| Objective1 Compare the differences in serum levels of 25(OH)D3,FGF23,and Klotho in patients with T2DM and DKD stage Ⅲ-Ⅴ,and analyze the correlation between 25(OH)D3,FGF23,Klotho and renal function,bone metabolism,and inflammatory fibrosis indicators in DKD to explore the evaluation value of the three in the progression of DKD.2 Observe the distribution pattern of 25(OH)D3,FGF23,Klotho in different syndrome types of DKD,and explore the correlation between 25(OH)D3,FGF23,Klotho and traditional Chinese medicine syndrome.MethodsUsing a cross-sectional survey research method,126 T2DM patients and DKD stage ⅢⅤ patients hospitalized at Dongzhimen Hospital of Beijing University of Chinese Medicine from May 2021 to March 2023 were included.Collect general information,blood routine,comprehensive metabolic panel and other relevant clinical test data of the enrolled patients,and perform syndrome differentiation and typing based on the four diagnostic information of traditional Chinese medicine.Use enzyme-linked immunosorbent assay(ELISA)to detect the serum FGF23,Klotho,and TGF-β1 level.SPSS 27.0 was used for statistical analysis to observe the changes in serum levels of 25(OH)D3,FGF23,and Klotho among each group.Correlation analysis was used to explore the correlation between serum 25(OH)D3,FGF23,Klotho,FGF23/Klotho levels and renal function,bone metabolism,inflammatory fibrosis indicators,and traditional Chinese medicine syndromes in DKD patients.Results1 General data:30 cases in the T2DM group and 96 cases in the DKD group(31 cases in DKD stage Ⅲ,34 cases in DKD stage Ⅳ and 31 cases in DKD stage Ⅴ)were included in this study,and there were no statistical differences in gender,age and BMI between the groups(P>0.05),which were comparable among multiple groups.2 Medical history:the duration of disease was 6.5(13.3)years in the T2DM group and 16.5(10.0)years in the DKD group.Among all comorbidities in DKD,the proportion of combined hypertension was the highest,reaching 83.3%,while the incidence of combined hyperlipidemia and coronary artery disease was not statistically different among groups(P>0.05).The incidence of combined hypertension,hyperuricemia,and osteoporosis in DKD gradually increased as the disease progressed,and the combined hypertension,hyperuricemia,and osteoporosis in DKD stage Ⅴ was as high as 100%,51.6%,and 80.6%.3 Clinical data:In the DKD group,the levels of red blood cell count,hemoglobin,albumin,blood calcium,and estimated glomerular filtration rate decreased sequentially,and the levels of blood phosphorus,whole segment parathyroid hormone,urea,blood creatinine,blood uric acidinterleukin 6,neutrophil count to lymphocyte count ratio,platelet count to lymphocyte count ratio,and transforming growth factor β1 increased gradually in the patients from stage Ⅲ-Ⅴ,and the differences between the groups The differences between all groups were statistically significant(P<0.05);The differences in C-reactive protein and systemic immune inflammatory index between the three groups were statistically significant(P<0.05),and the differences between the DKD stage Ⅲ and DKD stage Ⅳ and DKD stage Ⅴ groups were statistically significant when compared between the two groups(P<0.05);Blood glucose and monocyte count to lymphocyte count ratios were statistically different between the three groups(P<0.05),and the differences between the DKD stage Ⅴ group and the DKD stage Ⅲ and DKD stage Ⅳgroups were statistically significant when compared between the two groups(P<0.05);The differences in total cholesterol,triglycerides,low density lipoprotein-cholesterol,high density lipoprotein-cholesterol,and alkaline phosphatase between the 3 groups were not statistically significant(P>0.05).4 Study indexes:Regarding the content differences:There was a statistically significant difference in 25(OH)D3,FGF23,and Klotho among the four groups(T2DM group,DKD Ⅲgroup,DKD Ⅳ group,and DKD Ⅴ group).Pairwise comparison showed that there was a statistically significant difference in 25(OH)D3 levels between the T2DM group and the DKD stage Ⅳ and DKD stage Ⅴ groups,as well as between the DKD stage Ⅲ group and the DKD stage Ⅳ and DKD stage Ⅴ groups(P<0.05);There was a statistically significant difference in FGF23 levels between the T2DM group and the DKD Phase Ⅴ group,as well as the DKD PhaseⅢ and DKD Phase Ⅴ groups(P<0.05).From the T2DM group→DKD stage Ⅲ group→DKD stage Ⅳ group→ DKD stage Ⅴ group,the mean serum 25(OH)D3 and Klotho levels gradually decreased and the mean FGF23 level gradually increased.In terms of correlation:25(OH)D3 showed positive linear correlation with estimated glomerular filtration rate and blood calcium(P<0.05).negative linear correlation with blood creatinine,urea,blood uric acid,24-hour urine protein quantification,blood phosphorus,whole segment parathyroid hormone,alkaline phosphatase,interleukin 6.C-reactive protein,neutrophil-to-lymphocyte ratio,monocyte-to-lymphocyte