| Hypertensive renal damage is a serious hypertensive complication,and it is also the second cause of end-stage renal disease(ESRD).The effective prevention and treatment of hypertensive renal damage is of great significance to prevent and delay the formation and progress of renal disease.Based on the guidance of the basic theory of traditional Chinese medicine,the clinical effect of Zishen Pinggan Decoction was studied from both clinical and experimental aspects,and its effect on renal damage in two-kidney one-clip hypertensive rat(2K1C-RHR)and its regulation in TGF β-1/Smads signal pathway were observed to explore the possible mechanism of its effect.Clinical study:Clinical Study of Zishen Pinggan Decoction on Hypertensive Renal Damage Type of Yin Deficiency and Yang HyperactivityObjective:1.To observe the effects of Zishen Pinggan Decoction on serum cystatin C(CysC),creatinine(Scr),urinary β2-microglobulin(β2-MG),urinary Microalbumin(mALB),N-acetyl-β-glucosaminidase(NAG)and blood pressure,and to further explore the therapeutic effect of Zishen Pinggan Decoction on hypertensive renal damage,so as to provide relevant scientific basis for the treatment of hypertensive renal damage with traditional Chinese medicine.2.To observe the effect of Zishen Pinggan Decoction on TCM syndromes of hypertensive renal damage and explore its related rules.Methods:The samples of 60 cases of hypertensive renal damage in Yangzhou Hospital of Traditional Chinese Medicine were collected.The treatment group and the control group were randomly set up,and different intervention treatments were given.Among them,the scheme of the control group was lifestyle intervention,health education and routine western medicine treatment.In addition to the basic therapy consistent with the control group,the treatment group was added with Zishen Pinggan Decoction,once a day,200ml each time,taken in the morning and evening after meals,4 weeks of treatment,a total of 3 courses.Observe and compare the changes of blood pressure,laboratory examination,single integral and total integral of TCM syndrome before and after treatment,record data and statistical analysis,based on which to analyze and judge the clinical effect.Results:1.Based on the comparison of age,sex,height,weight and course of disease between groups,there was no statistical significance(P>0.05).that is,there was no significant difference between the two groups.2.TCM syndrome score:Zishen Pinggan Decoction can effectively improve the TCM syndrome of patients,especially vertigo,headache,dysphoria In Chestpalms-soles,palpitation,which is in line with the statistical requirements(P<0.05).3.The blood pressure of the two groups changed in different degrees before and after treatment,and it was in line with the statistical requirements from the comparison of the decrease of blood pressure between the two groups(P<0.05).4.Laboratory inspection:Comparing the changes of urine β2-MG,urine mALB,NAG,Scr and CysC before and after treatment,there was no significant difference in the control group except NAG(P>0.05),and the difference in the treatment group was statistically significant(P<0.05).The difference between the two groups after treatment was statistically significant except Scr(P<0.05),suggesting that the performance of the treatment group was better than that of the control group.5.Clinical efficacy:In terms of blood pressure changes,4 patients(13.33%)showed significant effect in the control group,and 24 patients(80.00%)in the treatment group,with statistical significance.The efficacy of TCM syndromes is 80.00%in the treatment group and 53.00%in the control group,which is statistically significant(P<0.05).6.In the course of the study,there were no adverse events.Conclusion:Taking Zishen Pinggan Decoction according to the course of treatment can effectively reduce blood pressure,CysC,urine mALB,urine β 2-MG and NAG,in patients with hypertensive renal damage,improve TCM syndromes such as vertigo,headache,dysphoria In Chestpalms-soles and palpitation,delay the course of disease and improve the quality of life.Experimental study:protective effect and mechanism of Zishen Pinggan Decoction on renal damage in two-kidney one-clip hypertensive ratsObjective:To observe the protective effect of Zishen Pinggan Decoction and its effect on TGF β1/Smads signal pathway in the model of renal damage in two kidney clip hypertensive rats(2K1C-RHR).Methods:The 2K1C-RHR model was replicated and evaluated at 4 weeks.32 successful rats were selected and randomly divided into model group,irbesartan group,the large-dose treatment group,the low-dose treatment group.Then,8 SD rats of the same age were selected to establish a sham operation group,and the samples of each group were given intragastric administration without difference for 8 weeks.At the same time,the tail artery systolic blood pressure was measured at 4 weeks and 2,4,6,8 weeks after gavage.After treatment,urine mALB,NAG,urine β2-MG,BUN,SCr,CysC were measured.The pathological changes of renal tissue were observed and compared,and the expression of p-Smad2/3 and TGF β1 was detected by Western blotting(Westernblotting).Results:1.According to the results of blood pressure,the blood pressure in irbesartan group and high dose treatment group were significantly lower than those in model group(P<0.05,P<0.01).2.Compared with the model group,the large-dose treatment group’s levels of urine mALB,NAG,β 2-MG,serum SCr and CysC decreased significantly(P<0.05,P<0.01).3.From the point of view of renal pathological injury,the high dose treatment group was greatly alleviated.4.From the expression of p-smad2/3 and TGF β1,irbesartan group and high dose treatment group were significantly down-regulated.Compared with the model group,the difference was statistically significant(P<0.01).Conclusion:Zishen Pinggan Decoction has the effect of protecting kidney damage caused by hypertension,and the specific mechanism may be related to the inhibition of TGF β1/Smads signal pathway. |
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