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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 investigate the effect of hemodiafiltration combined with Jinshuibao tablet on serum inflammatory factors and oxidative stress indices in patients with diabetic nephropathy. Methods:A total of 86 patients with diabetic nephropathy who received treatment in The Second People's Hospital of Liaocheng from April 2019 to April 2020 were included in this study. They were randomly assigned to receive either hemodiafiltration (control group, n = 42) or hemodiafiltration combined with Jinshuibao tablet (observation group, n = 44). Microinflammatory state, oxidative stress index level, renal function and nutritional status were compared between the two groups. Results:Before treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in the control group were (30.13 ± 3.25) ng/L, (9.43 ± 2.57) mg/L, (46.69 ± 3.54) ng/L respectively, and they were (30.16 ± 3.34) ng/L, (9.48 ± 2.65) mg/L, (46.73 ± 3.38) ng/L respectively in the observation group. There were no significant differences in these indices between the two groups (all P > 0.05). After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in the control group were (16.69 ± 2.73) ng/L, (8.12 ± 2.21) mg/L, (35.63 ± 2.75) ng/L, respectively, and they were (12.34 ± 2.52) ng/L, (6.47 ± 1.53) mg/L, (26.65 ± 2.13) ng/L, respectively in the observation group. After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels in both groups were significantly lower than those before treatment (control group: t = 20.52, 2.50, 15.99; observation group: t = 27.60, 6.16, 32.57, all P < 0.05). After treatment, serum interleukin-6, high-sensitivity C-reactive protein and tumor necrosis factor-α levels were significantly lower than those in the control group ( t = 7.68, 4.04, 16.97, all P < 0.05). Before treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the control group were (5.63 ± 1.36) nmol/L, (63.38 ± 7.56) mU/L, and (195.96 ± 26.36) IU/L, respectively, while those in the observation group were (5.68 ± 1.25) nmol/L, (63.25 ± 7.38) mU/L, and (195.83 ± 26.27) IU/L, respectively. There were no significant differences in these indices between the two groups (all P > 0.05). After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the control group were (4.83 ± 1.13) nmol/L, (83.46 ± 5.75) mU/L and (236.69 ± 18.75) IU/L respectively, while those in the observation group were (4.24 ± 0.86) nmol/L, (88.75 ± 5.47) mU/L and (258.76 ± 15.47) IU/L, respectively. After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in each group were superior to those before treatment (control group: t = 2.93, 13.70, 8.16, P = 0.002, < 0.001, < 0.001; observation group: t = 6.15, 17.99, 13.37, all P < 0.001). After treatment, serum levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase in the observation group were superior to those in the control group ( t = 2.73, 4.37, 5.96, P = 0.004, < 0.001, < 0.001). After treatment, blood urea nitrogen, serum creatinine and 24-hour urine protein in the observation group were significantly lower than those in the control group ( t = 7.85, 8.71, 2.06, P < 0.001, < 0.001, 0.021), and creatinine clearance rate in the observation group was significantly higher than that in the control group ( t = 3.01, P = 0.002). Total protein, prealbumin and albumin levels in the observation group were significantly higher than those in the control group ( t = 9.47, 12.13, 6.18, all P < 0.001). Conclusion:Hemodiafiltration combined with Jinshuibao tablet for the treatment of diabetic nephropathy has a positive effect on microinflammatory state and oxidative stress index level and improves patient's renal function and nutritional status.
