Effect Of Colonic Dialysis Combined With Yishen Decoction On Serum SIRT1 And TLR4 Levels In Elderly Non-dialysis Patients With CKD Stage 3-5

Objective:To observe the effect of colonic dialysis combined with Yishen decoction on serum SIRT1 and TLR4 levels in elderly non-dialysis patients with CKD stage 3-5,and to explore the therapeutic value of colonic dialysis combined with Yishen decoction on elderly patients with CKD,in order to provide more treatment options for elderly patients with CKD.Method:Using a prospective study method,patients with CKD who attended our nephrology department from December 2021 to October 2022 were used as the study population,and finally selected 93 patients according to the inclusion and exclusion criteria,and randomly divided into three groups:the control group,the colonic dialysis group and the colonic dialysis combined with Yishen decoction group.The control group was given conventional medical treatment,the colonic dialysis group was given conventional medical treatment+colonic dialysis,and the colonic dialysis combined with Yishen decoction group was given conventional medical treatment+colonic dialysis+retention enema with Yishen decoction.Basic information of the patients,routine biochemical indexes and serum SIRT1 and TLR4 levels before and after 4 weeks of treatment were collected.Serum SIRT1 and TLR4 levels before and after treatment were measured by enzyme-linked immunosorbent assay(ELISA),and the data were analyzed by using SPSS22.0 statistical software.Results:1.Comparison of general information in the three groups: there was no statistically significant difference(P>0.05)in the comparison of primary disease,CKD stage,gender,age,body mass index(BMI).2.Comparison of biochemical indexes before treatment in the three groups:hemoglobin(Hb),total protein(TP),albumin(Alb),parathyroid hormone(PTH),calcium(Ca),phosphorus(P),magnesium(Mg),kalium(K),sodium(Na),chloride(Cl),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),serum creatinine(Scr),blood urea nitrogen(BUN),uric acid(UA),erythrocyte sedimentation rate(ESR),high sensitivity C-reactive protein(hsCRP),SIRT1,TLR4 were compared before treatment,and the difference was not statistically significant(P>0.05).3.Comparison of biochemical indexes before and after treatment in each group: Scr,BUN,UA decreased in the control group after treatment compared with those before treatment(P<0.05).After treatment,SIRT1 increased(P<0.05)and Scr,BUN,UA,ESR,hs-CRP,TLR4 decreased(P<0.05)in the colonic dialysis group compared with those before treatment.After treatment,SIRT1 was significantly higher(P<0.05)and Scr,BUN,UA,ESR,hs-CRP,TLR4 were significantly lower(P<0.05)than before treatment in the the colonic dialysis combined with Yishen decoction group.4.Comparison of biochemical indexes after treatment in the three groups: compared with the control group,SIRT1 increased(P<0.05)and Scr,BUN,UA,ESR,hs-CRP,TLR4decreased(P<0.05)in the colonic dialysis group and the colonic dialysis combined with Yishen decoction group after treatment.Compared with the colonic dialysis group,SIRT1 was significantly increased(P<0.05)and Scr,BUN,UA,ESR,hs-CRP,TLR4 were significantly decreased(P<0.05)in the colonic dialysis combined with Yishen decoction group after treatment.5.Correlation analysis of SIRT1,TLR4 and other biochemical indicators after treatment:Pearson and Spearman correlation analysis suggested that SIRT1 was negatively correlated with Scr(r=-0.453,P=0.014),BUN(r=-0.586,P<0.001),UA(r=-0.443,P<0.001),ESR(r=-0.447,P=0.017),hs-CRP(r=-0.443,P=0.019),TLR4(r=-0.468,P=0.009).TLR4 was positively correlated with Scr(r=0.561,P<0.001),BUN(r=0.555,P<0.001),UA(r=0.410,P<0.001),ESR(r=0.465,P=0.010),hs-CRP(r=0.460,P=0.012).Conclusion:1.Colonic dialysis and colonic dialysis combined with Yishen decoction can both improve the level of toxins and inflammation in elderly non-dialysis patients with CKD stage 3-5 and delay the progression of renal function,and the effect of colonic dialysis combined with Yishen decoction is significantly better than that of colonic dialysis;2.Colonic dialysis combined with Yishen decoction may play a protective role in kidney by increasing serum SIRT1 level and down-regulating TLR4 level in elderly nondialysis patients with CKD stage 3-5.