糖尿病肾病患者中医证型与TGF-β1的关系

The Relationship between Syndromes of Traditional Chinese Medicine and Plasma TGF-β1 in Diabetic Nephropathy Patients

目的探讨2型糖尿病肾病患者中医证型与血浆TGF-β1的关系。方法应用ELISA法检测2型糖尿病(Type 2diabetes,T2D)及糖尿病肾病(diabetic nephropathy,DN)45例患者血浆TGF-β1水平,同时检测患者尿白蛋白肌酐比值(Urine Albumin-to-creatinine Ratio,UACR),并对患者进行中医辨证分型。结果 T2D、DN患者血浆TGF-β1水平明显高于正常对照组(P<0.05),大量蛋白尿组更加明显(P<0.05),且与患者蛋白尿水平呈正相关(r=0.644,P=0.003);脾肾阳虚患者外周血TGF-β1水平最高,其次是阴阳两虚患者,明显高于肝肾阴虚与气阴两虚患者,而脾肾阳虚患者与阴阳两虚患者(P=0.310)、气阴两虚与肝肾阴虚患者(P=0.530)未见显著性差异;血浆TGF-β1在浊毒证患者中水平最高,水饮证患者次之,血瘀证及湿热证患者紧随其后,但二者相比无统计学差异(P>0.05),浊毒证、水饮证及血瘀证患者均显著高于无兼证、肝阳上亢及燥热证患者(P<0.05);无兼证患者血浆TGF-β1水平最低,与燥热证、肝阳上亢患者相比无显著差异(P>0.05)。结论血浆TGF-β1水平与DN病情严重程度相关,其变化规律符合DN中医证型演变,可考虑将TGF-β1作为2型糖尿病肾病患者中医辨证的客观指标之一。

Objective To investigate the relationship between syndromes of traditional Chinese medicine and plasma TGF-β1 in diabetic nephropathy patients. Methods We detected the levels of plasma TGF-β1 and urine albumin to creatinine ratio in 45 type 2 diabetes and diabetic nephropathy patients,the syndromes of traditional Chinese medicine of patients were confirmed at the same time. Results Comparing with normal adults,the levels of T2 D and DN patients plasma TGF-beta 1 were significantly increased,particularly in DN patients with massive proteinuria,and showed a positive correlation with the levels of proteinuria. Patients with deficiency of yang in the spleen and kidney exhibited a significantly increased plasma TGF-β1,followed by patients with deficiency of yin and yang comparing with patients with deficiency of liver yin and kidney yin and deficiency of both qi and yin. There was no statistically significant difference between the patients with deficiency of yang in the spleen and kidney and patients with deficiency of yin and yang,between the patients with deficiency of liver yin and kidney yin and deficiency of both qi and yin either. When it comes to traditional Chinese medicine accompanied symptoms and signs,the plasma TGF-β1 of patients with turbid toxin were the highest,patients with fluid retention syndrome exhibited the second-highest plasma TGF-β1,followed by patients with blood stasis and patients with dampness-heat who appeared resemblance. By contrast,patients with dryness-heat,upper hyperactivity of liver yang,and patients without accompanied symptoms and signs showed lower plasma TGF-β1.Conclusions The results showed a close relationship between plasma TGF-β1 level and severity of DN,the change laws of the plasma TGF-β1 was accorded with evolution of syndromes of traditional Chinese medicine. TGF-β1 can be considered as a one of objective indicators of syndrome of traditional Chinese medicine in patients with diabetic nephropathy.