| Objective:The purpose of the research was to observe the efficacy of Yunpiqiangsheng Fang in the treatment of chronic kidney disease protein-energy wasting(CKD-PEW)and its effect on serum IGF-1 and ALB levels,so as to explore the mechanism of the treatment of CKD-PEW.Method:In this clinical research,51 patients in ckd4-5 phase with PEW diagnosis were divided into 27 cases in the treatment group(7 cases in CKD stage 4,4 cases in 5 stage,16 cases in 5D stage)and 24 cases in the control group(4 cases in CKD stage 4,5 cases in 5 stage,15 cases in 5D stage).These two groups were given conventionalest wern medicine treatment,including high-quality protein diet(non-dialysis patients with protein intake of 0.4-0.6g/kg·d,dialysis patients with protein intake of 1.0-1.2g/kg·d),blood pressure control,Correct anaemia,adjust calcium and phosphorus metabolism and other treatments.Among them,the treatment group added traditional Chinese medicine Yunpiqiangsheng Fang on the basis of conventional Western medicine treatment,and the control group added Compound ?-Ketoacid Tablets(ketosteril)on the basis of conventional Western medicine treatment,4 tablets/time,3 times a day,with a treatment period of 3 months.During the research period,the researchers observed the TCM syndrome scores,anthropometric indicators,MQSGA scale and hemoglobin(Hb),serum albumin(ALB),Changes in triglyceride(TG),cholesterol(CHOL),urea nitrogen(BUN),creatinine(Scr),insulin-like growth factor(IGF-1)and other indicators.In experimental research,60 male SD rats were selected and fed adaptively for 1 week,and 10 male SD rats were randomly selected as a blank control group and fed with normal diet.The CKD-PEW rat model established by 50 rats in the remaining studies was modelled by feeding adenine and low-protein feed into a mixed feed for 3 weeks.After successful modelling,the rats in the model group were randomly divided into a model group,ketosteril group and Yunpiqiangsheng Fang high-dose group and low-dose group.In the research,the model group was given 0.5%sodium carboxymethylcellulose(CMC-Na)for gastric gavage treatment.In the research,the drug intervention group began to treat the ketosteril group,Yunpiqiangsheng Fang high-dose group and Yunpiqiangsheng Fang on the first day after modelling the low-dose group was treated with gavage.Observe the weight of rats after gavage treatment of these groups for 4 weeks,collect blood from the femoral artery to collect serum to detect serum TP,ALB and IGF-1,and collect liver to detect IGF-1 mRNA expression by fluorescence quantitative PCR and other indicators.Result:Clinical research(1)Comparison of the baseline between the two groups:before treatment,there was no significant difference between the two groups in gender,age,course of the disease,primary disease,CKD stage,TCM syndrome score,anthropometric index,SGA score and laboratory index,so it was comparable(P>0.05).(2)Comparison of TCM syndrome scores of the two groups:in the group comparison,the TCM syndrome scores of the treatment group decreased in the first,second and third months after treatment compared with that before treatment,and the difference was statisticallly significant(P<0.05).In contrast,that of the control group decreased in the first,second and third months after treatment compared with that before treatment,and the difference was statistically significant in the second and third months(P<0.05).The difference between the two groups before and after treatment was compared.The difference in the first,second and third months in the treatment group was lower than that in the control group.The difference in the second and third months was statistically significant(P<0.01).The treatment group was better than the control group in improving the main symptoms of deficiency of spleen and kidney qi,such as fatigue,shortness of breath and laziness,weakness of waist and knee,and poor appetite(P<0.05).(3)Comparison of BMI,AC,TSF,AMC and SGA between the two groups:?Before and after treatment,there was no significant difference in BMI(P>0.05);?AC:compared with that before treatment,the AC of the two groups increased at each time point after treatment,the difference was statistically significant(P<0.05).The difference between the two groups before and after treatment was more significant than that in the control group(P<0.01).? TSF:within the group,compared with before treatment,the TSF of the two groups was significantly higher at each time point after treatment,the difference was statistically significant(P<0.05).The difference between the two groups before and after treatment was significantly higher than that in the control group(P<0.05,P<0.01).?AMC:compared with before treatment,after treatment,each time point of the two groups was significantly higher,the difference was statistically significant(P<0.05).There was no significant difference between the two groups(P>0.05).?SGA scale:compared with before treatment,the scores of the two groups were significantly lower after treatment(P<0.05).The differences between the two groups before and after treatment were statistically significant(P<0.01,P<0.05,P<0.01).(4)Before and after treatment,Hb,ALB,TG and CHOL were compared between the two groups:?Hb:comparison within the group,compared with before treatment,HB level in the treatment group and the control group after treatment were slightly higher than before treatment,but there was no significant difference between the two groups(P>0.05).?Serum ALB:compared with before treatment,the level of Alb in the two groups after treatment was higher than before,and the difference was statistically significant(P<0.05).There was no significant difference between groups before and after treatment(P>0.05).?TG,CHOL:compared with before treatment,there was no significant difference in TG,CHOL levels between the two groups after treatment(P>0.05).