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Chronic renal failure （CRF） is generally characterized by micro-inflammatory state， which can aggravate the CRF process in severe cases， leading to the deterioration of renal function， malnutrition， anemia and other complications. Therefore， it is of great significance to improve the micro-inflammatory state of CRF. "Deficiency of Qi and stagnation" is the basic pathogenesis of the micro-inflammatory state of CRF， which runs through the whole process of the disease and affects the formation and outcome of CRF in different forms. Traditional Chinese medicine （TCM） has unique advantages in improving the micro-inflammatory state and enhancing the immunity of the body due to its advantages of syndrome differentiation and treatment， strengthening the righteousness and eliminating pathogenic factors. Therefore， the author systematically sorted out the relationship between micro-inflammatory state and CRF， understanding of micro-inflammatory state of CRF and its prevention and treatment of TCM by referring to relevant literature， based on the theory of "deficiency of Qi and stagnation"， and proposed that spleen and kidney failure （deficiency of Qi） is the origin of micro-inflammatory state of CRF， and blood stasis and poisonous evil （stagnation） is the target of its onset. Deficiency of Qi and stagnation adhered to each other， acted as cause and effect， and developed in a spiral manner throughout the development of the disease. TCM has the effects of nourishing the spleen and kidney， removing blood stasis and turbidity. By down-regulating C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor alpha （TNF-α） and other micro-inflammatory indicators， it can eliminate the pathological wastes derived from spleen and kidney deficiency， reduce the micro-inflammatory state， restore the balance of Yin and Yang in the body to achieve the purpose of eliminating pathogens and protecting renal function， providing guidance for the clinical treatment of CRF.
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Objective:To discuss the efficacy and safety of Shenwu Yishenpian on stage 4-5 chronic kidney disease-nondialysis （CKD） with deficiency of spleen and kidney Qi， and the effect on renal interstitial fibrosis （RIF） and microinflammation. Method:One hundred and twenty patients were randomly divided into observation group and control group. A total of 58 patients in control group completed the treatment （including 2 patients falling off or lost）. And 58 patients in observation group completed the treatment （including 1 patient was falling off or lost visit， and 1 eliminated）. Both groups got comprehensive treatment of western medicine. Patients in control group got simulated medicine of Shenwu Yishenpian， 4 pieces/time， 3 times/day. Patients in observation group got Shenwu Yishenpian， 4 pieces/time， 3 times/day. The treatment lasted for 6 months until the renal replacement therapy， and the 6-month follow-up was recorded. For every month， blood creatinine （SCr） was detected， and glomerular filtration rate （eGFR） were calculated. The 12-month renal replacement （dialysis or kidney transplantation）， progress （CKD4 to CKD5） and mitigation （CKD5 to CKD4 or CKD4 to CKD3） were recorded. Before and after treatment， levels of urea nitrogen （BUN）， hemoglobin （HB）， plasma albumin （ALB）， urine protein quantity （24 hUp） and blood uric acid （UA） levels were detected， deficiency of spleen kidney Qi was scored， and transforming growth factor-β1 （TGF-β1）， connective tissue growth factor （CTGF）， serum Klotho， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， interleukin-1 （Lkn-1） and interleukin-12 （IL-12） were detected. And the safety was evaluated. Result:At the 3th and 6th after treatment， SCr in two groups increased （P<0.01）， while eGFR decreased （P<0.01）. Compared with control group， SCr was less than that in control group （P<0.01）， whereas eGFR was higher than that in control group （P<0.01）. During 12 months of observation， the reduction rate of CKD was 13.79% （8/58）， which was higher than 1.72% （1/58） in control group. The progress rate of CKD was 11.43% （4/35）， which was lower than 31.58% （12/38） in control group （P<0.05）. Levels of BUN， 24 hUp and UA were lower than those in control group （P<0.01）， while levels of Hb and ALB were higher than those in control group （P<0.01）. Effect in observation group was better than that in control group （Z=2.051， P<0.05）. And levels of TGF-β1， CTGF， TNF-α， IL-6， Lkn-1 and IL-12 were lower than those in control group （P<0.01）， and level of Klotho was higher than that in control group （P<0.01）. There was no adverse reaction relating to Shenwu Yishen Pian. Conclusion:Shenwu Yishenpian can delay the progress of renal function and CKD， reverse the progress of renal function in some patients， reduce the risk factors of disease progress， reduce the state of micro inflammation and resist RIF， and protect or improve renal function. Its clinical effect is better than placebo， and it is safe to use.
