| Objective Through observation of non dialysis chronic kidney disease of renal osteodystrophy with damp heat syndrome of lumbar bone mineral density and serum bone morphogenetic protein-7 changes and the intervention effect of turbid granule retention enema with rhubarb,the research is aimed at discussing relief therapeutic effects of turbid Granule on ROD and its mechanism.Methods Choose 64 patients with non-dialysis CKD3~5 period damp-heat syndrome who met the inclusion criteria, randomly separate them into Treatment group with 32 patients and Control group with 32 patients. In the course of treatment, four patients were loss of follow-up, two from Treatment group and two from Control group.Therefore, the research actually completed 60 patients. Meanwhile, healthy normal group with 20 patients was established. Two groups of patients were given corresponding step-down, diuresis, correction of renal anemia, regulation of calcium and phosphorus levels and inhibition of hyperparathyroidism and other symptomatic treatment. In addition, rhubarb Xiezhuo granule retention enema was added in the Treatment group once a day. Two groups were treated for 8 weeks. Observe the changes of damp-heat syndrome and renal function indexes of the two groups patients and adverse reaction.Detect changes of indexes of serum calcium(Ca), Phosphorus(P),alkaline phosphatase(ALP), parathyroid hormone(i PTH), level of BMP-7 and Ca, P,ALP, i PTH levels and lumbar spine 2~4 vertebral bone mineral density(L2~4 BMD),Z value of the two groups of patients before and after treatment. Meanwhile, detect level of BMP-7,L2~4BMD,Z value of the normal group of patients before treatment.Efficacy determination and statistical analysis was based on the experimental results.Results The Treatment group was significantly better than the Control group in clinical efficacy, Damp-heat Syndrome and other main symptoms clinical efficacy, and the difference was statistically significant(P<0.05 or 0.01). After treatment, Damp-heat Syndrome integral of the two groups of patients decreased significantly(P<0.05 or0.01) as course of treatment increased. In the same course of treatment, the Treatment group decreased more significantly than the Control group(P<0.01). The renal function(BUN, Scr) and e GFR in Treatment group were improved significantly after treatment in comparison with that before treatment. None was improved significantly(P>0.05)except for BUN in Control group. After treatment, the above indexes of Treatment group were improved more significantly than these of Control group(P<0.01). The L2~4 BMD, Z value and the level of BMP-7 of the two groups of patients was significantly lower than that of Normal group(P<0.01), but there was no significant difference(P>0.05) between the two groups. After treatment, L2~4 BMD, Z value and the level of BMP-7 of the two groups patients increased significantly compared with that before treatment(P<0.05 or 0.01). And Treatment group improved more significantly than Control group(P<0.01). Analyzed with the method of Pearson, L2~4BMD and BMP-7 levels of the patients of the two groups were positively correlated with e GFR, serum Ca and negatively correlated with serum P, i PTH, ALP, which was statistically significant(P<0.01).Conclusions Comparison of L2~4 BMD, Z value and BMP-7 levels in patients with Non-dialysis CKD renal osteodystrophy with Damp-heat Syndrome decreased more significantly than that of healthy individuals. Rhubarb Xiezhuo granule retention enema could significantly improve the clinical manifestation and renal function of Non-dialysis CKD renal osteodystrophy patients combined with ROD Damp-heat Syndrome, evaluate serum Ca, reduce blood P, i PTH, ALP levels, L2-4 BMD and Z value. The therapy of rhubarb Xiezhuo granule retention enema can effectively prevent ROD, improving the prognosis of patients with CKD, whose mechanism may be related to the increase of BMP-7 content in serum. |
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