Correlation Between TCM Syndromes Of Diabetic Nephropathy And Serum Endocan And VEGF-C

Diabetic kidney disease is one of the major microvascular complications of diabetes mellitus,and currently it has become a major threat to global human health.Insidious onset diabetes,kidney disease,the treatment is no precise and effective method,conventional laboratory test indicators have low sensitivity to predict value for disease progression.Endocan(human umbilical vein endothelial cells,ESM-1),as a novel type of endothelial cell molecule,is principally exist in lung and kidney endothelial cells.VEGF-C(vascular endothelial growth factor,VEGF)is a memeber of the vascular endothelial growth factors.It is a vascular growth factor related to nephropathy,and it plays an important role in the kidney function.Many studies have cleared that endocan and VEGF-C are related to kidney disease.Among them,endocan is confirmed to be correlated with CKD staging,glomerular filtration rate(eGFR),and urinary microprotein.There are likely to become diabetic kidney disease(Diabetic Kidney Disease,DKD)evaluation and prediction of disease biomarkers.Objective:1.To investigate the changes of serum endocan and VEGF-C in the course of DKD,and their connection with the disease progression.We also observed the relationship between both biomarkers and renal related indexes,such as 24-hour urinary protein,creatinine,glomerular filtration rate,etc.It is hoped to reveal its evaluation value for diabetic nephropathy.2.Observe the change of endocan and VEGF-C among different syndrome groups of DKD,find the relationship between endocan and VEGF-C and TCM syndromes,and provide a basis for TCM to treat endothelial cell damage in diabetic nephropathy.Methods:1.In the first part,215 patients were collected,including 18 in the normal healthy group,21 in the diabetic group,and 176 in the diabetic nephropathy group.Collect patients general information and laboratory indicators.The serum endocan and VEGF-C are used Luminex antibody.Using SPSS 25.0 statistical software,observe the changes of serum endocan and VEGF-C among the groups.2.Part two,a total of 164 patients were collected,of which 48 were in the early group,67 were in the middle group,and 49 were in the late group.They were evaluated according to the TCM Syndrome Scale,and the distribution of TCM syndromes of DKD patients,and the relationship between endocan,VEGF-C and TCM syndromesResults:1.In general,the deficiency syndrome is mainly Yin deficiency syndrome,followed by Yang deficiency syndrome,Qi deficiency syndrome,and blood deficiency syndrome.In the early stage,yin deficiency is the main syndrome,in the middle and late stages,the proportion of yin deficiency and qi deficiency syndrome decreases,and in the late stage,yang deficiency is the main syndrome.On the whole,the syndrome of evil was mainly heat,followed by damp-heat,phlegm and dampness,qi stagnation and blood stasis.The proportion of fever syndrome and qi stagnation syndrome decreased in the middle and late stage.The proportion of blood stasis in the middle and late stages was higher than that in the early stage.The serum endocan level in the dampness-heat syndrome group was significantly higher than that in the non-dampness-heat syndrome group(P<0.05).Serum endocan was positively correlated with dampness-heat syndrome(correlation coefficient was 0.164).Compared with non-damp-heat syndrome,systolic blood pressure,cholesterol,low density lipoprotein,serum creatinine and serum uric acid were all higher(P<0.05).2.Serum endocan levels increased successively in the early,middle and late stages of DKD,and there were statistically significant differences between the early and late stages of DKD,and between the middle and late stages of DKD(P<0.05).Spearman correlation analysis showed that serum endocan level was negatively correlated with EGFR,with a correlation coefficient of-0.238.Endocan is positively correlated with SCR,and the correlation coefficient is 0.145.There was a positive correlation between serum endoCan and 24-hour urinary protein with a correlation coefficient of 0.173.There was a negative correlation between serum albumin and serum albumin with a correlation coefficient of-0.295.3.Serum VEGF-C levels showed a downward trend in the early,middle and late stages of DKD(P<0.05).After pairwise comparison,it can be seen that there are statistical differences between the early and late stages of DKD and the middle and late stages of DKD(P<0.05).Spearman correlation analysis found that VEGF-C has a positive correlation with eGFR,with a correlation coefficient of 0.239;there is a negative correlation with Scr,with a correlation coefficient of-0.195.VEGF-C has a negative correlation with 24-hour urine protein quantification,with a correlation coefficient of-0.233;and a positive correlation with serum albumin,with a correlation coefficient of 0.280.4.The level of eGFR was analyzed in groups and divided into three groups:eGFR? 90 ml/min·1.73 m2,60 ml/min·1.73 m2?eGFR<90ml/min·1.73 m2,and 15 ml/min·1.73 m2?eGFR<60ml/min·1.73 m2.Serum endocan levels were found to increase in the three groups(P<0.05).It was found that there was a statistically significant difference between 15 ml/min·1.73 m2 ?eGFR<60 ml/min·1.73 m2 and eGFR? 90 ml/min ·1.73 m2between the two groups(P<0.05);serum VEGF-C levels were eGFR>90 ml/min·1.73 m2 and 15 ml/min·1.73 m2 ? eGFR<60ml/min 1.73 m2,60 ml/min·1.73 m2 ? eGFR<90 ml/min·1.73 m2 and 15 ml/min·1.73 m2 ?eGFR<60 ml/min·1.73 m2.There is a statistical difference between the groups(P<0.05).5.The quantitative levels of 24-hour urinary protein were grouped into three groups:24hUTP<500 mg/24h,500 mg/24h?24hUTP<1000 mg/24h and 24hUTP? 1000 mg/24h.Among them,there were statistically significant differences in Endocan between 24hUTP<500 mg/24h and 24hUTP? 1000mg/24h,500 mg/24h<24hUTP<1000 mg/24h and 24hUTP? 1000 mg/24h(P<0.05).The serum VEGF-C was significantly different between 24hUTP<500 mg/24h and 24hUTP?1000 mg/24h(P<0.05).Conclusion1.The serum endocan level increased with the progression of DKD,while the serum VEGF-C decreased with the progression of DKD.Serum endocan and VEGF-C are correlated with renal function evaluation indexes(24-hour urinary protein,serum creatinine,and EGFR).Serum endocan and VEGF-C can better evaluate the progression of diabetic renal disease and may become a new therapeutic evaluation index.2.There is a correlation between the dampness-heat syndrome and serum endocan,which is a marker of inflammation and endothelial dysfunction,and may also become the material basis of "heat syndrome",providing a new theoretical idea for the prevention and treatment of endothelial cell damage in diabetic renal disease by traditional Chinese medicine.