Influence of Addition and Subtraction Therapy of Zhenwutang to Residual Renal Function and Nutritional Status of Patients with Maintenance Hemodialysis / 中国实验方剂学杂志

Objective:To discuss influence of addition and subtraction therapy of Zhenwutang to residual renal function （RRF）， nutritional status， dialysis adequacy and quality of life of patients with maintenance hemodialysis （MHD）. Method:One hundred and thirty-six patients were randomly divided into control group （68 cases） and observation group （68 cases） by random number table. Patients in two group got MHD， 3 times/week， 4 h/time， levocarnitine injection （1 g dissolved in 5-10 mL water for injection） after the dialysis， 2-3 min/time， recombinant human erythropoietin injection with subcutaneous injection for 4 weeks， 3 000 U， 3 times/day， valsartan capsules for 3 months， 80 mg/time， 1 time/day. The control group took Manshenning mixture， 35 mL / time， 3 times / day.Patients in observation group added addition and subtraction therapy of Zhenwutang for 3 months， 1 dose/day. Before and after treatment， urea nitrogen （BUN）， creatinine （CR） and 24 hours' urine volume were recorded. And RRF， rate of decrease of RRF and rate of decrease in urine volume were also calculated. Levels of hemoglobin （HB）， albumin （ALB）， prealbumin （PA） and transferrin （TRF） were detected. After treatment， standardized protein metabolism rate （nPCR）， urea clearance index （Kt / V） and glomerular filtration rate （EGFR） were discussed. And improved subjective comprehensive nutrition assessment （SGA）， dialysis related quality of life （kdta） and health survey summary （SF-36） were graded. Six months' follow-up， primary end point event （24 h urine volume ≤ 400 mL） and no residual renal function （24 h urine volume ≤ 400 mL） were recorded. Result:Levels of RRF， Kt/V， nPCR， eGFR， Hb， Alb， PA， TRF and total scores of KDTA and SF-36 in observation group were higher than those in control group （P<0.01）. And score of SGA， rate of decrease of RRF and rate of decrease in urine volume were less than those in control group （P<0.01）.Incidence rate of primary end point event was 27.94%（19/68） lower than 47.06%（32/68） in control group （χ2=5.302， P<0.05）， incidence rate of no residual renal functionwas 17.65%（11/68） lower than 36.76%（25/68） in control group （χ2=6.274， P<0.05）. And BUN and Cr were lower than those in control group （P<0.01）， 24 h urine volume was more than that in control group （P<0.01）. Conclusion:Addition and subtraction therapy of Zhenwutang can maintenance of RRF， improvement of nutritional status， improvement of dialysis adequacy and quality of life of patients .

[Influence of inhibitors of nitric oxide synthase and L-arginine on the survival rate in a rat model of traumatic shock].

OBJECTIVE: To investigate the influence of inhibitors of nitric oxide synthase (NOS) and L-arginine on the survival rate in a rat model of traumatic shock. METHODS: A rat model of traumatic shock was established by fracturing the posterior limb of the rat. Nomega-nitro-L-arginine-methyl ester (L-NAME, non-selective NOS inhibitor, 10 mg/kg), amino- guanidine (AG, selective inducible nitric oxide synthase (iNOS) inhibitor, 100 mg/kg) and L-arginine (L-Arg, the precursor of nitric oxide (NO) synthesis 100 mg/kg) were injected intravenously during resuscitation,survival time and survival rate were observed. RESULTS: There were no significant changes in survival time and 24-hour survival rate between L-NAME ((23.80+/-9.09) hours and 40 percent) and control group (18.78+/-4.64)hours and 10 percent, both P>0.05); the survival time of AG group (28.72+/-6.25) hours and L-Arg group (30.64+/-8.77) hours prolonged apparently (both P<0.01), and 24-hour survival rate was also increased (both 80 percent, both P<0.01). CONCLUSION: Selective iNOS inhibitor AG and L-Arg exert beneficial effects on after traumatic shock rats.

[L-arginine decreases P-selectin expression in traumatic shock].

OBJECTIVE: To investigate the changes of P-selectin distribution in the vital organs and plasma during traumatic shock and explore the significance of these changes. METHODS: Twenty-four normal SD rats were randomly assigned into 3 groups (n=8), namely traumatic shock group, L-arginine (L-Arg) treatment and control group. The rats in the former 2 groups were subjected to traumatic shock with L-Arg treatment group given 100 mg/kg L-Arg during resuscitation while the other receiving no medication. The control group received only intubation without trauma or phlebotomy. P-selectin expression in the vital organs including the heart, lungs, spleen, liver and small intestine was determined by means of streptavidin-biotin (SABC) immunocytochemical staining technique and serum P-selectin level assayed by enzyme-linked immunosorbent assay. RESULTS: Before traumatic shock, P-selectin was scarcely detected in the vital organs except the lungs, and the serum was positive for P-selectin expression. Four hours after shock, intense P-selectin expression was observed in almost all the vital organs and the serum P-selectin level was significantly higher than that of the control group. In L-Arg treatment group, P-selectin levels were significantly lowered than those of shock group. CONCLUSIONS: P-selectin expression in the vital organs and serum is up-regulated during traumatic shock in rats, possibly due to severe microcirculatory disorder and endothelial dysfunction in this condition. L-Arg may decrease the expression of P-selectin very likely through promoting endothelial NO synthesis.

[Therapeutic effect of L-arginine on traumatic shock in rats].

OBJECTIVE: To evaluate the therapeutic effect of L-arginine (L-Arg) on traumatic shock in rats and explore the possible mechanisms. METHODS: Rat models of traumatic shock were established in Sprague-Daulay rats, which were randomly divided into two groups either to receive L-Arg treatment or not. The plasma concentration of endothelin (ET) and oxygen partial pressure in the tissues from the skeletal muscles, liver and small intestine were measured before and after the shock and 1, 3, and 5 h after resuscitation. The hemodynamics of the rats and their survival rates at 12 and 24 h were recorded. RESULTS: The changes of plasma ET levels and oxygen partial pressure in tissues of both groups were statistically significant after traumatic shock (P<0.05). Plasma ET concentration at 5 h after resuscitation was significantly lower in the treatment group than in the non-treatment shock group (P<0.05), while oxygen partial pressure in the liver and small intestine after resuscitation were significantly higher in the treatment group (P<0.05). The survival rates at 12 and 24 h were also significantly different between the 2 groups. CONCLUSION: Adscititious L-Arg can decrease plasma ET levels, improve oxygen partial pressure of internal organs and significantly increase the survival rate of the rats with traumatic shock.

Dynamic changes in serum level of nitric oxide and its mechanisms in rats with traumatic shock.

OBJECTIVE: To investigate the dynamic changes of serum nitric oxide (NO) level and its mechanisms in rats in traumatic shock. METHODS: Rat models of traumatic shock were established by fracturing the posterior limb of the rats. Serum levels of nitrate/nitrite were measured with the method described by Griess. RESULTS: No significant changes in serum NO level took place during traumatic shock. One hour after resuscitation, however, serum NO level first underwent marked decline and then increased to the peak level at 6 h after resuscitation, retaining a high level till 24 h after resuscitation. No obvious changes of serum NO levels were observed in rats without resuscitation. CONCLUSION: Serum NO level does not significantly alter during traumatic shock, while after resuscitation, NO level increases after transient decrease, possibly due to reperfusion injury.