nephrin,and TCM syndrome score before and later remedy in the two groups of patients,and evaluate the two patients in this group had curative effects on disease and TCM syndromes.Results:1.Efficacy of the disease:In terms of main effective ratio,the contrast group and the remedy group were 57.14% and 82.76% respectively,with striking discrepancy(P<0.05).2.Efficacy of TCM syndromes:The main effective ratio of the remedy group and the contrast group were 89.66% and 64.29%,respectively,with a striking discrepancy between the two groups(P<0.05).3.TCM Syndrome Score:When not treated,no striking discrepancy was found between the two groups(P>0.05);later remedy,the two groups were descended striking(P<0.05 and P<0.01);compared with the contrast group,the remedy group showed significant advantages(P<0.01).4.UACR,24 h UPr: Comparison of the two groups without remedy showed no statistical value(P>0.05);later remedy,the two groups decreased striking and were statistically significant(P<0.05 and P<0.01);compared with the contrast group,the remedy group showed a significant advantage in the reduction of these two indicators(P<0.01).5.Serum creatinine(Scr),estimated glomerular filtrate rate(e GFR),blood urea nitrogen(BUN),fasting plasma glucose(FPG),2 hours plasma glucose(2h PG):No significant alterations were observed in all indicators in the two groups compared with those without remedy(P>0.05).6.Serum Hcy:Before remedy,compared with the normal group,both groups increased striking(P<0.01).There was no statistical significance in the comparison between the two groups before remedy(P>0.05);later remedy,compared with the untreated patients,both groups showed a significant reduction(P<0.05 and P<0.01).Moreover,compared with the contrast group,the remedy group showed a significant advantage(P<0.01).7.Urine Nephrin,PCX:Before remedy,both groups showed significant increase compared with the normal group(P<0.01).Before remedy,the comparison between the two groups showed no statistical value(P>0.05);later remedy,the two groups of patients compared with those before remedy,they were striking decreased(P<0.05 and P<0.01).Moreover,compared with the contrast group,the remedy group showed obvious advantages(P<0.01).8.Safety indicators:There were no significant alterations in serum routine,stool routine,alanine aminotransferase(ALT),and electrocardiogram in the two groups.Conclusion:1.The application of Tangshenkang Pellets can striking improve the clinical symptoms of HHcy-DKD patients with qi-yin absence and serum stasis syndrome and reduce the level of urinary protein and serum Hcy.2.HHcy-DKD patients with qi-yin deficiency and blood stasis syndrome had significantly higher levels of Nephrin and PCX in urine cell marker proteins than healthy people,indicating that podocyte injury is involved in the pathogenesis of HHcy-DKD.3.Tangshenkang Pellets can reduce the levels of urinary foot cell markers Nephrin and PCX in patients with HHcy-DKD absence of qi-yin and serum stasis syndrome,this may be one of the mechanisms of action of Tangshenkang Pellets in the remedy on HHcy-DKD.Objective:To observe the influence of Tangshenkang Pellets on the podocyte marker protein Nephrotic(Nephrin)and Podocalyxin(PCX)in hyperhomocysteinemia(HHcy)diabetic kidney disease(DKD)rats,and clarify the mechanism of action of Tangshenkang Pellets on HHcy-DKD rats.Methods:Fifty male SD rats were randomly separated into 5 groups,including normal group,DKD model group(model 1 group),HHcy-DKD group(model 2 group),Tangshenkang group,and valsartan group.Except the normal group,the remaining 40 rats were surgically excised single kidney,combined with a high-sugar and high-fat diet and streptozotocin(STZ)DKD model was prepared by the method.In addition to model1,the remaining DKD model rats were fed with 1% high methionine(Met)feed to prepare the HHcy-DKD model.The remaining rats were separated into Tangshenkang group and valsar based on the above models Tan group.The Tangshenkang group was administered the Tangshenkang Pellets aqueous solution at 4.0g/(kg·d),and the valsartan group was administered the valsartan capsule suspension at 20mg/(kg·d).The Tangshenkang group and the valsartan group started to be administered on the first day later the successful modeling of the model 2 group.The normal group,the model 1 group,and the model 2 group were administered the same amount of distilled water to the stomach for 8 weeks.The urinary albumin / urinary creatinine ratio(UACR),24-hour urinary protein quantification(24h UPr),serum creatinine(Scr),urea nitrogen(BUN),serum homocysteine(Hcy),urine Nephrin,and PCX levels were measured by ELISA;Western blot was used to detect the expression of Nephrin and PCX in kidney tissue;the thickness of glomerular basement membrane(GBM)and the morphology of podocytes were observed with an electron microscope.Results:1.UACR,24 h UPr comparison:Compared with the normal group,the model 2group showed a significant increase and showed a striking discrepancy(P<0.01);compared with the model 2,the valsartan group and the Tangshenkang group all showed a decrease,there are striking discrepancys(P<0.01);there is no striking discrepancy between Tangshenkang group and valsartan group(P>0.05).2.Renal function(BUN,Scr)comparison:There was no striking discrepancy in each group(P>0.05).3.Serum Hcy comparison:compared with the normal group,there was no striking discrepancy in the model 1 group(P>0.05),and the model 2 group was striking increased,with a striking discrepancy(P<0.01);compared with the model 2 group,Tangshenkang Both the valsartan group and the valsartan group decreased,with striking discrepancys(P<0.01);there was no striking discrepancy among the Tangshenkang group and the valsartan group(P>0.05).4.Comparison of UNECR and UPCR levels:Compared with the normal group,the model 2 group was increased,with striking discrepancys(P<0.01);compare to model 2group,the Tangshenkang group and valsartan group were decreased There were striking discrepancys(P<0.01);there were no striking discrepancy between Tangshenkang group and valsartan group(P>0.05).5.Nephrin and PCX expression in the kidney tissue(Western blot):Compared with the normal group,the model 2 group was reduced,with striking discrepancys(P<0.01);Compared with the model 2 group,the Tangshenkang group and the valsartan group increased,with significant differences(P<0.01);there were no striking discrepancy among the Tangshenkang group and the valsartan group(P>0.05).6.Pathological and morphological alterations of kidney in each group of rats:(1)Macroscopic observation of kidney tissue:In the normal group,the left kidney of the rat was normal in size and showed dark red.The volume of left kidney in rats in model 2group became significantly larger.Both the Tangshenkang group and the valsartan group were larger than the normal group,but were smaller than the model 2 group.(2)Electron microscopy:Compared with normal group rats,the GBM in model 2 group was striking thickened,and the fusion of the foot processes even disappeared.The rats in the Tangshenkang group and valsartan group had slightly thicker GBM and the foot processes were slightly integrated.In terms of pathological types,compared with the model 2 group,all of them showed significant down-regulation.Conclusion:1.The application of Tangshenkang Pellets can effectively improve the quality of life of rats with HHcy-DKD,and reduce the levels of urinary protein and serum Hcy in rats with HHcy-DKD.2.HHcy-DKD rats' urinary podocyte marker proteins Nephrin and PCX were striking increased,while renal tissue podocyte marker proteins Nephrin and PCX were striking decreased,indicating that HHcy-DKD had podocyte damage and Tangshenkang Pellets could descended striking the content of urinary podocyte marker proteins Nephrin and PCX,and striking increased the expression of renal podocyte marker proteins Nephrin and PCX.3.Tangshenkang Pellets can improve the renal pathological manifestations of HHcyDKD rats. |
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