To Observe The Clinical Effect Of Zhenwu Decoction In The Treatment Of Cardiorenal Syndrome Types ? And ?

Cardiorenal syndrome(CRS),a complex pathophysiological disorder of both the heart and kidneys,is a condition in which acute or chronic damage to one organ can lead to acute or chronic dysfunction of the other organ.Due to its complex pathogenesis and high mortality rates,CRS has become a significant burden on the global community.CRS is a common problem in patients with advanced heart failure(HF).The main clinical features of CRS which include neurohormonal activation,systemic and intrarenal vasoconstriction,and salt and water retention,eventually leading to a gradual decline in renal function.Impaired renal function in HF patients often reflects more advanced stages of cardiac failure,and thus is associated with a worse prognosis.Treatment of patients with HF and decreased or decreasing renal function is a vexing clinical problem.To date there is no specific treatment of CRS in acute decompensated heart failure(ADHF)that unequivocally demonstrates benefit.At present,the clinical treatment of CRS mainly includes diuretic,vasodilators,angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB),Beta blocker and so on.However,the progression of heart and kidney function in some patients still can not reverse.Therefore,the search for new treatment is particularly important.Chinese medicine treatment of heart failure,renal failure can effectively control the clinical,improve the prognosis of the disease,reduce the side effects of western medicine,but also can improve the patient's immune function and quality of life,Therefore,the combination of traditional Chinese and Western medicine treatment was significantly better than Western medicine alone,which can improve symptoms more quickly and improve the patient's hemodynamics,inhibition of neuroendocrine system over-activation,reduce uremia,angiotensin II,endothelin and aldosterone.Zhenwu Tang comes from the "Treatise on Febrile Diseases" and has the effect of warming Yangshui.It is commonly used as a moisturizing agent in traditional Chinese medicine.At present,a large number of studies have applied Zhenwu Decoction to the treatment of chronic heart failure and chronic renal failure,and have achieved certain results.He Qingjun et al.randomly divided 80 patients with chronic heart failure into two groups.40 patients in the treatment group received routine treatment plus Zhenwu Decoction,while 40 patients in the control group received routine treatment alone.The results showed that the clinical efficacy of the treatment group was significantly higher than that of the control group.NT-ProBNP significantly decreased compared with the control group.Tan Qibin found that Zhenwu Decoction has a significant role in lowering serum creatinine,urea nitrogen,and improving glomerular filtration rate,through observe 58 patients with chronic renal insufficiency treated with Zhenwu Decoction.This article intends to explore the therapeutic effect of Zhenwu Decoction in cardio-renal syndrome by comparing the difference in efficacy between conventional drugs and Zhenwu Decoction.Objective:To observe the short-term clinical efficency and safety Zhenwu Decoction in treatment of cardiorenal syndrome,and provide scientific basis for clinical treatment.Methods:Choosing 100 patients of CRS therapy to our hospital between 2017 March to 2017 November.In a random 1:1 throw coins which were devided into control group and Zhenwu Decoction group,each group were 50 people.The control group with routine treatment of Western medicine,including diuretics,ACEI/ARB,beta blockers,vasodilators,positive inotropic drugs and so on.Patients with coronary heart disease,dyslipidemia,diabetes were given the corresponding platelet antagonists,statins,hypoglycemic agents.According to the patient's vital signs to adjust the dose of these drugs,and to correct anemia and water and electrolyte,acid-base balance disorders.The Zhenwu Decoction group in the control group recieve the Zhenwu Decoction treatment(Prescription:Monkshood 12g,Poria 10g,White atractylodes rhizome 10g,Ginger 9g,Radix paeoniae alba 10g),1 dose daily,Sub-morning and evening twice.Both groups were treated for 1 week.The primary outcome was N-terminal pro-brain natriuretic peptide(NT-proBNP)and Glomerular filtration rate(eGFR).Secondary outcomes included Serum creatinine(SCr),Blood urea nitrogen(BUN),Indoxyl sulfate(IS),Echocardiography,Lee's integral,TCM syndrome integral and TCM Syndromes efficacy changes.Results:1.The two groups of patients before treatment,including general,age,gender,weight,blood pressure,heart rate,blood lipids,blood glucose,liver function,myocardial enzymes,history and medication history have no significant difference.2.In the comparison of TCM Syndromes efficacy:Zhenwu Decoction group's total effective rate was significantly higher than the control group,the difference was statistically significant(P<0.05).3.In the comparison of cardiac function:There was no significant difference between the two groups before treatment in NT-proBNP,Lee's integral,TCM syndrome integral(P>0.05).After treatment,the levels of NT-proBNP decreased in both groups,but did not have statistical differences.After treatment,Lee's heart failure scores and TCM syndrome scores in Zhenwu Decoction group were significantly reduced,and there was a statistically significant difference compared with the control group.(P<0.05).4.In the comparison of renal function:There was no significant difference between the two groups before treatment in eGFR,SCr,BUN(P>0.05).After treatment,the eGFR level in Zhenwu Decoction group increased,and the eGFR level in Zhenwu Decoction group at 3b-phase was significantly higher than that in the control group(P<0.05).There was no significant difference in other periods.After treatment,the SCr and BUN levels in the Zhenwu Decoction group decreased,but there was no significant difference between the two groups.5.There was no significant difference in IS level between the two groups before treatment.After treatment,the IS level in Zhenwu Decoction had a tendency to decrease,while the IS in the control group showed an upward trend.The comparison between the two groups was P=0.09.6.Before and after the comparison,both Lee's heart failure score and TCM syndrome scores after treatment in both groups were significantly lower than before treatment(P<0.05).The NT-proBNP levels in the Zhenwu Decoction group were significantly lower than those before treatment(P<0.001),but there was no significant difference between the NT-proBNP group and the control group before and after treatment(P>0.05).There was significant difference between the treatment of eGFR in Zhenwu Decoction group 3b and before treatment(P<0.05).There was no significant difference in the change of eGFR in each group of control group.Comparison of SCr and BUN before and after treatment in both groups showed that the SCr and BUN levels in the Zhenwu Decoction group were significantly lower than those before treatment(P<0.05),but there was no significant difference between the control group and the pretreatment group.The level of IS in 3b-phase Zhengwu Decoction group was significantly lower than that before treatment(P<0.05).There was no significant difference in IS level between the control group and the control group.7.There was no significant difference in liver function and electrolyte changes between the two groups before and after treatment(P>0.05).No adverse events occurred in both groups.Conclusion:1.Zhenwu Decoction can improve heart function in patients with CRS types ? and?.2.Zhenwu Decoction can improve renal function in patients with CRS types ? and?.3.Zhenwu Decoction treatment of CRS types ? and ? has good safety.