| [objective]To evaluate the effect of meliorated renal failure decoction(MRFD)on renal tissue oxygenation in CKD3-4 patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome caused by primary glomerulonephritis(PGN)by using blood oxygen level-dependent magnetic resonance imaging(BOLD MRI).[methods]CKD3-4 patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome caused by primary glomerulonephritis were randomly divided into control group(39 cases)and treatment group(39 cases),with a total of 78 cases.During the study,5 cases in the control group fell off,5 cases in the treatment group fell off,and finally 68 cases were included in the statistical analysis,including 34 cases in the control group and 34 cases in the treatment group.The control group was treated with the integrated treatment scheme + Niaoduqing granules,and the treatment group was treated with the integrated treatment scheme + meliorated renal failure decoction(MRFD).Observe for 6 months.Before and after treatment,observe:(1)clinical effect and TCM syndrome effect comparison;(2)BOLD MRI(T2: the oxygenation level of bilateral renal cortex and medulla);(3)laboratory indicators: renal function(SCr,Bun,e GFR);uric acid(UA);plasma albumin(Alb);24-hour urinary protein quantity(24h UP);(4)safety indicators: blood routine,liver function and ECG and possible adverse reactions.[results]1 Baseline comparisonBefore treatment,contrasting gender,average age,course of the disease,TCM symptom scores,BOLD MRI(T2),SCr,Bun,e GFR,UA,Alb,Hb,24 h UP and other indicator,there were no statistically significant difference between the control group and treatment group(P>0.05).The two groups were comparable.2 Comparison of clinical efficacy of PGN(CKD3-4)patients in two groups after treatmentThe total effective rate of clinical efficacy was 82.35% in the treatment group,and that was 55.88% in the control group.The difference was statistically significant by rank sum test(P<0.01),and the treatment group was superior to the control group.3 Comparison of curative effect of TCM syndromes between the two groups of PGN(CKD3-4)patients after treatmentThe total effective rate of TCM syndromes curative effect was 94.12% in the treatment group,and that was 67.65% in the control group.The difference was statistically significant by rank sum test(P<0.05),and the treatment group was superior to the control group.4 Comparison of biochemical indexes of PGN(CKD3-4)patients between two groups after treatmentAfter treatment,the Scr and Bun in the treatment group were decreased significantly(P<0.01).After treatment,the e GFR in the treatment group was improved significantly(P<0.01).After treatment,the Alb in the treatment group was improved significantly(P<0.05).After treatment,the SCr in the treatment group was lower than that in the control group(P<0.01).After treatment,the Bun in the treatment group was lower than that in the control group(P<0.05).After treatment,the e GFR in the treatment group was higher than that in the control group(P<0.01).After treatment,the24 h UP of the patients in the treatment group was decreased significantly(P<0.05).It is suggested that meliorated renal failure decoction(MRFD)can reduce the SCr,the Bun and the 24 h UP,increase the Alb and glomerular filtration rate in PGN(CKD3-4)patients with spleen kidney deficiency and damp heat stasis type.5 Comparison of renal oxygenation of PGN(CKD3-4)patients in two groups after treatment(1)Comparison of oxygenation in the renal cortex: After treatment,T2 of the left renal cortex,T2 of the right renal cortex,`T2 of the bicortical cortices(`T2 of the bicortical cortex: mean value of the left and right renal cortices)in the treatment group were improved significantly(P<0.01).After treatment,T2 of the left renal cortex and`T2 of the bilateral renal cortices in the treatment group were higher than those in the control group with statistical significance(P<0.05).(2)Comparison of oxygenation in renal medulla: After treatment,T2 of the left renal medulla,T2 of the right renal medulla,`T2 of the bicortical medullas(`T2 of the bicortical medullas: mean value of the left and right renal medullas)in the treatment group were improved significantly(P<0.01).After treatment,T2 of the left renal medulla,T2 of the right renal medulla and`T2 of the bicortical medullas in the treatment group were higher than those in the control group with statistical significance(P<0.05).In conclusion,it is suggested that meliorated renal failure decoction(MRFD)can improving renal cortical and medullary oxygenation in PGN(CKD3-4)patients.6 Comparison of glomerular filtration rate and renal oxygenation level Pearson in PGN(CKD3-4)patients between two groupsThere was a significant positive correlation between the cortical`T2 and medulla`T2 of both kidneys and e GFR in the treatment group before and after treatment.It indicated that there was a significant positive correlation between glomerular filtration rate and renal oxygenation in CKD patients.It increases the glomerular filtration rate by improving the renal oxygenation,and thus improve the renal function of CKD patients.[conclusion](1)On the basis of modern integrated treatment,adding Meliorated renal failure decoction(MRFD)can improve the clinical efficacy and TCM syndrome of PGN(CKD3-4)patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome.(2)The oxygenation of renal medulla was lower than the renal cortex in PGN(CKD3-4)patients,suggesting that renal medulla was more prone to hypoxia than renal cortex.(3)Meliorated renal failure decoction(MRFD)can reduce the Scr,Bun and increase the glomerular filtration rate of PGN(CKD3-4)patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome.(4)Meliorated renal failure decoction(MRFD)can improve the oxygenation level of renal tissue(including bilateral renal cortex and medulla)in PGN(CKD3-4)patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome.(5)There was a significant positive correlation between renal oxygenation level(including bilateral renal cortex and medulla)and glomerular filtration rate(e GFR)in PGN(CKD3-4)patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome.The renal function of CKD patients may be improved by increasing the oxygenation of renal tissue.(6)The improvement of the renal function(increased e GFR)in PGN(CKD3-4)patients with Spleen and Kidney Deficiency Type or Damp Heat Stasis Syndrome may be related to the improvement of renal oxygenation(increased T2). |
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