| Objective Observation the levels of blood CD4 +T and CD8 +T cells, serum IL-2, IL-4, IL-17 and urinary PCX, B7-1 in patients with chronic glomerulonephritis and spleen-kidney deficiency syndrome. To explore the therapeutic mechanism of Shendi granules in cellular immune regulation and podocyte protection.Methods We include 60 chronic glomerulonephritis patients with spleen-kidney deficiency type,which were randomly divided into treatment group and control group, 30 cases in each, and 20 cases of normal group. The patients in control group were treated with valsartan 80 mg orally once a day. The treatment group treated with Shendi granules 3times a day, 10 g each time with warm water flushes the clothing. The course of treatment was 12 weeks. Observing the 24 h urinary protein, blood urea nitrogen(BUN),blood creatinine(SCr), estimated glomerular filtration rate(e GFR), blood CD4+ and CD8+T cells and serum IL-2, IL-4, IL-17 and urinary PCX, B7-1 level changes, in two groups of patients before and after treatment.Results1. In treatment group 3 cases were excluded and 2 cases in control group. 55 cases were actually completed, 27 cases in the treatment group, 28 cases in the control group.Finally, 20 cases in normal control group, 27 cases in treatment group and 28 cases in control group were included in the statistical analysis.2. The efficacy of Chinese medicine: Clinical curative effect, the total effective rate of treatment group was 92.59%, and 60.71% in control group. The treatment group was better than control group(P<0.05). The efficacy of TCM syndrome, treatment group total effectiveness was 90.62%, and 53.57% in control group. The treatment group was better than control group(P<0.05). TCM syndrome score, the treatment group was improved more than the control group(P<0.05).3. 24 h urine protein: With the prolongation of treatment time in two groups of 24 hours urine protein decreased, lower than that of the control group and the treatment group level. Variance analysis showed: the treatment time, F=238.943, P<0.05, the difference was statistically significant. Group F=22.46, P<0.05, the difference was statistically significant. The interaction, treatment time and treatment of F=66.381, P<0.05, the difference was statistically significant.4. The T cell subsets:(1)The blood CD4+T level and the ratio of CD4+T/CD8+T among the three groups were analyzed, the variance before treatment, significant differences among the normal group and P<0.05 treatment group and control group, the differences between the control group and treatment group mean P>0.05. The treatment group and the control group after treatment the blood CD4+T level and CD4+T/CD8+T ratio is increased, the paired sample t test P value of less than 0.05, the difference was statistically significant. The treatment group and the control group, the difference between before and after treatment, the treatment group than the control group, two independent samples t test P<0.05, the difference was statistically significant.(2)The blood CD8+T level: analysis of variance among the three groups before treatment, there are significant differences in P<0.05 group and normal control group and treatment group, control group and treatment group, the difference between mean P>0.05. The treatment group and the control group after treatment the blood CD8+T level was decreased, paired samples t test P<0.05, the difference was statistically significant. The treatment group and the control group, the difference between before and after treatment,the treatment group than the control group, two independent samples t test P<0.05, the difference was statistically significant.5. The serum levels of IL-2, IL-4, IL-17:(1)The serum IL-2 and IL-17 levels among the three groups: analysis of variance, before treatment, significant difference in P<0.05 group and normal control group and treatment group, control group and treatment group,the difference between mean P>0.05. The treatment group and control group after treatment of serum IL-2 and IL-17 levels decreased, paired samples t test P were less than 0.05, the difference was statistically significant. The treatment group and the control group, the difference between before and after treatment, the treatment group than the control group, two independent samples t test P were less than 0.05, the difference was statistically significant.(2)The serum IL-4 levels among the three groups were analyzed, the variance before treatment, significant difference in P<0.05 normal group and control group and treatment group, control group and treatment group, the difference between mean P>0.05. The treatment group and the control group did the serum level of IL-4 prognosis than before, paired samples t test P<0.05, the difference was statistically significant. The treatment group and the control group, the difference between before and after treatment, the treatment group than the control group, two independent samples t test P>0.05, the difference was not statistically significant.6. Podocyte marker protein: Analysis of variance among the three groups before treatment, there are significant differences in P<0.05 group and normal control group and treatment group, control group and treatment group, the difference between mean P>0.05. The treatment group and control group after treatment the urine B7-1 and PCX levels decreased, paired samples t test P were less than 0.05, the difference was statistically significant. The treatment group and the control group, the difference between before and after treatment, the treatment group than the control group, two independent samples t test P were greater than 0.05, the difference was not statistically significant.7. Renal function: Before treatment between the two groups of BUN, Scr, eGFR, two independent samples t test P were greater than 0.05, the difference was not statistically significant. The same group before and after treatment of BUN, Scr, e GFR, paired samples t test P were greater than 0.05, the difference was not statistically significant.The two groups before and after treatment of BUN, Scr, e GFR difference, two independent samples t test P were greater than 0.05, the difference was not statistically significant.8. The blood routine test, ECG, aspartic amino acids transfer enzyme(ALT), alanine amino shift enzyme(AST) had no significant change before and after treatment.Conclusion1 Abnormal expression of T cell subsets;serum IL-2, IL-4, IL-17;and foot cell marker proteins of patients with chronic nephritis spleen-kidney deficiency syndrome,suggesting that immune cells anomaly in the pathogenesis of chronic nephritis, chronic nephritis patients associated with podocyte injury at the same time.2, Shendi granules to correct chronic nephritis spleen-kidney deficiency syndrome of T cells in patients with subsets imbalance; serum IL-2, IL-4, IL-17; and reduce the formation of immune inflammation and immune complexes; at the same time by protecting