ratio,and immune index,and transforming growth factor beta 1 were negatively linearly correlated(P<0.05);No linear correlation was found between Klotho and indicators of bone metabolism,renal function,and inflammatory fibrosis(P>0.05);There was a positive linear correlation between FGF23 and blood creatinine,urea,blood uric acid,blood phosphorus,whole segment parathyroid hormone,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,immune inflammatory index,and transforming growth factor beta 1(P<0.05),and a negative linear correlation with estimated glomerular filtration rate(P<0.05);There is a linear relationship between the serum Klotho/FGF23 ratio and blood creatinine,urea,estimated glomerular filtration rate,blood phosphorus,whole parathyroid hormone,neutrophil to lymphocyte ratio,platelet to lymphocyte ratio,and systemic immune inflammation index(P<0.05).5 Distribution of Traditional Chinese Medicine Syndrome Types:The overall deficiency syndrome of DKD is mainly spleen and kidney deficiency,followed by qi and yin deficiency,liver and kidney yin deficiency,and yin and yang deficiency.There is a statistical difference in the composition ratio of this deficiency syndrome among each group(P<0.05).In terms of staging,DKD stage Ⅲ is mainly characterized by qi and yin deficiency syndrome,followed by spleen and kidney deficiency syndrome and liver and kidney yin deficiency syndrome.The proportion of Qi and Yin deficiency syndrome and liver and kidney yin deficiency gradually decreases in DKD stage Ⅳ and V,with spleen and kidney deficiency syndrome being the main type.The overall deficiency syndrome type of DKD stage Ⅲ-Ⅴ has transitioned from qi and yin deficiency syndrome to spleen and kidney deficiency syndrome,with yin and yang deficiency syndrome visible in stages Ⅳ and Ⅴ.The overall distribution of standard evidence is mainly based on dampness heat syndrome,followed by phlegm stasis syndrome,dampness turbidity syndrome,and blood stasis syndrome.There is no statistical difference in the composition of standard evidence between each group(P>0.05);DKD patients with osteoporosis are mainly characterized by spleen and kidney deficiency syndrome and dampness heat syndrome.6 Correlation between research indicators and traditional Chinese medicine syndrome types:There is a statistical difference in the distribution of 25(OH)D3 between the deficiency syndrome types(P<0.05).Compared with the two groups,the liver and kidney yin deficiency syndrome group has the highest level of 25(OH)D3,and there is a statistical difference compared with the spleen and kidney deficiency syndrome,qi yin deficiency syndrome,and yin yang deficiency syndrome(P<0.05);The 25(OH)D3 level in patients with yin yang deficiency syndrome group is the lowest,and there is a statistical difference compared to spleen kidney deficiency syndrome,qi yin deficiency syndrome,and liver kidney yin deficiency syndrome(P<0.05).There were statistical differences in the distribution of Klotho between the deficiency syndrome types(P<0.05),Compared between the two groups,there were statistical differences between the qi and yin deficiency group and the spleen and kidney deficiency and yin and yang deficiency evidence,the liver and kidney yin deficiency group and the spleen and kidney deficiency evidence and yin and yang deficiency evidence were statistically significant,and the Klotho levels of qi and yin deficiency/liver and kidney deficiency group were higher than those in the spleen and kidney deficiency/yin and yang deficiency group.There was no significant difference in the distribution of FGF23 between the deficiency syndrome types(P>0.05).In the standard empirical evidence,there was no significant difference in the distribution of 25(OH)D3 and Klotho(P>0.05);The distribution of FGF23 was statistically different(P<0.05),and the content of FGF23 was the highest in the humid heat group,which was statistically different from that of wet turbidity,blood stasis and sputum stasis(P<0.05).Conclusion1 As DKD stage Ⅲ-Ⅴ progresses,the levels of serum 25(OH)D3 and Klotho gradually decrease,while the levels of serum FGF23 gradually increase.There is a linear correlation between serum 25(OH)D3,FGF23,Klotho/FGF23 ratio and renal function,bone metabolism,and inflammatory fibrosis indicators in DKD,which can provide reference for mineral metabolism and disease progression assessment in DKD.2 There is a certain correlation between serum 25(OH)D3,Klotho,and FGF23 in patients with DKD stage Ⅲ-Ⅴ and traditional Chinese medicine syndromes.The content of 25(OH)D3 is highest in the liver kidney yin deficiency group and lowest in the yin yang deficiency group.The content of Klotho is higher in the liver kidney yin deficiency/qi yin deficiency group than in the spleen kidney deficiency/yin yang deficiency group,and the content of FGF23 is highest in the damp heat syndrome group. |
PDF Full Text Request