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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 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 explore the impact of levocarnitine on microinflammatory state in hemodialysis patients with diabetic nephropathy(DN) .Methods Sixty outpatients and inpatients with DN in the Second Aid Hospital of Xinjiang Uygur Autonomous Region from January 2010 to December 2012 were selected as the research subjects according to the inclusion and exclusion stand‐ards and randomly divided into DN conventional treatment group (conventional treatment group ,n=30) and levocarnitine treatment observation group (levocarnitine treatment group ,n=30) .Contemporaneous 20 individuals undergoing the healthy physical exami‐nation were selected as the healthy control group ,DN was excluded .The two treatment groups were given the insulin therapy ,on the basis of the routine therapy the levocarnitine treatment group was added with levocarnitine oral solution (2 g daily) .The treat‐ment in both groups lasted for 3 weeks .The efficacy was observed and the indicators were detected before and after treatment ,in‐cluding interleukin‐6 (IL‐6) ,C‐reactive protein (CRP) ,tumor necrosis factor‐α(TNF‐α) ,urinary albumin excretion rate (UAER) , serum albumin (Alb) ,hemoglobin (Hb) ,endogenous creatinine clearance rate (Scr) ,total cholesterol (TG) and triglycerides (TC) .The above indicators in the healthy control group were detected in physical examination .Results The CRP ,IL‐6 ,TNF‐αlev‐els after treatment in the conventional treatment group and levocarnitine treatment group were higher than those in the healthy con‐trol group .The CRP ,IL‐6 and TNF‐αlevels after treatment in the levocarnitine treatment group were lower than those in the con‐ventional treatment group .The above 3 inflammatory cytokines levels after treatment in the levocarnitine treatment group were low‐er than before treatment .The TC ,TG and Ccr levels after treatment in the levocarnitine treatment group were lower than those in the conventional treatment group ,while the Alb and Hb levels were higher than those in the conventional treatment group ,the differences were statistically significant (P<0 .05) .Conclusion The microinflammation level after levocarnitine treatment in main‐tenance dialysis patients with DN is alleviated to some extent ,the renal function and nutritional status have certain improvement .
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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 investigate the effect of intra-dialytic exercises on micro-inflammatory state in maintenance hemodialysis (MHD) patients. Methods Sixty clinically stable MHD patients from the Hemodialysis Center were enrolled in the study . The patients were divided into exercise group and control group with 27 cases in each group by using the random digit number table. The patients in the exercise group underwent a 6-month intra-dialytic exercise, in which the patients conducted physical exercises supinely on a cycle ergometer each for 50 minutes, 3 times a week. The patients in the control group were treated without any exercise intervention. Serum interleukin-6(IL-6), C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α) were determined after the study for 0 and 6 months. Results After the 6-month intradialytic exercise program, serum IL-6, CRP and TNF-α were all decreased in the exercise group (P 0.05). Conclusion The intra-dialytic exercises can alleviate micro-inflamatory state in maintenance hemodialysis patients.
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Objective To observe the influence of hemoperfusion(HP) on microinflammatory state and atherosclerosis in uremic patients .Methods Thirty‐six patients with uremia were randomly assigned into 2 groups ,18 cases in eath group .The hemo‐dialysis(HD) group took hemodialysis for 3 times per week ,4 h per time;the HP+ HD group took once HP per week on the basis of HD .The levels of C‐reactive protein(CRP) ,total cholesterol(TC) ,triglyceride(TG) ,urea nitrogen(BUN) and serum creatinine (Cr) were measured before therapy and in six months after therapy .The atherosclerotic plaque size was detected by ultrasound with fine resolution .Results The levels of CRP ,TG and TC after treatment in the HP+ HD group were significantly decreased com‐pared with those before treatment and the HD group (P0 .05) .Conclusion HP can alleviate the inflam‐matory reaction and decrease the atherosclerosis occurrence .
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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 the effect of Niaoduqing Particles on the microinflammatory state in patients with maintenance hemodialysis. Methods Totally 240 patients with hemodialysis for more than 6 months were randomly divided into conventional hemodialysis group, Chinese medicine group (treated with Niaoduqing Particles) and western medicine group (treated with Vitamin E), 80 cases in each group, with 30 healthy people as control group. The levels of hs-CRP, IL-6 and HCY were detected before and after 1, 3, 6 months of treatment. Results Before treatment, the levels of inflammatory factors in hemodialysis patients were higher than control group. And after 3 months of treatment, the levels of hs-CRP, IL-6 and HCY of Chinese medicine group were decreased. And after 6 months of treatment, the levels of inflammatory factors were decreased obviously compared with pretherapy (P<0.01), and the difference with the conventional hemodialysis group was significant (P<0.01). Compared with pretherapy, the changes of inflammatory factors of western medicine group were statistically insignificant. Conclusion Niaoduqing Particles can significantly improve the microinflammatory state in maintenance hemodialysis patients, and the effect is superior to Vitamin E.