podocytes, maintain glomerular capillary structure and filtration barrier function complete subtractive protein urine, and alleviate the pathological damage of kidney tissue.3, Shendi granules can significantly reduce chronic nephritis spleen-kidney deficiency syndrome in patients with TCM syndrome integral, improve the clinical symptoms, reduce the 24-hour urine protein quantitative is the treatment of chronic nephritis is one of the effective methods.4. In this study, no adverse reactions occurred in the patients taking Shendi, which suggested that the Shendi granules have good safety.Objective Establishing the model of mesangial proliferative glomerulonephritis rat,measure the level of T cell subsets(CD4+T?CD8+T), cytokine(IL-2?IL4?IL17) and podocalyxin.And Ca N expression in renal tissue, to explore its role in the development in mesangial proliferative glomerulonephritis.To explore the mechanism of Shendi granules for mesangial proliferativeglomerulonephritis protection.Methods45 healthy rats(males) were purchased and fed one week.According to the randomized block method to choose 10 as the normal group, the remained 30 rats were established as model of Ms PGN. Collected urine for urinalysis one week later,excluding the urine protein negative rats.there remaining rats were randomly grouped into three groups:Shendi granules group, Valsartan group and the untreated group. Shendi granules group were gave Shendi granules solution 4ml(4.0g/kg · d). Valsartan group were gave Valsartan solution 4ml(1.03mg/100 g · d), and the normal group and untreated group were gave the same volume of saline. All rats were not unlimited to drink and eat.Respectively in the end of 0th ? 6th ? 12 th weekend to collect 24-hour urine in metabolic cages, testing the level of 24 h urinary protein quantitative. 12 weeks later the rats were sacrificed, blood was measured serum creatinine,level of T cell subsets(CD4+T ? CD8+T),cytokine(IL-2 ? IL4 ? IL17) and podocalyxin. And Ca N expression in renal tissue.Result1. The general condition of rats: after establishing a successful model, all rats were apathetic, accidie, hair dull, eating less. The normal group of hair bright, lively, normal diet intake. After gavage for 12 weeks, the control group and the experimental group animals state better than before, diet and water than before the increase, increased mobility, hair is shiny, the experimental group compared with the control group improved significantly, model groups of animals were not improved obviously.2.24 h urinary protein quantitative: model rats 24 h urinary protein was higher than the normal group, t test and analysis of P<0.05, the difference was statistically significant.With the prolongation of treatment time, the urine protein in the control group and the experimental group was decreased, and the experimental group was lower than the control group. Repeated measurement data analysis of variance showed that: treatment time F=463.684, P<0.05, the difference was statistically significant. Intervention F=6269.452, P<0.05, the difference has statistical significance, treatment time and intervention mode of interaction F=178.328, P<0.05, the difference has statistical significance.3 Podocalyxin marker protein: the model group of urine B7-1 and PCX levels were higher than the normal group, t test and analysis of P values were less than 0.05, the difference was statistically significant. Urine B7-1 and PCX levels: model group>control group>experimental group, the variance analysis P values were less than0.05, the differences between the groups were statistically significant.4 serum creatinine: model group serum creatinine than normal group, P<0.05 test T, the difference was statistically significant. Model group, control group and experimental group of serum creatinine level: model group>control group>experimental group, the variance analysis of P values were less than 0.05, the differences between the groups were statistically significant.5.T cell subsets: the level of CD4+T cells in model group was lower than that in normal group, the level of CD8+T cells was higher than that in normal group, and the T value was less than 0.05, the difference was statistically significant. CD4+T cell level, model group<control group<experimental group, variance analysis P values were less than0.05, the differences between the groups were statistically significant. CD8+T cell level,model group > control group > experimental group, the variance analysis P values were less than 0.05, the differences between the groups were statistically significant.6 Serum levels of IL-4, IL-2, IL-17: model group serum IL-2 levels higher than the normal group, serum IL-4 was lower than the normal group, the serum IL-17 was higher than the normal group, t test and analysis of P values were less than 0.05, the difference was statistically significant. Serum levels of IL-2 and IL-17, model group>control group>experimental group, the variance analysis P values were less than 0.05, the differences between the groups were statistically significant. The level of serum IL-4,model group<control group<experimental group, the variance analysis P value is less than 0.05, the difference between the two groups has statistical significance.7 The expression of CaN in renal tissue: the relative expression of CaN in model group was higher than that in normal group, t test and analysis P<0.05, the difference was statistically significant. Model group, control group and experimental group Ca N relative expression: model group>control group>experimental group, the variance analysis of P values were less than 0.05, the differences between the groups were statistically significant.8. Kidney tissue by HE, PAS staining: Ms PGN rat glomerular mesangial region showed mesangial cells and an increase in mesangial matrix proliferation; the experimental group and the control group and model group compared to the increase in mesangial cells and mesangial matrix proliferation were reduced; the experimental group and the control group compared to the increase of mesangial cells and mesangial matrix proliferation reduce.Conclusion:1.Ms PGN model rats, there was an imbalance of T cell subsets and cytokines IL-2, IL-4and IL-17 secretion, and accompanied by a certain degree of foot cell injury.2 Shendi granules can effectively improve the general quality of survival in Ms PGN model rats, reduce 24 h urinary protein, relieve mesangial area and mesangial matrix hyperplasia, podocyte protection. Delay the progress of renal damage.3. Shendi granules in treating Ms PGN rat mechanism may be by adjusting the level of CD4+T and CD8+T and improve the immune function of Ms PGN rat model, reduce the formation of immune complexes; down regulation of serum IL-2, IL-17 levels,increased serum level of IL-4, inhibit inflammatory and immune development; urineB7-1 and PCX level down, and kidney tissue calcineurin expression and protect the foot cells. |
PDF Full Text Request