To Explore The Association Between Stagnation Syndrome Of Chronic Kidney Disease And Heart And Kidney Injury Based On Intestinal Uremic Toxin

Research backgroundChronic kidney disease(CKD)has an increased risk of cardiovascular disease and death.The disease progresses to the end-stage.Even after dialysis treatment,the risk of cardiovascular events and death cannot be effectively reduced,after controlling traditional risk factors.This type of problem still cannot be effectively solved.Therefore,how to effectively improve the prognosis of CKD patients and delay the progression of chronic kidney disease is an urgent problem to be solved by the nephrology community.In recent years,the effect of uremic toxins on CKD has been increasingly emphasized and deeply studied by nephrologists and scholars.It means that when kidney function declines,metabolites produced by organs,tissues,and cells in the body accumulate in the body and cannot be eliminated.A class of substances that cause damage to the body,thereby exhibiting uremia symptoms and multiple system dysfunctions.Intestinal uremic toxins represented by Indoxyl Sulfate(IS)and p-cresyl sulfate(PCS)have been shown to have an effect on CKD progression,cardiovascular events,and mortality.Has an important influence.Therefore,clinical interventions for enterotoxic uremic toxins have important implications.Western medicine is currently still in the research stage of its interventional treatment.The high-expected activated carbon adsorbent AST-120 is still controversial in delaying the progress of CKD.In China,many CKD patients benefit from Chinese medicine treatment.Chinese medicine has accumulated a wealth of experience in delaying the progression of CKD and improving the prognosis of the disease.Modern doctors generally believe that the spleen and kidneys are declining,and blood stasis and wet turbidity are the key to the pathogenesis of the disease.The clinic is mostly based on blood stasis and turbidity.The clinical curative effect is remarkable,but the mechanism of its action in China is not yet very clear.The effects of serum IS and PCS on the heart and kidney have certain similarities with the traditional Chinese medicine's "Toxicity injury vein",and the intestinal uremic toxin may be There is a certain correlation with the bloody evil of Chinese medicine.To understand the changes in the level of toxins in different renal functions,to find the relationship between toxins and cardiovascular diseases,to explore the correlation between IS,PCS and chronic kidney disease blood stasis and wetness syndrome,so as to clinical treatment of blood circulation,phlegm and phlegm treatment Chronic kidney disease provides an objective basis.Objectives1.To observe the changes of IS and PCS levels in different renal function stages;2.To explore the correlation between IS and PCS and cardiovascular injury;3.To investigate the correlation between IS and PCS and CKD patients with TCM turbidity and blood stasis syndrome.MethodsThrough cross-sectional study,the clinical data and serum samples collected from 153 CKD patients who met the inclusion criteria were selected,and serum IS and PCS from 17 health care workers were selected as normal control groups.The levels of serum IS and PCS in patients with CKD were detected by high performance liquid chromatography-fluorescence method.The changes of renal function,IS and PCS levels in CKD patients were analyzed.The concentrations of IS,PCS and blood stasis syndrome,wet cloud syndrome,and turbidity were analyzed.Inhibit the relationship between clinical indicators such as score,age,blood pressure,body mass index(BMI),serum creatinine(Scr),urea nitrogen(BUN),uric acid(UA),eGFR,hemoglobin(Hb);compare carotid intima-media thickness Differences in clinical parameters such as serum IS,PCS,blood stasis syndrome,wet cloud syndrome score,and turbid turbidity syndrome score between thick group and normal group;analysis of left ventricular mass index(LVMI)and serum IS,PCS,blood Differences in clinical indicators such as points of syndromes and syndromes,wetness and cloudiness points,and turbidity-resistance syndrome scores.Results1.This study included a total of 173 subjects in the study,17 in the healthy group,7 in males,and 