Clinical Study On The Relationship Between Kidney-yang Deficiency Syndrome And Mitochondrial Damage In Diabetic Nephropathy

Objective:The instructor,Professor Liu Hongfang,pointed out that " essence depletion and collateral impediment " is the core pathogenesis of diabetic kidney disease(DKD),emphasizing that the disease is centered on the kidney.Kidney essence transforms kidney qi,and kidney qi is divided into kidney yin and kidney yang.As the yuan yang of the whole body,kidney yang has the function of warming and promoting.It can regulate the function of viscera and enhance the body's activities.It is the direct power of the body's energy metabolism.Modern medicine believes that mitochondria are the center of energy metabolism in eukaryotic cells.Under physiological conditions,they can produce triphosadenine(ATP)and a small amount of reactive oxygen species(ROS).In a high glucose environment,the body's oxidative stress is enhanced,the oxidation and the antioxidant are out of balance,ROS production increases,superoxide dismutase(SOD)content decreases,ROS attacks biofilm to form lipid peroxidation product malondialdehyde(MDA),therefore ATP,SOD,MDA are closely related to mitochondrial damage.The function of kidney yang in Chinese medicine is similar to that of mitochondria,this study explored the relationship between DKD kidney-yang deficiency syndrome and mitochondrial damage,and provided the objective basis for microscopic syndrome differentiation for the prevention and treatment of DKD kidney-yang deficiency syndrome.Method:From July 2019 to January 2021,86 cases of DM and DKD patients were collected in the Dongcheng District and Tongzhou District of Dongzhimen Hospital of Beijing University of Chinese Medicine,and the Community Health Service Station of Huixin East Street,Chaoyang District,Beijing.Collect patients' general information,TCM syndrome information and clinical biochemical indicators,and detect the levels of serum mitochondrial damage indicators ATP,SOD,and MDA.According to the diagnostic criteria of diabetes and diabetic kidney disease,all subjects were divided into 30 cases in simple diabetes group(DM group)and 56 cases in diabetic nephropathy group(DKD group).Then,according to the"TCM Syndrome Evaluation Table" of the previous study,the subgroups were analyzed and divided into DKD kidney-yang deficiency syndrome group(38 cases)and non-kidney-yang deficiency syndrome group(18 cases),DM kidney-yang deficiency syndrome group(13 cases)and non-kidney-yang deficiency group(17 cases).The differences in general data,laboratory indexes and mitochondrial damage indicators of DKD group and DM group,DKD kidney-yang deficiency group and non-kidney-yang deficiency group,DM kidney-yang deficiency group and non-kidney-yang deficiency group,DKD kidney-yang deficiency group and DM kidney-yang deficiency group were compared respectively.To explore the correlation between the scores of DKD and DM Kidney Yang Deficiency Syndrome and laboratory indicators.Result:1.Comparison of general information between DKD group and DM group:basic information,the course of disease in the DKD group was longer than that in the DM group(P<0.05),laboratory indicators,the levels of BUN and Scr in the DKD group were higher than those in the DM group(P<0.05),and the levels of HGB,eGFR and TC were lower than those in the DM group(P<0.05).2.Comparison of mitochondrial damage indicators between the DKD group and the DM group:the serum ATP level of the DKD group was lower than that of the DM group(P<0.05),the MDA level was higher than that of the DM group(P<0.05).3.Comparison of the proportion of kidney-yang deficiency syndrome between the DKD group and the DM group:there were 38 cases(67.9%)of kidney-yang deficiency syndrome in DKD group and 13 cases(43.3%)of kidney-yang deficiency syndrome in DM group.Compared with DM group,the proportion of kidney-yang deficiency syndrome in DKD group was higher(P<0.05).4.Comparison of general data between DKD kidney-yang deficiency syndrome group and non-kidney-yang deficiency syndrome group:basic information,the number of smokers in the kidney-yang deficiency group was 13 cases(34.2%),which was lower than 13 cases(72.2%)in the non-kidney-yang deficiency group(P<0.05),laboratory indicators,compared with the non-shen-yang deficiency group,the HGB,ALB,eGFR,and Ca levels in the kidney-yang deficiency group decreased(P<0.05),and the levels of BUN and Scr increased(P<0.05).5.Comparison of mitochondrial damage indicators between the DKD kidney-yang deficiency syndrome group and the non-kidney-yang deficiency syndrome group:compared with the non-kidney-yang deficiency syndrome group,the serum ATP and SOD levels in the kidney-yang deficiency syndrome group decreased(P<0.05),and the MDA level increased(P<0.05).6.Correlation between the scores of DKD kidney-yang deficiency syndrome and laboratory indicators:the score of kidney-yang deficiency syndrome was negatively correlated with ATP,HGB,TB,ALB,eGFR,and Ca(P<0.05),and positively correlated with MDA,BUN,Scr,P,TC,and 24h urine total protein(P<0.05).7.Comparison of general data of DM with kidney-yang deficiency syndrome group and non-kidney-yang deficiency syndrome group:basic information,compared with the non-kidney-yang deficiency group,the kidney-yang deficiency group is older and has a smaller waist-to-hip ratio(P<0.05),laboratory indicators,the FPG level of the kidney-yang deficiency group was lower than that of the non-kidney-yang deficiency group(P<0.05).8.Comparison of mitochondrial damage indicators between DM kidney-yang deficiency syndrome group and non-kidney-yang deficiency syndrome group:the MDA level in the kidney-yang deficiency group was higher than that in the non-kidney-yang deficiency group(P<0.05).9.Correlation between DM kidney-yang deficiency syndrome score and laboratory indicators:the score of kidney-yang deficiency syndrome was negatively correlated with TC(P<0.05),and positively correlated with MDA and BUN(P<0.05).10.Comparison of general data between DKD kidney-yang deficiency syndrome group and DM kidney-yang deficiency syndrome group:basic information,compared with the DM kidney-yang deficiency syndrome group,the DKD kidney-yang deficiency syndrome group is younger,has a longer course of disease,and has a larger waist-to-hip ratio(P<0.05),laboratory indicators,compared with the DM kidney-yang deficiency syndrome group,the DKD kidney-yang deficiency syndrome group had lower levels of HGB and eGFR(P<0.05),while the levels of FPG,BUN,and Scr increased(P<0.05).11.Comparison of mitochondrial damage indicators between DKD kidney-yang deficiency syndrome group and DM kidney-yang deficiency syndrome group:the levels of ATP and SOD in the DKD kidney-yang deficiency syndrome group were lower than those in the DM kidney-yang deficiency syndrome group(P<0.05).In conclusion:1.The damage of mitochondria in the DKD group was more severe than that in the DM group,suggesting that mitochondria damage may be involved in the development of DM to DKD.2.Serum ATP and SOD levels in the DKD kidney-yang deficiency syndrome group are lower than those in the DM kidney-yang deficiency syndrome group,the score of DKD kidney-yang deficiency syndrome is positively correlated with MDA and negatively correlated with ATP.Mitochondrial damage may be involved in the pathogenesis of DKD kidney-yang deficiency syndrome.