| ObjectiveThe topics to Chinese medicine, "the phlegm stasis ties mutually" is the pathogenesis key which the peritoneum fibrosis occurs as the theoretical basis, Uses the clinical method which unifies with the animal experimentation, observes and discusses the phlegm reduction to remove extravasted blood the law prevention in peritoneal dialysis patients the clinical effect. And key from TGF-β/Smads signal passage, further discusses the phlegm reduction to remove extravasted blood the law prevention peritoneum fibrosis big mouse model the function and the mechanism. Comprehensive evaluation of the use of phlegm and blood stasis and the prevention and treatment of peritoneal fibrosis in clinical efficacy for the prevention of peritoneal fibrosis in peritoneal dialysis patients to provide a new theoretical basis and methods of Chinese medicine.MethodsThrough the collection of our hospital from January 2010 to January 2011 met the inclusion criteria of the peritoneal dialysis patients Phlegm and blood stasis observed in patients on peritoneal dialysis clinical symptoms and laboratory parameters such as serum creatinine, urea nitrogen, albumin, blood lipids, blood analysis, liver filament four item and peritoneal fluid TGF-β1, VEGF expression factor such as the impact of phlegm and blood stasis objective evaluation of the clinical efficacy of prevention and treatment of peritoneal fibrosis. Through the establishment of big mouse peritoneum fibrosis model, after the observation durable phlegm reduction removes extravasted blood the traditional Chinese medicine intervention, the peritoneum fibrosis big mouse model peritoneum structure's histology change, expounded that the phlegm reduction removes extravasted blood the traditional Chinese medicine to oppress the anti-big mouse model peritoneum fibrosis the validityAnd applies the indirect immunity fluorescence method to determine each group of big mouse somatopleura peritoneum TGF-β1, p-Smad2/3 andα-SMA, E-cadherin and the p-Smad7 protein expression, the discussion phlegm reduction removes extravasted blood the traditional Chinese medicine to oppress the anti-peritoneum fibrosis and the regulative TGF-β/Smad signal passage's relations, promulgates the phlegm reduction to remove extravasted blood the law prevention peritoneum fibrosis initially the function mechanism.Result(一) The phlegm reduction removes extravasted blood the law prevention peritoneum fibrosis the clinical research1,Phlegm and blood stasis syndrome influnce score of Chinese medicine After the treatment group durable phlegm reduction removes extravasted blood the traditional Chinese medicine treatment, the facial color is gloomy, the flesh armor is wrong, the body numb or the stabbing pain, the feeling of heaviness in the limbs is sleepy, wan abdomen puffiness, in the mouth sticks greasily, dry mouth do not want to drink, the food few losses of appetite, stool viscosity the improvement function surpasses the control group obviously (P<0.05), whichshow phlegm reduction removes extravasted blood the traditional Chinese medicine to improve the symptoms, the treatment group better than the control group.2,Phlegm and blood stasis related indicators of the impact of peritoneal fibrosisEffluent treatment group after treatment factors in the TGF-β1 levels decreased significantly (130.56±14.54 pg/ml), compared with before treatment (164.84±32.38 pg/ml), there was significant difference (P<0.05); the control group Good pre-treatment showed no significant difference (P> 0.05), after treatment, comparison between the two groups, treatment group, dialysate factor in the decreased levels of TGF-β1 was significantly higher (P<0.01). Effluent treatment group after treatment factors in the VEGF levels were significantly decreased (63.62±12.95pg/ml), compared with before treatment (95.87±18.59pg/ml), there was significant difference (P<0.05); the control group before treatment well there was no significant difference (P>0.05), after treatment, comparison between the two groups, the treatment group factor of decline in peritoneal dialysis fluid VEGF levels were significantly higher (P<0.01).Indicators reflect the degree of fibrosis:hepatic-fibrosis four, treatment and control groups before treatment after treatment compared were decreased, but only statistically significant difference between the treatment group (P<0.05), no statistical difference between the control group significance (P>0.05); after treatment between the two groups was statistically significant difference (P<0.01); showed that patients treated with peritoneal dialysis on liver blood stasis Phlegm fiber four indicators have some improvement.3,Phlegm and blood stasis effect on laboratory parametersTreatment group after treatment with phlegm and blood stasis, the i mprovement of creatinine, urea nitrogen, total cholesterol, triglycerides, low density lipoprotein, fibrinogen better than the control group (P<0. 05), indicating that the phlegm and blood stasis in improving renal funct ion, blood lipid, have a good effect.4,Phlegm and blood stasis observed indicators of drug safetyTreatment group, reflecting the heart and liver function indicators of CK-MB, AST, ALT, GGT, before and after treatment, the difference was not statistically significant (P>0.05), showed that patients treated with peritoneal dialysis phlegm and blood stasis, on cardiac function and liver no functional effect, taking safety.(二) Experimental study of phlegm and blood stasis to Prevent and Treat the peritoneal fibrosis1,Peritoneal mesothelial cells exist in TGF-β1, Smad2/3, Smad7, SMA, and E-cadherin protein expression, and confirmed that high glucose dialysate and LPS have synergistic effects, can signal in rat peritoneal tissue TGF-β1/Smads pathway activation, resulting in more significant peritoneal fibrosis.2,TGF-β1/Smads signaling pathway is a common pathway of peritoneal fibrosis, phlegm and blood stasis TGF-β/Smad signaling pathway through the influence of antagonistic to peritoneal fibrosis, the Chinese high-dose group had a better prevention and treatment of peritoneal fibrosis.3,phlegm and blood stasis can increase TGF-βinhibitory Smad7 expression of signaling proteins, which may inhibit the regulation of TGF-βreceptor signaling protein (Smad2/3) activation, also showed that blood stasis can reduce phlegm E-cadhefin lower protein levels, and increased levels ofα-SMA protein level, then explain the phlegm and blood stasis can reduce the transdifferentiation of peritoneal mesothelial cells in the extent and prevent the development of peritoneal fibrosis, peritoneal membrane function protectionConclusion1,Through January 2010 to January 2011 30 patients met the inclusion criteria of the standard continuous ambulatory peritoneal dialysis (CAPD) treatment of clinical studies suggest that:phlegm and blood stasis can improve clinical symptoms of peritoneal dialysis patients, increased peritoneal dialysis treatment2,Blood stasis and phlegm reflect the:compound can significantly reduce the relevant indicator of peritoneal fibrosis (liver fiber four, peritoneal fluid TGF-β1, VEGF factor), can protect the structural integrity of peritoneal morphology and reduce the rat model of peritoneal fibrosis, peritoneal thickness of the dense layer, play the role of peritoneal fibrosis antagonist. Phlegm and blood stasis initially showed better prevention and treatment of peritoneal fibrosis.3, Through 5/6 nephrectomy rats application of 4.25% of the high-glucose peritoneal dialysis fluid and lipopolysaccharide (LPS) caused by retroperitoneal fibrosis were found:phlegm and blood stasis on the impact of TGF-β/Smad signaling pathway possibly by increased TGF-βsignaling inhibition protein expression of Smad7 and inhibit TGF-βreceptor signaling protein regulated (Smad2/3) activation, prevents peritoneal fibrosis in animal models of peritoneal mesothelial cell transdifferentiation occurs, thereby preventing or reducing the incidence and progression of peritoneal fibrosis, Protection of peritoneal function.
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