| Objective: To explore the effect of Tongluo Digui decoction on non-dipping blood pressure,urinary sodium excretion,and renin-angiotensin-aldosterone system activity in stage Ⅳ diabetic kidney disease(DKD)patients,and provide theoretical basis for Tongluo Digui decoction in the treatment of DKD.Methods: A total of 80 patients who were diagnosed with DKD Ⅳ period,merging the nondipping blood pressure and with syndrome differentiation of Yin deficiency and blood stasis during2019.01 and 2020.03 in nephrology,endocrinology clinic or hospital in Henan Province Hospital of Traditional Chinese Medicine were chosen.The random number table method was used to divide the patients into the control group and the observation group,each group with 40 patients.The control group was given basic treatments like antihypertensive,hypoglycemic,and lipid-lowering.And the observation group was given Tongluo Digui decoction on the basis of the control group.After 8 weeks of treatment,renal function indexes,Traditional Chinese Medicine(TCM)syndrome scores,blood pressure changes,blood pressure variability,non-dipping blood pressure reversals,urinary sodium,plasma aldosterone,renin,and angiotensin II receptor levels were compared between the two groups.And adverse reactions were recorded between the two groups.Results:1.Comparison of renal function,proteinuria and blood glucose: serum creatinine,urea nitrogen,24 h urinary protein and Hb A1 c in the two groups were significantly lower than before treatment(P<0.05),estimated glomerular filtration rate(e GFR)increased(P<0.01);serum creatinine and 24 h urinary protein levels in observation group were significantly lower than those in control group(P<0.05),and e GFR was significantly higher than those in control group(P<0.01);2.Comparison of TCM syndrome scores: the TCM syndrome scores in the observation group significantly decreased after treatment(P<0.01),but there had no significant differences in the control group(P>0.05).The TCM syndrome scores decreased more significantly in the observation group than that of the control group(P<0.05);3.Comparison of blood pressure: 24 h SBP,d SBP,n SBP and n DBP in the observation group were significantly lower after treatment(P<0.01);24 h SBP and d SBP in the control group were significantly lower than before treatment(P<0.01);The 24 h DBP,n SBP and n DBP decreased more significantly in the observation group than those of the control group(P<0.05);4.Comparison of blood pressure variability: 24 h SBPCV,d SBPCV,n SBPCV and n DBPCV significantly decreased in the observation group(P<0.01),d SBPCV significantly decreased in the control group(P<0.01).The observation group’s n SBPCV and n DBPCV were significantly lower than the control group(P<0.01);5.Comparison of non-dipping blood pressure reversal rate: after treatment,the proportion of nondipping blood pressure in observation group decreased(P<0.05),but there was no significant difference in control group(P>0.05).The proportion of non-dipping blood pressure in the observation group were significantly lower than the control group(P<0.05).The reversal rate of dipping blood pressure in observation group was 60%,which was higher than 35% in control group(P<0.05).6.Comparison of urinary sodium excretion level and renin-angiotensin-aldosterone system activity:the level of 24 h urinary sodium significantly increased(P<0.05),while plasma aldosterone decreased(P<0.05)in the observation group,plasma aldosterone level significantly decreased in the control group(P<0.05);there was no significant difference in 24 h urine sodium,plasma aldosterone,renin and angiotensin II receptor levels between the observation group and control group(P>0.05).Conclusions:1.Tongluo Digui decoction can improve renal function of DKD stage IV patients,reduce serum creatinine,urea nitrogen,proteinuria and blood glucose level,increase e GFR;2.Tongluo Digui decoction can significantly relieve the TCM clinical symptoms of DKD stage IV patients and improve the quality of life;3.Tongluo digui decoction can reduce the nocturnal blood pressure of DKD stage IV patients,alleviate the variability of nocturnal blood pressure,reverse non-dipping blood pressure,and restore blood pressure rhythm;4.Tongluo digui decoction can increase the 24 h urinary sodium level in DKD stage IV patients,with relatively high safety and without significant effect on RAAS. |