(5)The comparison of serum BUN and SCR of Non dialysis between the two groups before and after treatment:in the two groups,there was no significant difference between the two groups(P>0.05).(6)Comparison of serum IGF-1 level between the two groups:the results showed that the IGF-1 level in the two groups increased at each time point after treatment compared with that before treatment,and the difference was statistically significant(P<0.05).The difference between the two groups was statistically significant in the third month after treatment,and the increasing trend of the treatment group was more obvious than that of the control group(P<0.05).Experimental research(1)General situation:rats in the blank control group were more alert,with a normal diet,glossy hair and normal weight growth.After three weeks of feeding with adenine and low protein diet,the rats in the model group showed mental state depression,poor glossiness of hair,accompanied by depilation,taking less food and drinking more water.After modelling,compared with the blank control group,bun and SCR in the model group increased significantly,ALB decreased significantly(P<0.01).Under HE staining light microscope,there were a large number of inflammatory cells infiltration and renal interstitial fibrosis in the model group,which indicated that CKD-PEW rat model was successful.In the third week of modelling,one rat died in the model group,and six rats died before the end of modelling.After drug intervention,all rats died,including two rats in the model group,three rats in the same group,two rats in the high dose group and three rats in the low dose group.(2)After administration,the changes of body weight in each group:after three weeks of feeding with adenine and low protein feed,the body weight of rats in the model group was significantly lower than that in the blank control group,and the difference was statistically significant(P<0.01).Compared with the model group,each time point after administration of the same group increased compared with the model group.Still,the difference was statistically significant(P<0.01)until the fourth week compared with the model group,and each time point after administration of high and low dose Yunpiqiangsheng Fang rats' body weight increased compared with the model group,and the difference was statistically significant(P<0.05,P<0.01).Compared with Kaitong group,there was no significant difference in body weight of high-dose group of traditional Chinese medicine in the first,second and third weeks,and there was significant difference in body weight of low-dose group of traditional Chinese medicine in the second week(P<0.05),and there was no significant difference in other periods(P>0.05).(3)The changes of serum TP and ALB in each group:compared with the model group,after treatment,the difference between ketosteril group and Yunpiqiangsheng Fang high-dose group was statistically significant(P<0.01),and the difference between the low-dose group and the model group was statistically significant(P<0.05).There was no significant difference between the high dose group and low dose group(P>0.05).(4)Comparison of serum IGF-1 in each group:? compared with the blank control group,the content of serum IGF-1 in the model group was lower than that in the blank control group,and the difference was statistically significant(P<0.01).? compared with the model group,the serum IGF-1 of ketosteril group and high dose group was higher than that of the model group,the difference was statistically significant(P<0.01).There was no significant difference between the low dose group and the model group(P>0.05).?compared with ketosteril group,the serum IGF-1 level in high dose group was higher than that in ketosteril group,and that in the low dose group was lower than that in ketosteril group(P<0.05).(5)Expression of IGF-1 mRNA in liver tissue of each group:compared with the blank control group,the expression of IGF-1 mRNA in liver tissue of rats in the model group was lower than that in the blank control group,and the difference was statistically significant(P<0.01).Compared with the model group,the expression of IGF-1 mRNA in Yunpiqiangsheng Fang high dose group and ketosteril group was higher than that in the model group,and the difference was statistically significant(P<0.01).The expression of IGF-1 mRNA in Yunpiqiangsheng Fang low dose group was higher than that in the model group,but the difference was not statistically significant(P>0.05).Compared with ketosteril group,there was no significant difference between Yunpiqiangsheng Fang high dose group and ketosteril group(P>0.05),and the difference between low dose group and ketosteril group was statistically significant(P<0.05).Conclusion:(1)On the basis of conventional treatment of Western medicine,Yunpiqiangsheng Fang can improve the clinical symptoms of CKD-PEW patients such as fatigue,shortness of breath,weakness of waist and knee,poor appetite.It is better than compound ?-ketoacid tablet in increasing the anthropometric indexes AC,TSF and reducing the score of MQSGA.It has the same effect as compound ?-ketoacid tablet in increasing the level of serum ALB.(2)Yunpiqiangsheng Fang can improve the nutritional status of CKD-PEW rat model established by feeding the mixture of adenine and low protein feed.(3)The mechanism of Yunpiqiangsheng Fang in improving CKD-PEW may be related to up-regulating the expression of IGF-1mmRNA in liver tissue and promoting the synthesis of albumin in the liver. |
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