Effect Of Luofengning No.2 On Patients With Heart And Kidney Syndrome Based On The Theory Of Internal Motility

BackgroundWith the increasing of the aging population,cardiorenal syndrome has gradually attracted people’s attention. Cardiorenal syndrome is a new diagnosis.In the state of physiological and pathological disorder of cardiac and renal function, acute and chronic function of an organ damage leads to another organ’s function injury.The combined injury of heart and kidney is a common clinical disease,fast progression,dangerous prognosis,cardiovascular events and total mortalityrate was significantly increased.An epidemiological data shows that the morbidity and mortality of cardiovascular disease is closely related to renal function. ADHERE database shows 30% of chronic heart failure patients have chronic renal insufficiency.In the prospective study of PRAISE,the patients with diuretic resistance and cardiorenal syndrome have the high rate of death,sudden death and pump failure.The rapid decline in heart function usually leads to nephric insufficiency and the worsening of renal function may improve the progress of heart failure.They both influence each other,creating a vicious cycle.Therefore, how to interrupt the vicious cycle and improve the life quality of patients has become a new focus of clinical heart failure disease.Clinical study has found that clinical efficacy of westen medicine is not ideal and a variety of them have a certain degree of adverse reaction and limitations.In this context, traditional Chinese medicine is expected to play a greater role.At present, the theory of coordination between the heart and kidney is used to explore etiology and pathogenesis of cardiorenal syndrome.We can use the treatment of heart and kidney derived from same fountainhead to promote heart-kidney interaction and keep the balance and harmony of two organs.There are certain clinical efficacy of TCM,but the recent efficacy maintains at a certain level and it need to be promoted. The majority of patients occur frequently with high hospitalization rate and worrying long-term efficacy.So it is profoundly meaningful to explore TCM treatment of cardiorenal syndrome.In recent years, Professor Wang put forward the theory that:endogenous collateral wind is also one of the important pathogenesis of myocardial fibrosis and cardiorenal syndrome based on previous research,and create a formula which is called Luo Feng Ning NO.2(LFN-2) for the treatment of myocardial fibrosis and cardiorenal syndrome, it has been confirmed that wind drug could achieve significant clinical efficacy for heart failure which lays a solid foundation for this study.PurposeIn order to explore the clinical effect and the possible mechanism of LFN-2 as well as elaborate theoretical value of the theory of endogenous collateral wind,we"ll study on this topic from two methods:first,we analyse risk factors of chronic heart failure of coronary heart disease with deterioration in renal function;and then we explore the effect of LFN-2 to the quality of life of patients with CRS and the impact which the formula make on inflammatory factors, myocardial fibrosis and heart-kidney related biomarkers.Methods1 Risk factors analysis all the eligible patients with chronic heart failure of coronary heart disease were divided into CRS group(n=120) and non-CRS group(n=148) based on the occurrence of deterioration in renal function.We recorded clinical medical records and test results of these hospitalized patients in detail.At the same time, we selected possible factors leading to CRS with the help of literature and medical records. All the data can be pulled into a computer after Proofread and then we calculated results by conducting the single factor analysis and the multivariate regression analysis.2 Clinical study According to the randomised controlled principle, there is a total of 120 cases of patients with cardiorenal syndrome.Among them,there are only 104 qualified patients (The loss rate was 13.33% in this clinical study).104 patients with CRS were randomly divided into the LFN-2 group(n=35),the remove expelling wind drug group(n=36)and the western medicine group(n=33). Medication for two months.(1) The standard of curative effect evaluation,Minnesota Living With Heart Failure Questionnaire,6-minute walk test,the typical symptom quantitative score of heart and kidney changes were used as the index for appraising quality of life before and after the treatment respectively.(2) We observed the changes of related biomarkers along with different cardiac functional grading and renal functional staging by detecting biomarkers with ELISA method before and after the treatment.(3) The concentration changes of inflammatory factors,such as hs-CRP, LP-PLA2 and CT-1 were detected with ELISA method before and after the treatment.(4) The concentration changes of myocardial fibrosis and related heart-kidney biomarkers, such as sST2,Gal-3,NT-proBNP, TnI and CystatinC were detected with ELISA method before and after the treatment.Results1 The results showed high risk factors for chronic heart failure of coronary heart disease with deterioration in renal function were NYHA Ⅲ-Ⅳ, history of diabetes and hypertension, Scr, CysC by conducting a multivariate regression analysis.2 We regard changes of NYHA cardiac functional classification as efficacy index. After treatment,the difference of total efficiency of three groups was not statistically significant(P>0.01),but the total efficiency of three groups from large to small ordenthe LFN-2 group,the remove expelling wind drug group, western medicine group.3 After treatment, MLHFQ score of three groups was statistically significant (P<0.01 or P<0.05)compared with before, the western