Effect Of Xiaojianzhong Decoction On Improving PEW In Hemodialysipatients

Objective: 1.To Survey the PEW morbidity among the patients who are maintenance hemodialysis in our blood purification center in order to provide the basis for early nutritional intervention.2.To observe the clinical curative effect of Xiaojianzhong Decoction dealing with protein-energy wasting(PEW)in hemodialysis patients.3.To explore the mechanism of Xiaojianzhong Decoction to improve PEW by observing the relationship between inflammatory mediators and PEW and to reveal the correlation between PEW and the type of primary disease.Methods:1.From January 2018 to December 2019,186 patients was evaluated by the nutritional evaluation MQSGA scale through the method of fixed-point continuous sampling,in fact 60 patients with MQSGA score >10 were evaluated,and the PEW morbidity was calculated.2.From June to September in 2019,51 patients with maintenance hemodialysis in the blood purification center of the Affiliated Hospital of traditional Chinese medicine of Southwest Medical University,aged 45-84 years,who met the inclusion criteria,were randomly divided into 2 groups according to the random number table method.According to different treatment methods,they were divided into Xiaojianzhong Decoction group and blank control group.Xiaojianzhong Decoction group wastreated with basic therapy combined with Oral administration of Xiaojianzhong Decoction,and the blank control group was treated with basic therapy only,all of which were tested with open method,and the intervention lasted for 12 weeks.Follow up and fill in the clinical observation form,including the record of the general status,nutritional indicators,body surface measurements,inflammatory factors,MQSGA score,patient quality of life score by SF-36,etc.Finally,the statistical analysis was used to evaluate the effect of Xiaojianzhong Decoction on PEW in patients with maintenance hemodialysis.Results:1.Morbidity:The prevalence of PEW in patients with long-term maintenance hemodialysis in our blood purification center was 32.3%.2.The total effectiveness:Based on the assessment of the growth of the upper arm muscle circumference after treatment,among the 28 patients in xiaojianzhong tang group,There were13 patients(46.43%)showed significant effect,10patients(35.71%)were effective,and 5 patients(17.86%)were ineffective.The total effective rate was 82.14%.Among the 23 patients in the control group,2 patients(8.7%)showed significant effect,8 patients(34.78%)were effective,and 13 patients(56.52%)were ineffective.The total effective rate was 43.48%.The effect of xiaojianzhong decoction group was significantly better than that of the control group,with statistically significant difference(p<0.01).3.Nutrition indicators: PA,ALB and TC after treatment with Xiaojianzhong Decoction group were higher than before(p<0.05),and TIBC were significantly higher thanbefore(p<0.01),but without TG(p>0.05).There were no significate differences between these indicators before and after treatment in the control group.After treatment,the increase of PA,ALB and TC in the xiaojianzhong decoction group were more significant than those in the control group(p<0.05),the increase of TIBC was significanly(p<0.01).4.Body surface measurements: in study group,weight,BMI,TSF,MAMC,and MAC were all increased compared with before(p<0.01),HGS was increased(p<0.05).There was little change in body surface measurement indexes in the control group(p>0.05).After12 weeks of treatment,MAMC and MAC in xiaojianzhong decoction group were increased obviously more than those in the control group(p<0.01).5.MQSGA scores:After treatment,MQSGA scores of xiaojianzhong decoction decreased obviously(p<0.01),but control group not decreased(p>0.05).The oupdecrease was more significant in xiaojianzhong decoction group than control group,with statistically significant difference(p<0.05).The difference of nutritional status of xiaojianzhong decoction group that was good(1 case,accounting for 3.57%),mild to moderate(25 cases,accounting for 89.29%),severe(2 case,accounting for 7.14%)after treatment,compared with 0 cases,16 cases(57.14%)and 12 cases(42.86%)before treatment,was statistically significant(p<0.05).There was no significant difference in MQSGA grade changes between the two groups after treatment(p>0.05).6.Inflammation factors: After treatment,hs-CRP in Xiaojianzhong Decoction group were decreased(p<0.05),IL-6 and TNF-? in Xiaojianzhong Decoction group were decreased significantly(p<0.01),while there were no changed in control group(p>0.05),The decrease of IL-6 and TNF-? in Xiaojianzhong decoction group was more than that in the control group(p< 0.05).7.SF-36 quality of life score: in Xiaojianzhong Decoction group,the total score of SF-36 and the scores of the following dimensions MCS was increased after treatment(p<0.01),and PCS was increased after treatment(p<0.05).However,there was no significant improvement in the control group(p>0.05).MCS and PCS in xiaojianzhong decoction group were increased significantly more than those in the control group(p<0.01).Conclusion: 1.The prevalence of PEW in our dialysis center is 32.3%,and the mainly primary disease is diabetic nephropathy.2.Xiaojianzhong decoction can effectively improve the PEW in hemodialysis patients in order to improve the quality of life and prolong the survival period by means of strengthening the spleen and Qi and improving the appetite of patients.3.Xiaojianzhong decoction can reduce the levels of hs-CRP,IL-6,TNF-? inflammatory factors,and modulate the micro inflammatory status in maintenance hemodialysis patients,in order to improve the PEW of maintenance hemodialysis patients.