| Objective:1. Syndrome research: To Preliminary Reveal the distribution of the syndrome after recently kidney transplantation, and analysis the factors affecting formation of Syndromes, aim to further explore the Main Pathogenesis after recently kidney transplantation.2. Clinical observation : To Preliminary observate the effect of shan-zhi Particles on the recipients after renal transplantation under immunosuppressive therapy, and explore the related mechanisms. To lay a foundation for further clinical research.Method:1. Syndrome research:42 recipients undergoing renal transplantation who met the criteria were included, a perspective method of observation was adopted to research, and the period of observation was in the 3 monthes after renal transplantation, the median observation time was 3.2±0.4 monthes.First to comprehensive survey the Chinese medicine literature of kidney transplantation, and develop the table of traditional Chinese medical four diagnostic information of kidney transplantation. The patient retumed visit every one monthe after discharge in 3 monthes in order to record the information. After finishing the observation, inputted the whole information to the database on the SPSS 13. 0. Then we conducted a cluster analysis of classification of the syndrome, and four diagnostic information. To the rating information ridit analysis and rank analysis was used.2. Clinical observation62 cases were included according the diagnostic standards, There were no statistical difference in the common indexes between two grouos before and after operation.In accordance with the prospective randomized open and control clinical study, the cases were divided into integrative medicine intervention group and the only western medicine intervention group. The cases in the integrative medicine intervention group were administrated Shan-zhi-Particles, the early resumption of observation time was in two weeks after operation and the attenuated efficiency of the recent observation of time was in 3 monthes after operation.To observate the indexes of early recovery after kidney transplant such as 24 hour urineserum, serum creatinine (SCr), Creatinine Clearance, renal artery resistance index, the indicators of acute rejection (the rate of occurrence of acute rejection and the rate of efficiency under the same treatment), the indicators of efficacy of Chinese medicine to reduce the side effects of immunosuppressant drug(the routine blood, urine test as well as the renal and liver function test, blood electrolytes, glucose, blood lipids, serum protein, serum uric, infection rate).Finally fill the raw data in the observed follow-up table. All statistical tests were conducted on SPSS 11. 0 statistical platform.Result:1.Syndrome research:1.1 The distribution proportion of TCM syndrome after kidney transplantationrecently.The distribution of deficiency syndrome as follows: kidney-deficiency (50%), syndrome of spleen deficiency(26. 2%), spleen-kidney Qi deficiency (14. 3% ), Liver-kidney yin Deficiency(9.5% ); The distribution of positiveSyndrome as follows: blood stasis syndrome (59.5%), damp-heat syndrome (31.0%), Damp-heat-stagnation-type (9.5%) . 1. 2 The influencing factors of TCM syndrome after kidney transplant recently1.2.1 course of diseaseThe majority of kidney deficiency Syndrome (76.2%) after kidney transplantation had longer course of non-dialysis chronic renal failure (2-6 years); while the majority of spleen Qi deficiency(63. 6%) had shorter course of non-dialysis chronic renal failure(<2 years) ; damp-heat Syndrome after kidney transplantation had relatively shorter course of non-dialysis chronic renal failure (<2 years 46.2%, 2-4 years 30.8%, 4-6 years 23.0 %) , while the blood stasis syndrome had longer course of non-dialysis chronic renal failure (<2years 20%, 2-4years 32%, 4-6years 44%) ; The majority of kidney deficiency Syndrome (71. 4%) after kidney transplantation had longer course of dialysis (2-6years) , while The majority (75.0%) of Liver-kidney yin Deficiency after kidney transplantation had relatively shorter course of dialysis (<2 years) ; damp-heat Syndrome after kidney transplantation had relatively shorter course of dialysis (<2years 61. 5) , while the blood stasis syndrome had longer course of dialysis (>2years 84 %).1.2.2 Acute rejectionThe ratio of acute rejection was 38.1% in kidney-deficiency, and 36. 0% in blood stasis syndrome which was highest of the the various syndromes.1. 2. 3 ImmunosuppressantsIn positive the syndrome the damp-heat Syndrome had been used large amount of hormones (10 mg dose of hormones more than 69. 2%), while In the deficiency syndrome the cases used hormone dosage over the maintenance (> 10 mg) followed by kidney-deficiency (47.6%) , syndrome of spleen deficiency (72.8%) , Liver-kidney yin Deficiency (100%) ; The concentration of cyclosporine (CsA concentration> 300 ng / ml) in the kidney deficiency and blood stasis syndrome was higher than other syndrome, and the proportion of the recipient was 66. 6% and 64.0%.1. 2. 4 InfectionThe recipients of the spleen- kidney deficiency syndrome was easy to infection, the ration of the infection was 72. 7%and66. 7%.2. Clinical observation 2.1 The indexes of early recovery after kidney transplantThe 24-H urine of treatment group was significantly greater than that of the control group( P<0. 05) in the 3th day, 5th day after operation; The serum creatinine (SCr) of treatment group was significantly lower than that of the control group( P<0.05); The Creatinine Clearance of treatment group was significantly greater than that of the control group( P<0.05); The renal artery resistance index of treatment group was significantly greater than that of the control group ( P<0. 05) in the 7th day, 14th day after operation.2. 2 The indexes of acute rejection.The rate of acute rejection in treatment group was 21.9% which was significantly lower than that of the control group( P<0. 05);The rate of efficiency under the same treatment in the treatment group was 100% which was significantly greater than that of the control group( P<0.05); the level of the IL-6, TNF-αin treatment group was significantly lower than that of the control group( P<0. 05).2. 3 The indicators of efficacy of Chinese medicine reducing the side effects of immunosuppressant drug.The erythrocyte and leukocyte in treatment group was significantly greater than that of the control group ( P<0. 05); AST and ALT in treatment group was significantly lower than that of the control group( P<0. 05); serum albumin in treatment group was significantly greater than that of the control group ( P<0. 05), The urine erythrocyte and urine leukocyte in treatment group was significantly lower than that of the control group( P<0. 05); The total cholesterol, low-density lipoprotein and fasting blood glucose in treatment group was significantly lower than those of the control group( P<0.05).2.4 the core of syndrome of spleen deficiency and blood stasis syndrome in treatment group was significantly lower than that of the control group( P<0. 05).Conclusion1. Syndrome research:1.1 After the resumption of in the March afterThe distribution of the TCM syndrome of the normal kidney transplant recipient had certain laws, in which the Kidney deficiency and blood stasis was the most common syndrome status.1. 2 The Chinese syndrome of the normal kidney transplant recipient had very close relations with the diseases of the uremia, acute rejection, infection and the application of immunosuppressive agents.2. Clinical observation2.1 Shan-zhi-particles could promote the early resumption of renal transplantation, improve the performance of the transplanted kidney hemorheology, increased urination of renal transplantation, to reduce symptoms of uremia, etc.2. 2 Shan-zhi-particles to a certain extent could prevent the acute rejection or mitigate the extent of the damage, manifestated in reducing the incidence of acute rejection rate and increase the remission rate of hormone therapy.2.3 Shan-zhi-particles had certain control on the side effects of immuno -suppressive drugs, such as prevented the bone marrow suppression of immunosuppressant; reduce the immunosuppressive drugs on liver function injury; protected the graft; improved the metabolic disorder by the immunosuppressant; reduced the incidence of infection caused by immuno - suppressant. |
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