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Objective: To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis (PD) and investigate its effect on peritoneal fibrosis and microinflammation.Method: The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study, and divided into control group (32 cases) and study group (33 cases) according to the random number table. The control group received routine treatment. The study group received routine treatment+Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and 3 months after treatment to measure serum creatinine (SCr) and urea nitrogen (BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein (24 h UP) was measured by colorimetry; glomerular filtration rate (eGFR) was calculated; residual renal function (RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence, including interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) levels. Serum Janus Kinase (JAK) 2 as well as signal transducer and activator of transcription (STAT) 3 levels were determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). E-cadherin and α-smooth muscle actin (α-SMA) levels were determined by Western blot.Result: Before treatment, there was no significant difference in the residual renal function between two groups. After treatment, the residual renal function of the study group was significantly better than that of control group (PPα in study group were lower than those in control group (PPPα-SMA protein was significantly increased after treatment (Pα-SMA protein after treatment.Conclusion: Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients, and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body, showing a high application value.
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Objective: To analyze the therapeutic effect and mechanism of Yishen Simiaotang on gouty nephropathy (GN) complicated with renal failure (RF). Method: Totally 96 cases of GN with RF treated at our hospital from March 2015 to December 2017 were divided into the control group (48 cases) and the observation group (48 cases) according to the random control principle. In addition to the basic therapy, allopurinol was added to the control group, and Yishen Simiaotang was added to observation group. After 2 months of treatment, the clinical efficacy and safety of two groups were compared. The urinary levels of β2-microglobulin (β2-MG), α1-microglobulin (α1-MG), 24 h urine protein (24 hUpro) and glomerular filtration rate (eGFR) were compared between two groups before and after treatment, and the levels of serum albumin (ALB), urea nitrogen (BUN), serum creatinine (SCr) and uric acid (UA) were detected and compared before and after the treatment. The serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and hypersensitivity C reactive protein (hs-CRP) were compared before and after treatment between two groups. Result: The total effective rate of observation group was 89.58%, which was significantly higher than 72.92%of control group (χ2=4.376,PPβ2-MG, α1-MG, 24 hUpro in both groups decreased significantly (PPα, hs-CRP and IL-6 in both groups were significantly lower than those before treatment, and the decrease in observation group was more obvious than that in control group (PConclusion: Yishen Simiaotang is effective in the treatment of GN combined with RF, and can reduce renal tubule injury, improve renal function, regulate the state of micro-inflammation, with a high safety.
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Objective To study curative efficacy of Angelica containing selenium in treatment of chronic renal failure and its effects on Micro-inflammatory state.Methods A total of 80 patients of chronic renal failure who received therapy from March 2014 to March 2015 in our hospital were selected as research objects,and divided into observation group and control group,40 patients in each group.The control group was treated with routine treatment,while the observation group was treated with routine treatment with selenium enriched Angelica.Then renal function indicators including blood urea nitrogen(BUN),serum creatinine (SCr),hemoglobin(Hb)levels changes,micro inflammatory state including C reactive protein(CRP),interleukin-6 (IL-6),tumor necrosis factor (TNF-a) level changes,TCM syndrome points,treatment efficacy of two groups before and after treatment were compared.Results After treatment,BUN,SCr in observation group were less than those in the control group[(16.08±3.29)mmol/L vs.(21.50±3.68)mmol/L,(330.21±81.96)μmol/L vs.(390.86±84.24)μmol/L],Hb was higher than that in the control group[(107.38±7.37)g/L vs.(98.27±6.36)g/L](P<0.05).CRP,IL-6,TNF-α in observation group were less than those the control group[(5.92±1.14)mg/L vs.(7.26±2.02)mg/L,(24.75±7.12)pg/mL vs.(41.08±9.07)pg/mL,(112.16±20.16)ng/L vs.(134.46±22.16)ng/L],the differences were statistically significant(P<0.05).The score of TCM syndrome in observation group was smaller than that in control group[(5.01±1.21)score vs.(9.36±2.43)score],the difference was statistically significant(P<0.05).The total effective rate of the observation group after therapy was better than the control group[95.00%(38/40) vs.75.00%(30/40)],The difference was statistically significant(P<0.05).Conclusion Angelica containing selenium is well for chronic renal failure,which could effectively improve the micro inflammatory state,and could improve the therapeutic effect.
