| Background and Purpose:Malnutrition is prevalent in patients with peritoneal dialysis(PD),and clinical manifestations are mainly due to inadequate dietary and calorie intake,low body mass index(BMI),hypoalbuminemia,micro-inflammatory state,and progressive skeletal muscle depletion,which severely affect the survival and prognosis of peritoneal dialysis patients.There are many causes of this malnutrition,such as decreased protein intake,accumulation of uremic toxins,gastrointestinal dysfunction,protein loss,micro-inflammatory status,metabolic acidosis and so on.At present,modern medicine has not made new breakthroughs in improving the malnutrition status in peritoneal dialysis patients,and Chinese medicine research has achieved certain effects in improving the malnutrition,but most of them are focus on the observation of clinical efficacy,and the relevant mechanism is not yet clear.Therefore,they are particularly important to further clarify the role of Chinese medicine in improving peritoneal dialysis patient of malnutrition,and explore its related mechanisms of action.Shen Ning ? is an empirical prescription of Professor Yao's treatment of the Chronic renal failure,which has achieved good therapeutic effect in clinical therapy.This prescription has the therapeutic effects of nourishing the kidney,activating blood,supplementing Qi,developing blood,removing blood stasis,removing collaterals and removing detoxification.The clinical symptoms of peritoneal dialysis patients showed more than the deficiency of spleen and kidney,lack of blood-based,blood stasis syndrome as the standard.Therefore,in this experiment,the four Chinese medicines of Hangqi,Danggui,Shouwu,and Chuanxiong were used to observe the expression of albumin mRNA about total protein and albumin in serum,dialysate,and liver tissue in malnourished rats with peritoneal dialysis,to explore the mechanism of its malnutrition state in the traditional Chinese medicine,in order to further guide and help clinical applications.Methods:Model rats were intragastrically perfused with 25%adenine liquid for 4 weeks.The successful model rats were randomly divided into model group(M),high-dose HuangqiDanggui group(AH),low-dose Huangqi danggui group(AL),high-dose ShouwuChuanxiong group(BH),low-dose ShouwuChuanxiong group(BL),high-dose combination group(CH)and low-dose combination group(CL).The normal group was injected intraperitoneally with normal saline 100ml/(kg.d),and the remaining ones were intraperitoneally injected with 2.5%peritoneal dialysis fluid 100ml/(kg.d)to construct a model of peritoneal dialysis.At the same time of peritoneal dialysis,the normal and the model group were given normal saline 15ml/(kg.d)to gavage,and each treatment groups were given the corresponding drugs to gavage for 5 weeks.The weight of rats were recorded before and after the treatment of traditional Chinese medicine.Before the end of the experiment,the rats were collected and measured for urinary protein quantification,and the Peritoneal Equilibration Tests were performed to record the dialysis fluid drainage.and give the dialysate to check the creatinine,urea nitrogen,total protein,albumin and glucose.After the end of the experiment,the rats were sacrificed and blood was collected to measure the levels of serum creatinine,urea nitrogen,total protein and albumin in each group of rats.Rat liver and parietal peritoneum tissues were collected and observed under light microscope after hematoxylin and eosin(HE)staining.The expression of albumin mRNA in rat liver tissue was detected by real-time fluorescent quantitative PCR(RT-qPCR).All experimental data were statistically analyzed using SPSS17.0 software,P<0.05 was considered statistically significant,and P<0.01 was considered statistically significant.Results:(1)Biochemical indicators of blood and urine:The body weight,serum total protein and albumin levels in the model group were significantly lower than those in the normal group(P<0.01).The 24-hour urinary protein,serum creatinine and urea nitrogen levels were significantly higher than those in the normal group(P<0.01).The 24-hour urinary protein quantification in each Chinese medicine intervention group was significantly lower than that in the model group(P<0.01).The levels of serum total protein and albumin were higher than those in the model group.Except for the low-dose group of HangqiDanggui,the others had significant differences(P<0.05).The levels of serum creatinine and urea nitrogen in the treatment groups were decreased in different degrees compared with the model group.The high-dose group of HangqiDanggui,the high-dose group and low-dose group of ShouwuChuanxiong,the high-dose group of Combination were more obvious than the model group(P<0.01).(2)Peritoneal function:Compared with the normal group,the peritoneal ultrafiltration volume of the model group was significantly reduced(P<0.01),the total protein and albumin levels in the dialysate were significantly higher(P<0.01).Compared with the normal group,the scavenging function of the small molecule solute creatinine and urea nitrogen were decreased,and the reabsorption of glucose were increased significantly in the model group and the treatment groups(P<0.01).Compared with the model group,the peritoneal ultrafiltration volume of the high-dose and low-dose groups of HangqiDanggui,the high-dose and low-doses of ShouwuChuanxiong were increased(P<0.05);there was no significant difference in the D/P Urea index between the Chinese medicine treatment groups(P>0.05).The D/P Cr index in the low-dose group of HangqiDanggui,the high-dose and low-dose group of ShouwuChuanxiong were lower than the model group(P<0.05);The reabsorption of glucose was significantly less in the high-dose group of HangqiDanggui and the high-dose of ShouwuChuanxiong,than in the model group(P<0.05).The total protein and albumin levels in dialysate of high-dose group of Shouwu Chuanxiong and high-dose group of Combination were significantly lower than those of model group(P<0.01).(3)Pathological changes of peritoneal tissue:Under the light microscope,the peritoneal surface of normal rats was covered with a layer of intact and flat mesothelial cells,the subepithelial matrix was thin,fibroblasts,inflammatory cells and blood vessels were rarely seen in the matrix.The peritoneum in the model group was significantly thicker than that in the normal group,with hyperplasia and hypertrophy of the mesothelial cells on the surface,loss of local mesothelial cells,and even bare substrate.The subcutaneous connective tissue was swollen and loose,with obvious cellulose and inflammation in the matrix.Exudation of sexual cells;the remaining treatment groups compared to the model group,the above pathological changes have improved to varying degrees,manifested in reduced peritoneal thickening,mesothelial cell hyperplasia,reduced hypertrophy,reduced mesothelial cells,fibroblasts Cells,inflammatory cells,and vascular proliferation were reduced,among which the effect of high-dose group of ShouwuChuanxiong and the high-dose group of Combination were more obvious.(4)Expression of albumin mRNA in liver tissue of rats:Expression of albumin mRNA in liver tissue of model group and treatment groups were significantly lower than that in the normal group(P<0.01).Compared with the model group,the expression of liver albumin mRNA in each treatment groups were increased significantly(P<0.01).Comparing the treatment groups,the expression level of liver albumin mRNA in the high-dose Combination group was significantly higher than that in other treatment groups(P<0.01).The liver albumin mRNA expression levels in the high and low-dose groups of ShouwuChuanxiong were lower than those in other groups,and there was no significant difference in liver albumin mRNA expression among the other treatment groups(P>0.05).Conclusion:Traditional Chinese Medicine can reduce urinary protein,serum creatinine and urea nitrogen levels,increase serum total protein and albumin levels,and reduce the pathological changes of the peritoneal tissues in rats with peritoneal dialysis malnutrition to a certain extent.These were good for improving improving the status of this malnourished.The relevant mechanisms may be related to the up-regulation of albumin mRNA expression in liver tissue by Chinese medicine,and the promotion of hepatic protein synthesis and reduction of protein loss during dialysis. |
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