Clinical Study On Regulating T Cell Subsets In CKD3-4 Patients By Invigorating Spleen And Kidney And Drain Turbidity Method

Objective:To observe the effect of Chinese herbal compound Shenshuai Recipe on T cell subsets(CD4~+,CD8~+,CD4~+/CD8~+)and related cytokines(IL-2,IL-6,TGF-?1)in patients with stage 3-4 of CKD,and to further elaborate the potential relationship between pathogenesis of deficiency,dampness and Stasis Toxin in TCM and T cell subsets and related factors of chronic kidney disease,so as to improve CKD3-4 for kidney failure prescription(invigorating spleen,benefiting kidney and eliminating turbidity).The immune function status and renal function improvement of patients in stage A provide clinical objective basis.Methods:From March 2018 to October 2018,63 patients in nephrology department of Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were collected.It also conforms to the diagnostic criteria of TCM symptoms of spleen and kidney Qi deficiency and dampness and blood stasis syndrome.They were randomly divided into treatment group(32 cases)and control group(31 cases)according to the order of hospitalization.The patients in the control group were given CKD routine treatment.The patients in the treatment group were treated with Chinese medicine compound Shenshuai Decoction on the basis of the treatment in the control group.The treatment course was 4 weeks,and three courses were observed.T cell subsets were detected by flow cytometry,IL-2,IL-6and TGF-?were detected by ELISA,Scr and Bun in serum were detected by automatic biochemical analyzer,and eGFR was calculated by MDRD formula.TCM syndrome integral and clinical efficacy of patients were evaluated by the principles of TCM diagnosis and treatment of chronic kidney disease in Guiding Principles for Clinical Research of New Chinese Medicine.(1)Pearson or Spearman correlation analysis was used to explore the relationship between T cell subsets and clinical data of patients with CKD;(2)comparison of renal function,total score of TCM symptoms and clinical efficacy of the two groups before and after treatment;(3)comparison of T cell subsets(CD4~+,CD8~+,CD4~+/CD8~+),serum interleukin-2(IL-2),serum interleukin-6(IL-6),blood transforming growth factor?1(TGF-?1)before and after treatment.Result:(1)T cell subsets(CD4~+,CD8~+,CD4~+/CD8~+)were not correlated with sex,age,body mass index,renal function,IL-2,IL-6 and TGF-?1 in the treatment group and the control group.Scr,BUN in renal function were not correlated with T cell subsets.estimated glomerular filtration rate(eGFR)was not correlated with CD4~+,CD8~+,but positively correlated with the ratio of CD4~+/CD8~+(r=0.96,P<0.01);CD8+was not correlated with IL-2,IL-6,TGF-?1 in T lymphocyte subsets;CD4~+and CD4~+/CD8~+were correlated with the changes of IL-2,IL-6 and TGF-?1,among which CD4~+was positively correlated with IL-2(r=0.37,P<0.05),CD4~+was negatively correlated with IL-6 and TGF-?1.(r=-0.38,P<0.05;r=-0.38,P<0.05;r=-0.54,P<0.05;r=-0.54,P<0.05);CD4~+/CD8~+was positively correlated with IL-2(r=0.42,P<0.05),CD4~+/CD8~+was negatively correlated with IL-6and TGF-?1(r=-0.42,P<0.05;r=-0.58,P<0.05);CD8~+was not significantly correlated with IL-2,IL-6,TGF-?1(r=0.21,P=0.103>0.05;r=-0.04,P=0.73>0.05;r=-0.30,P=0.02<0.05);(2)The treatment group and the control group improved renal function(Scr,BUN,eGFR)after treatment:Scr and BUN in the treatment group decreased,while eGFR in the treatment group increased significantly;Scr in the control group decreased and eGFR in the blood increased,but there was no significant difference in BUN in the control group(P=0.16>0.05),and the treatment group improved renal function(Scr,BUN,eGFR)significantly better than the control group;(3)Treatment group and control group in improving TCM syndrome scores:two groups of patients in the treatment of scaly dry skin,limb numbness two secondary symptoms of TCM have no significant change(P>0.05);other TCM syndrome scores have been improved,and the improvement of patients in treatment group is better than that of control group(P<0.01);(4)The total effective rate of the treatment group was 81.3%and that of the control group was 58.1%.The clinical effect of the treatment group was better than that of the control group(P=0.034<0.05);(5)The treatment group and the control group improved the immune function of T lymphocyte subsets(CD4~+,CD8~+,CD4~+/CD8~+)after treatment:CD4~+,CD8~+,CD4~+/CD8~+in the treatment group increased,but CD8~+in the normal range before and after treatment;CD4~+,CD4~+/CD8~+in the control group also increased,but the improvement of CD8~+level was not significant(P=0.44>0.05),and the treatment group improved T lymphocyte subsets(P=0.44>0.05).The levels of CD4~+,CD8~+,CD4~+/CD8~+were significantly higher than those of the control group(P<0.01);(6)The effects of treatment group and control group on the levels of IL-2,IL-6 and TGF-?1 after treatment:After treatment,the levels of IL-2 increased in both groups,while the levels of IL-6 and TGF-?1decreased in both groups,and there were significant differences between treatment group and control group in the levels of IL-2,IL-6 and TGF-?1after treatment,The improvement of IL-2,IL-6 and TGF-?1 levels in the treatment group was significantly better than that in the control group(P<0.01).Conclusion:Chinese herbal compound ShenShuai Prescription can adjust the imbalance of T cell subsets immune function of CKD3-4 patients by Invigorating spleen,benefiting kidney and eliminating turbidity,improve the deteriorating renal function of patients,alleviate the main clinical symptoms of patients,and reduce the hospitalization cycle of patients.ShenShuai Prescription may regulate IL-2,IL-6 and TGF-?1 to increase the ratio of CD4~+,CD4~+/CD8~+,so as to restore the dysfunctional T cell subsets,thereby improving the patients'cellular immunity level to improve the deteriorating renal function,thereby delaying the progress of CKD patients.