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OBJECTIVE:To investigate the effects of L-carnitine on inflammatory factor,oxidant stress index and cardiac func-tion in patients with maintenance hemodialysis. METHODS:One hundred and twenty maintenance hemodialysis patients selected from our hospital during Dec. 2014-Feb. 2016 were randomly divided into observation group and control group,with 60 cases in each group. Control group received maintenance hemodialysis for 1 month,and then was given rhEPO injection 3000 IU subcuta-neously,3 times a week. Observation group was additionally given Levocarnitine for injection 2 g,iv,qod,1 day after hemodialy-sis,on the basis of control group. Two groups were treated for consecutive 3 months. The levels of inflammatory factors (IL-6, TNF-α,CRP),oxidant stress indexes(MDA,GSH-Px,SOD)and cardiac function indexes(CO,LVEF,LVST)were observed in 2 groups before and after treatment;the occurrence of ADR was recorded. RESULTS:There was no statistical significance in in-flammatory factor,oxidant stress index and cardiac fuaction before treatment between 2 groups(P>0.05). After treatment,the lev-els of IL-6,TNF-α,CRP and MDA in observation group were decreased significantly,while the levels of GSH-Px,SOD,CO and LVEF were increased significantly,compared to before treatment;the improvement of above indexes in observation group were sig-nificantly better than control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups during treat-ment. CONCLUSIONS:L-carnitine can effectively alleviate the micro-inflammatory state in maintenance hemodialysis patients and protect myocardial function with good safety.
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Objective:To investigate the relationship of micro-inflammation,cellular and humoral immune function and kidney disease of patients with diabetic nephropathy. Methods:124 cases of DN were randomly divided into normal albuminuria group ( NA, n=35),microalbuminuria group (MA,n=45) and clinical albuminuria groups(CP,n=44) based on 24 h urinary albumin excretion rate ( UAER) and the healthy subjects were selected as the control group ( n=35 ) . The levels of C-reactive protein ( CRP ) were measured with radioimmunoassay,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and humoral immunity(IgG enzyme-linked immunosorbent assay,IgA,IgM) were measured with ELISA. The levels of immune response ( CD4+Th17,Th17/Treg, CD4+ CD25+ Treg) were measured with flow cytometry cellular. The levels of creatinine ( Scr) ,cystatin C ( CYSC) and UAER of each groups were analyzed with fully automated biochemistry. Results:The levels of CRP,IL-6,TNF-α,Scr,CYSC,UAER of NA group,MA group,CP groups were higher than control groups(P<0. 05),the levels of CRP,IL-6,TNF-α,Scr,CYSC,UAER of CP groups were higher than NA,MA group (P<0. 05). The levels of CD4+CD25+ Treg,IgG were lower than the control group (P<0. 05),while the levels of CD4+ CD25+ Treg,IgG of CP groups were higher than NA group,MA group (P<0. 05). The levels of IgA,IgM,Th17/Treg, CD4+ Th17 of NA group,MA group,CP groups were higher than control groups(P<0. 05). The levels of CRP,IL-6,TNF-α were positively correlated with Scr, CYSC, UAER ( P<0. 05 ) and were negatively correlated with Th17/Treg, CD4+CD25+ Treg, IgG ( P<0. 05). Conclusion:DN patients with micro inflammatory status and immune function disorder,through the control or elimination of pro-inflammatory factors,improve the immune function of DN patients to delay the occurrence and progress of DN patients has important significance.
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OBJECTIVE:To investigate the effects of calcitriol on related indicators in patients with chronic renal failure (CRF). METHODS:114 patients with CRF were randomly divided into observation group(57 cases)and control group(57 cas-es). Control group was given high-quality low-protein and low phosphorus diet,if necessary,phosphate binders,Calcium D3 tablet and other conventional treatment;observation group was additionally given 0.25 μg Calcitriol soft capsule,once a day. The treat-ment course for both groups was 8 weeks. Serum levels of inflammatory factors,alkaline phosphatase,hemoglobin,erythrocyte, serum creatinine and urea nitrogen levels and adverse reactions in 2 groups before and after treatment were observed. RESULTS:Before treatment,there were no significant differences in the serum levels of inflammatory factors,alkaline phosphatase,hemoglobin, erythrocyte,senum creatininine and ureanitrogen between 2 groups(P>0.05). After treatment,serum inflammatory factors,alkaline phosphatase,serum creatinine and urea nitrogen levels in 2 groups were significantly shorter than before,and observation group was lower than control group,the differences were statistically significant (P0.05). And there was no obvious adverse reac-tions between 2 groups during treatment. CONCLUSIONS:Based on the conventional treatment,calcitriol can reduce the levels of serum inflammatory factors and improve micro-inflammatory state and renal function in patients with CRF.