10 in females.The male to female ratio was 0.7:1 and the age was 31.29±10.19;153 of them were CKD patients,92 males and 61 females.The ratio of male to female was 1.5:1,and the age was 52.29±18.41.Among them,40 were CKD1,26 were CKD2,32 were CKD3,22 were CKD4,and 33 were CKD5.The distribution of blood stasis and wetness syndrome in CKD patients:21 cases(13.7%)of non-blood wet turbidity syndrome,52 cases(34%)of blood stasis syndrome,and 15 cases(9.8%)of turbid phlegm and blood stasis syndrome in 65 cases(42.5%);2.Serum IS level in healthy group was 1.47±0.49?g/ml,PCS was below detection level(2.12?g/ml),serum level of CKD1-5 IS was able to detect,CKD1-5 serum PCS level was above detection level.With the progress of CKD,the serum IS and PCS concentrations showed an upward trend.3.Serum IS and PCS were excreted by the kidneys.With the decrease of GFR,the levels of serum IS and PCS were increased.The serum IS was positively correlated with the reciprocal of eGFR(R=0.644);the reciprocal of serum PCS and eGFR.Positive correlation(1/eGFR)(R=0.40)4.Pearson or Spearman correlation analysis was performed using IS(continuous variable)as the dependent variable and clinical indicators as independent variables.Among them,systolic blood pressure,age,wetness and turbidity scores,turbid turbidity resistance scores,SCr,BUN,iPTH,Hs-CRP,Ca,fasting blood glucose,MONO,PCS and serum IS were positively correlated,Hb,HDL-C,and LDL-C was negatively correlated with serum IS.Pearson or Spearman correlation analysis was performed using the PCS(continuous variable)as the dependent variable and the clinical index as the independent variable.The results showed that:systolic blood pressure,age,wetness syndrome score,turbid turbidity syndrome score,SCr,BUN were positively correlated with serum PCS,and Hb,HDL-C,LDL-C were negatively correlated with serum PCS.5.Comparison of clinical indicators between the carotid intima-media thickness group(n=31)and the normal group(n=28).The results showed that:the PCS level in the thickening group,the wetness syndrome integral,and the turbidity transresistance The card score was higher than the normal group(P<0.05),and the difference was statistically significant.6.Pearson or Spearman correlation analysis was performed using LVMI(continuous variable)as the dependent variable and clinical indicators as independent variables.The results showed that:systolic blood pressure,age,wet cloud syndrome,phlegm and blood stasis syndrome,IS,PCS,BUN,SCr,iPTH,Ca,fasting blood glucose were positively correlated with LVMI,eGFR,Hb,LDL-C and LVMI were negative Related.7.With eGFR as the independent variable,the linear regression was established with the integral of blood stasis syndrome,the integral of wet turbid syndrome and the integral of stagnation of stasis syndrome,and the results showed that eGFR was negatively correlated with the integral of wet turbid syndrome(R=0.271)and the integral of stagnation of stasis syndrome(R=0.266).8.Comparing the differences of clinical indicators between the Humidity and non-moistness syndrome groups(1:1.08),the serum IS,PCS,eGFR,Scr,and BUN in the Huzhuo group were higher than those in the non-moist Huo group.The significance of learning;Hb group was lower than the non-moistness group,the difference was statistically significant.Comparing the clinical index differences between the blood stasis group and the non-blood stasis syndrome group(2.7:1),there was no significant difference in serum IS,PCS,eGFR,Scr between the blood stasis syndrome group and the non-blood stasis syndrome group.The age of the group was higher than that of the non-blood group.The difference was statistically significant.ConclusionWith the progressive decline of renal function in patients with CKD,serum levels of the intestinal uremic toxins IS,PCS progressively increased,PCS and CKD patients with atherosclerotic lesions,heart damage,IS and CKD patients with heart damage.At the same time,the wetness and cloudiness syndromes and turbidity mutual resistance syndromes became more obvious;this study provided an objective basis for the traditional Chinese medicines for promoting blood circulation,removing blood stasis,delaying the development of chronic kidney disease,and improving cardiac outcomes.