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Objective: To study the effects of levocarnitine on recombinant human erythropoietin (rhEPO) dose and microinflammatory state in maintenance hemodialysis patients. Methods: Totally 326 maintenance hemodialysis patients were randomly divided into 2 groups: the treatment group (n = 163) and the control group (n = 163). The age, gender, course of disease, and conventional treatments were similar in the 2 groups. To maintain the hemoglobin (HB) within 110-120 g/L and hematocrit (HCT) at 33%-35%, the treatment group was given levocarnitine and rhEPO, and the control group was given rhEPO only. The weekly dose of rhEPO (IU/kg) and the erythropoietin response index (ERI) were calculated and compared between the two groups 8 months later. Meanwhile, the serum high-sensitivity C-reactive protein (hs-CRP) was monitored in the 2 groups before and after 8 months. Results: The weekly dose of rhEPO required for the treatment group was significantly lower than that required for the control group ([106±20] IU/kg vs [141±23] IU/kg, P<0. 05); the treatment group also had significantly lower ERI compared with the control group ([0. 93±0. 11] IU · L · kg-1 · g-1 vs [1. 35±0. 29] IU · L · kg-1 · g-1, P<0. 05). Serum hs-CRP level in the treatment group was significantly decreased 8 months after treatment ([5. 21±3. 20] mg/L vs [10. 33±2. 54] mg/L,P<0. 05), and it was also significantly lower than that in the control group after the treatment ([5. 21±3. 20] mg/L vs [9. 93±2. 12] mg/L, P<0. 05). Serum hs-CRP levels were not changed significantly in the control group before and after the treatment. Conclusion: Levocarnitine can reduce the dose of rhEPO in MHD patients, which might be associated with improvements of the microinflammation and erythropoietin resistance in MHD patients.
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Objective To study microinflammatory status in patients of end-stage renal disease undergoing maintained hemodialysis (MHD) and the relationship between microinfl-ammatory status of end-stage renal disease and anemia, malnutrition, left ventricular function in maintained hemodialysis patients. Methods One hundred patients undergoing hemodialysis were divided into non-microinflammation group ( hs-CRP ≤ 3 mg/L) and microinflammation group ( hs-CRP > 3 mg/L) . The serum levels of hs-CRP, albumin, triglyceride ( TG) , total cholesterol(TC) , lipoprotein(a) [LP( a)] and serum creatinine ( SCr) were measured. The levels of hemoglobin (Hb) and hematocrit (Hct) were measured. The left atrial (LAD)and ventricular diameter(LVD) ,interventricular septum thickness (IVST) ,left ventricular posterior wall thickness (LVPW) ,left ventricular ejective fraction (EF), ratio of E/A were measured by color Doppler echocardiography, and left ventricular mass index (LVMI) was calculated. Blood pressure was measured in different 5 stages, and their relation were analysed. Results ①The levels of Hb, Hct, Alb in microinflammation group were lower than those in the control group(t =2. 83 ,P <0.01; t=2.34, P<0.05;t = 5.30,P <0.01, respectively), the level of LP(a) was higher than that in the non-microinflammation group(t = 2. 68, P < 0. 05 ). ②The levels of LAD, LVD, LVPW, IVST, LVMI in the elevated microinflammation group were higher than those in the control group (P < 0.05), the levels of EF and E/A were lower than those in the non-microinflammation group ( P < 0. 05 ) .③ Blood serum hs-CRP concentration was negatively correlated with the level of Hb,Hct(r= -0. 283,P <0. 05;r = -0. 308,P <0.05;r = -0.387,P< 0. 01, respectively ) , and positively correlated with LP ( a ) ( r = 0.427, P < 0. 05 ) . Blood serum hs-CRP concentration was positively correlated with LVD,IVST,LVMI (P <0. 05) and negatively correlated with EF,E/A (P<0.05). ④hs-CRP, Hb, Hct, Kt/V, Alb, Lp(a) ,SBP and PP were risk factors of abnormal left ventricular structure and function. Conclusions In patients undergoing maintenance hemodialysis, the persistent increase of hs-CRP indicates the presence of microinflammation hs-CRP might.be a indicator of the anemia, nutrition status and left ventricular structure and function. Elevated hs-CRP is an independent risk factor of abnormal left ventricular structure and function.