| With the rising of obesity, an aging population, diabetes and hypertension, the incidenc e of atherosclerotic disease has been rising. Atherosclerotic renal artery stenosis or occlusi on, is the artery atherosclerotic renal artery stenosis (ARAS), is the leading cause of ische mic nephropathy. Population over40years,90%of ischemic nephropathy are caused by A RAS, and another10percent of Takayasu arteritis, fibromuscular dysplasia and so on. The incidence of ARAS in our country atherosclerosis patients was24.3%. According to overse as research reports ARAS due to end-stage renal disease (ESRD) accounted for16.5%of dialysis patients. ARAS is a serious threat to human health and it reflects the breadth and severity of systemic atherosclerosis lesions. In addition, as the major cause of renovascula r hypertension and ischemic nephropathy, ARAS may ultimately lead to the end point of cli nical cardiovascular events. According to U.S. reports, the annual mortality of the disease i s up to16%.We have preliminarily explored the pathogenesi and differential diafnosis of A RAS and achieved significant clinical efficacy.which also lay the foundation for future resear ch.The study observed whether Huanshuai Recipe could reduce the incidence of acute kidne y injury in ARAS patients taking RAAS blockers, and could further slow the rate of progress o f chronic kidney disease combined RAAS blockers, so as to provide the clinical evidence f or Traditional Chinese Medicine intervention in ARAS.Objective:To observe the effect of Huanshuai Recipe in the prevention of acute renal dysfun ction after RAAS blockadeand and the efficacy of ischemic nephropathy.lt is designed to find t heentry point and an effective method of Chinese medicine treatment of ischemic nephropath y.Methods:1.Case source:from January2007to December2011in our hospital and hospitalized patients,61patients meet the the ARAS definition and diagnostic criteria.2. treatment and group:except for the impact of contrast agent on renal function observed afte r one week, the cases incorporated were randomly divided into treatment group and control g roup according to the2:1; treatment group and control group were given basic treatment (RAS S block), the treatment group took Huanshuai Recipe oral solution20ml tid3. the clinical data collection:check the renal function(SCR, BUN, UA), blood lipids (CHO, T G and LDL), blood pressure levels (systolic, diastolic blood pressure),of cases monthly or ever y two months,Compare the renal function, blood lipids,and other indicators of tow groups at the end of research.(mainly compare the reciprocal of Scr over time (months) straight-line slo pe (b value)).(Observation period≥6months)4. TCM syndrome score:TCM standards with reference to chronic renal failure, and Chinese medicine symptom classification of quantitative criteria (Guidelines for clinical research with ref erence to the Traditional Chinese Drug treatment of chronic renal failure).5.Statistical analysis:application the SPSS11.0establish database and analyzed, when p≤0.05difference was considered to have statistical meaning.Results:1. A total of54cases of patients with ARAS were included in the statistics:36cases in tr eatment group and18cases in control group.2cases of control group were died due to severe cardiovascular disease. The observation period lasts6-50months, The average obs ervation period is16.20±10.43months. The staging situation of CKD in group patients:sta ge1:2cases;stage2:14cases (25.93%);stage3:31cases (57.41%);stage4:7cases (12.96%) The most of ARAS patients were in CKD stage3, prompted that the clinical diagnos is of ARAS were lagged, many of patients had missed the best timing of treatment.2. The most common comorbidities of ARAS patients is Hypertension(92.59%),followed by t he Hyperlipidemia (70.37%), Coronary artery disease (51.85%)、Diabetes (40.74%) Cere bral vascular disease (25.92%) and hyperuricemia (14.81%)3.(1)the sample-paired T test within group of the mean of Scr values, before and after tre atment, from the treatment group patients,*p<0.05,was statistically significant. Prompted tha t the advances in renal function of Qi-deficiency and blood stasis type’s ARAS patients cou Id be delayed by Huanshuai Recipe Oral Liquid which based on the therapy of reinforccing Qi,promoting blood circulation and removing dampness.(2)the sample-paired T test within group of the TCM’s symptoms points, before and after treatment, from the treatment group patients,*p<0.05,was statistically significant. Prompte d that the symptoms of Qi-deficiency and blood stasis type’s ARAS patients could be Impr oved by Huanshuai Recipe Oral Liquid which based on the therapy of reinforccing Qi.prom oting blood circulation and removing dampness.(3)the sample-paired T test within group of the Glomerular filtration rate (GFR<MDRD>),be fore and after treatment, from the treatment group patients,*p<0.05,was statistically signific ant. Prompted that the GFR of Qi-deficiency and blood stasis type’s ARAS patients could b e enhanced within a certain range by Huanshuai Recipe Oral Liquid which based on the t herapy of reinforccing Qi,promoting blood circulation and removing dampness..4.the sample-paired T test within group of Scr、the TCM’s symptoms points、GFR,before and after treatment, from the control group patients, Respectively,p=0.401, p=0.093, p=0.896, weren’t seen a significant difference.5.the sample-paired T test within group of BUN、UA、Lipid levels (CHO、TG、LDL)、ALB, before and after treatment, from the treatment and control group were tested respectively. Just the results of the treatment group were significant different,p<0.05, before and after tr eatment.6.the sample-Independent T test between both of the groups of the Albumin(ALB)’s level in all cases,p<0.05, before treatment, prompted that the level were significant different in t wo groups.But after treatment,p<0.05.we could not evaluate the effect of Huanshuai Prescri ption on the ALB’s level.This is the inadequacies in the process.7.After the RAAS Blocking,do the sample-paired T test on the SBP of the treatment grou p, before and after treatment,p<0.05.Results were significant different, prompted that the eff ect of Huanshuai Prescription to protecting the founction of kidney and Lowering the blood pressure at the same time, might be lowering by the Improveing the founction of kidney.8. calculated the slopes of the time varying (month)1/Scr’s values of every ARAS patien ts by The linear regression(b value); calculated the mean of b values of each group; analy sed the values earned above by scatter plot:in treatment group, b=(21.08±38.76)*10-5; in control group, b=(-0.04±33.43)*10-5,the b value of treatment group was larger than0, pro mpted that Huanshuai Recipe could delay the further deterioration of renal function in ARA S patients.Conclusion:1. The most common comorbidities of ARAS patients, Hypertension,Hyperlipidemia,Coronary artery disease,etc., prompt that we should screening on the patients have Hypertension,Hy perlipidemia,Coronary artery disease,etc.,for ARAS.to do a early diagnosis.2. The function of kidney in ARAS can be improved by Huanshuai Recipe. In treatment gr oup.the level of Scr significant lower, the GFR significant higher.and the marker b,reflect th e long-term effects of chronic renal failure(CRF),is greater than0after the treatment. All a bove prompt that the therapy of reinforccing Qi,promoting blood circulation and removing d ampness can protect the residual function of kidney effectively, block or delay the progress of CRF in a certain range.3. The symptoms of patients in ARAS can be improved by Huanshuai Recipe.In treatment group, the TCM’s symptoms points significant lower (*p<0.05)after the treatment,show a sig nificant difference among the effects before the treatment. All above prompt that the therap y of reinforccing Qi,promoting blood circulation and removing dampness can improve the sy mptoms of patients in ARAS, relieve the pain of patients in a certain extent, and higher th e quality of life effectively. |
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