medicine group appeared a increasing trend.Comparison among groups, the score of LFN-2 group was the lowest by the obvious improvement and the difference was statistically significant (P<0.05).4 Comparison before and after treatment among in LFN-2 group,6-minute walking distance was prolonged, the difference was statistically significant (P<0.01).Comparison among groups, there was no obvious improvement and the difference was not statistically significant (P>0.05).5 After treatment, the edema symptom score of LFN-2 group reduced obviously (T<0.05)compared with before. Comparison among groups, the score of LFN-2 group was the lowest by the obvious improvement and the difference was statistically significant (P<0.05). After 2 months, the other symptom score of three groups has no statistically significance(P>0.05).That is not obvious symptoms improvement before and after treatment about themselves.6 Comparison before and after treatment,LVEF,LVDs,LVDd,E/A of three groups has no statistically significance(P>0.05).7 After 2 months,The hs-CRP of LFN-2 group was decreasing compared with prior treatment,the difference was statistically significant(P<0.01).The hs-CRP of LFN-2 group decreased obviously compared with the remove expelling wind drug group and the western medicine group(P<0.05).After treatment, the LP-PLA2 of LFN-2 group and the western medicine group had changes compared with before(.P<0.01 or P<0.05),the western medicine group appeared a slight increasing change.There was no obvious LP-PLA2 changes in three groups.The difference was not statistically significant betweem each other (P>0.05).After 2 months, The CT-1 of three groups were all increasing compared with prior treatment, the difference was statistically significant (P<0.05).There was no obvious CT-1 changes in three groups.The difference was not statistically significant betweem each other (P>0.05).8 With the increasing of cardiac functional grading,the concentration of NT-proBNP and hs-CRP emerged the increasing trend and eGFR appeared decreasing trend. The difference was statistically significant(.P<0.01 or P<0.05).LVEF and sST2 appeared the trend of gradual changes along with the increasing of cardiac functional grading,though the difference was not statistically significant(P>0.05).CysC,cTnI,CT-1 and Lp-PLA2 had no statistically significance(P>0.05).9 With the increasing of renal functional staging, the concentration of NT-proBNP emerged the increasing trend and eGFR appeared decreasing trend. The difference was statistically significant betweem each other（P<0.05). LVEF and CysC had no statistically significance(P>0.05).10 After 2 months,the decreasing of sST2 of LFN-2 group and the remove expelling wind drug group was statistically significant(P<0.01 or P<0.05). There was no obvious sST2 changes in three groups.The difference was not statistically significant betweem each other(P>0.05).After treatment,There was no obvious Gal-3 changes in three groups compared with prior treatment or interaction.The difference was not statistically significant betweem each other (.P>0.05).11 After 2 months,the decreasing of NT-proBNP of LFN-2 group was statistically significant P<0.05),the remove expelling wind drug group and the western medicine group had no statistically significance compared with prior treatment, the western medicine group appeared a slight increasing change (P>0.05).The NT-proBNP of LFN-2 group and the remove expelling wind drug group decreased obviously compared with the western medicine group(P<0.05). After treatment, There was no obvious TnI changes in three groups compared with prior treatment or interaction.The difference was not statistically significant betweem each other (P>0.05).12 After 2 months.the decreasing of CystatinC of LFN-2 group was statistically significant (P<0.05), the remove expelling wind drug group and the western medicine group had no statistically significance compared with prior treatment(P>0.05).The CystatinC of LFN-2 group decreased obviously compared with the remove expelling wind drug group and the western medicine group(P<0.05).After treatment, the change of eGFR of three groups was not statistically significant(.P>0.05).The eGFR of LFN-2 group increased obviously compared with the remove expelling wind drug group (P<0.05).Conclusion1 The results were obtained through analysis of risk factors that NYHAⅢ-Ⅳ, history of diabetes and hypertension,Scr,CysC were most closely associated with chronic heart failure of coronary heart disease with deterioration in renal function.2 LFN-2 is effective to a certain extent in the treatment of CRS patients.LFN-2 can prolong 6-minute walking distance, reduce MLHFQ score and edema symptom score.improve the life quality of CRS patients.3 LFN-2 may reduce the expression of hs-CRP, LP-PLA2,and then increase the level of CT-1,We speculate that LFN-2 protect the heart and kidney function by inhibiting the chronic inflammatory state and blocking the intermediate links of the heart and kidney function deterioration.4 The expression of sST2.NT-proBNP and CystatinC was gradually reduced and eGFR was increased in the treatment of LFN-2.We speculate that LFN-2 protect the heart and kidney function by improving and even reversing the process of myocardial fibrosis.5 In summary,we speculate that LFN-2 can inhibit the chronic inflammatory state,reduce the expression of inflammatory factors and then inhibit hyperplasia and excessive accumulation of myocardial extracellular matrix, improve even reverse the process of myocardial fibrosis.That in turn increases myocardial compliance,improves myocardial systolic and diastolic function, increases cardiac output and renal blood flow.Finally,the prognosis and quality of life of patients are improved.