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Objective To study the correlation of serum hepcidin with residual renal function and micro-inflammation state in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods Thirty-four stable CADP patients were involved in this study as observers (CAPD group),who had accepted CAPD treatment more than three months; twenty non-dialysis patients with stage 5 of chronic kidney disease were selected as control group.According to the level of high sensitivity Creactive protein (hs-CRP),CAPD patients were divided into two subgroups.There were 14 patients in the hsCRP elevated group (hs-CRP ＞ 3.00 mg/L) and 20 patients in the hs-CRP normal group.In addition,there had been 14 patients with residual renal function in CAPD group.Serum hepcidin was measured by ELISA.Serum Ferritin (FER),hs-CRP,routine blood and biochemistry were measured by routine methods.Calculated estimated glomerular filtration rate (eGFR).Pearson correlation and linear regression were used to assess the correlation of serum hepcidin with other laboratory parameters in CAPD patients.Results (1) Serum hepcidin was significantly higher in CAPD patients than control group,but eGFR was significantly lower (P ＜ 0.01).(2) Serum hepcidin levels of no residual renal function patients increased more significantly in CAPD group (P ＜ 0.05).(3) Serum hepcidin levels were higher in hs-CRP elevated group than hs-CRP normal group (P ＜ 0.05).(4) Pearson correlation analyses revealed that serum hepcidin was positively correlated with hs-CRP (r=0.501) and FER (r=0.847,all P ＜ 0.01),and was negatively correlated with Hb (r=-0.919),TRF (r=-0.751),TIBC (r=-0.532,all P ＜ 0.05).(5) Multiple linear regression analysis showed that ferritin and hs-CRP were closely associated with serum hepcidin level in CAPD.Conclusions Serum hepcidin level markedly elevate in CAPD patients,especially in the patients with no residual renal function and micro inflammatory state increased more significantly.
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Objective To investigate the effects of meliorated renal failure decoction (MRFD) on renal function and inflammatory cytokines in patients with CKD 3-4 stages. Methods Sixty-two patients with CKD 3-4 stages were divided into treatment group and control group through random number table method. Both groups were given conventional treatment of western medicine, and the treatment group was given MRFD additionally. After 6 months of treatment, the changes of TCM symptom scores, Hb, Scr, BUN, 24 h UP, IL-6, IL-8, TNF and eGFR were observed. Meanwhile, the clinical efficacy was evaluated. Results The total clinical effective rate in treatment group was 65.63%(21/32), and 30.00%(9/30) in the control group (P0.05). Conclusion MRFD can improve TCM syndrome and renal function, delay the progress of patients with CKD at 3-4 stage by means of reducing the inflammatory cytokines and inhibiting micro-inflammatory state.
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Objective To investigate secretory IgA change in uremic patients ane its relationship with inflammation. Methods Sixty uremic noneialysis patients( uremic non eialysis group)ane 60 hemoeialysis patients( hemoeialysis group ),the other 40 healthy volunteers( control group ) were selectee as our subjects. Enzyme linkee immunosorbent assay( ELISA)methoe were appliee to eetect the fecal secretory IgA content. Immune nephelometry were usee to measure the level of high sensitivity C reactive protein(hs-CRP). Results The level of fecal secretory IgA expression in hemoeialysis group((2. 39 ± 0. 81)μmol/ L)ane the non eialysis group((2. 43 ± 0. 84)μmol/ L)were significantly lower than that of the control group((2. 89 ± 0. 87)μmol/ L),ane the eifference was significant(F = 5. 042,P 0. 05). The negative correlation was seen between secretory IgA content ane hs-CRP in patients(r = - 0. 629,P < 0. 01). Conclusion The secretory IgA eecreasee in patients with or without uremic eialysis ane it is correlatee with inflammatory state.
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Objective To compare the different micro inflammatory states between pafients undergone peritoneal dialysis and the pafients of chronic renal failure without dialysis,and to observe the condition of the occurrence of the micro inflammatory state in the peritoneal dialysis patients.Methods This study included 53 peritoneal dialysis patients who were followed-up in our dialysis center,34 chronic renal failure patients without dialysis and 47 normal controls,hs-CRP,IL-6,IL-8,TNF-? in venous blood were defected with empty stomach,and then compare the number of patients in each group.Results Patients'hs-CRP of the group of the PD is lower than that in the group of the chronic renal failure without dialysis,and higher than that in the normal people(P