| Purpose:Observe Yishen Huoxue therapy's clinical efficacy on treating renal osteopathy of the patients with chronic renal insufficiency(CKD4-5).Based on the treatment of chronic kidney disease and symptomatic treatment of renal osteopathy,the patients who conform to the diagnostic criteria of renal osteopathy,apply Yishen Huoxue therapy for treatment,the comprehensive treatment of Western Medicine(basic treatment and symptomatic treatment)follows the related routine method to diagnosis and treat of western medicine;make an observation and contrast of clinical index and TCM syndrome,then judge the curative effect of treating this disease,so as to evaluate the clinical effect of Yishen Huoxue Method on treating patients with renal osteopathy,and understand Yishen Huoxue Method's advantage in the treatment of renal osteopathy,according to the theory and experimental research of this issue discuss the pathogenesis of renal osteopathy.Method:According to Professor Sun Wei's unique insights and rich clinical experience in clinical practice for decades on the treatment of chronic renal insufficiency and renal osteopathy,based on inheritance and development of Chinese medicine theory,combine with western medicine's newest treatment methods in recent years,apply TCM therapeutic scheme that combine with TCM differentiation and Western medicine differentiation,Yishen Huoxue Method to treat renal osteopathy.The study included 40 patients who met the criteria,and patients were divided into treatment group(20 persons)and control group(20 persons).The treatment group bases on the treatment of Western conventional high quality low protein low phosphorus diet,correcting anemia,correcting acidosis,calcitriol soft capsule etc,utilizes the tutor's experience of agreement party of Yishen Huoxue Prescription to conduct treatment based on syndrome differentiation,modify according to symptoms in clinical application,the control group applies the treatment of Western conventional high quality low protein low phosphorus diet,correcting anemia,correcting acidosis,controlling blood pressure,DN and blood glucose control of merged-diabetic patients with kidney disease etc,and take oral calcitriol soft capsules.To compared the physicochemical indexes of two groups before and after treatment(blood routine,liver and kidney function,PTH,etc.),imaging index(bone mineral density),TCM syndrome score and the changes of clinical symptoms(nutritional status,the incidence of adverse events,incidence,tongue and pulse changes fracture),and evaluate the clinical efficacy and safety of Yishen Huoxue Decoction in the treatment of renal osteodystrophy.Result:In 40 cases of renal osteopathy patients in this clinical study,there were 20 males and 20 females.Experimental results show that In the aspect of the patient's clinical symptoms improved in patients in the treatment group compared with the control group,the aversion to cold,waist and discomfort,joint pain,bone arthralgia,double lower limbs edema has significantly improved.The data were statistically significant.In the treatment group,20 patients improved after treatment with increasing serum calcium,reducing blood phosphorus and reducing blood PTH.The Ca in blood increased from 2.21 + 0.32 mmol/L to 2.41 + 0.29 mmol/L,P in blood dropped from 2.35 ±0.66 mmol/L to 1.85 ±0.61 mmol/L.In the control group,The Ca in blood increased from 2.19 ±0.35 mmol/L to 2.29 ±0.24 mmol/L,P in blood dropped from 2.33±0.77 mmol/L to 2.23 ± 0.58 mmol/L,After calculation,P<0.05,the data were statistically significant.From this we can see that Yishen Huoxue method is effective in the treatment of renal osteodystrophy.In the treatment group,The average PTH before treatment was 674.4±179.56,the average PTH after treatment was 354.2±145.72;in the control group,the average PTH before treatment was 695.2±201.6,average PTH after treatment was 581.9±123.5.PTH comparison between the two groups before and after treatment,the data were statistically significant,and the difference of PTH concentration between the two groups after treatment was statistically significant(P<0.05).In terms of renal function,two indicators of BUN and Scr were assessed.The total effective rate of the treatment group was 65%,The total effective rate of the control group was 49%.Comparing the treatment group and the control group after treatment of renal function(BUN,Scr),and through the two groups of data between the control,there is statistical difference.in the treatment group,the average bone density was-2.48±0.13 before treatment,after treatment the average bone density turned to-2.31 ±0.17,The t test showed that the imaging effect of the treatment group was statistically different(P<0.05).In the control group,before treatment,the average bone density was-2.34±0.15 and after treatment,the average bone density became-2.21±0.12.The t test showed that has statistical significance,and after treatment,the results of the treatment group and the control group were statistically significant(P<0.05).In terms of evaluation of symptoms and therapeutic effects of TCM.In the treatment group,15 patients were cured,4 patients showed marked effect and effectiveness and 1 patients were invalid.The effective rate was 95%.In the control group,2 patients were cured,16 patients showed marked effect and effectiveness and 2 patients were invalid.The effective rate was 90%.After statistical test,we get P<0.05,which is statistically significant.It can be explained that the combination of traditional Chinese medicine and Western medicine can improve the clinical symptoms of renal osteodystrophy.Safety analysis:The treatment group had no serious adverse events during the treatment period(3 months).during the treatment,the treatment group had no abnormality in blood routine,liver function,twelve lead electrocardiogram,routine fecal examination and content of potassium in electrolyte,which explained that Yishen Huoxue therapy was safe and reliable on patients with renal osteopathy and renal insufficiency.Conclusion:In this study,the treatment group was better than the control group in clinical efficacy,which had significant statistical difference.Yishen Huoxue therapy combined with western medicine's therapy and improvement in corresponding clinical indexes of patients,which had obvious curative effect in elevating serum calcium,reducing serum phosphorus and PTH,increasing bone density,improved the patient's clinical symptoms of joint pain,abdominal distension,edema,nausea and vomiting.It greatly improved the life quality of patients and the prognosis of the disease.The method reduced the incidence of fractures in patients with renal osteodystrophy,and also avoided the risk factors of cardiovascular,soft tissue calcification and so on.Considering the mechanism,Chinese medicine can improve the metabolism of calcium and phosphorus and inhibit the secretion of PTH in patients with chronic renal failure.The results show that Yishen Huoxue method has remarkable curative effect in the treatment of renal osteodystrophy,and is worthy of clinical application. |
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