The Effects Of Jia Wei Liuwei Dihuang Decoction On The Level Of Serum OPG And RANKL In 3-4 Stage CKD Patients With Deficiency Of Spleen And Kidney And Dampness Poisoning Syndrome

Objective: This study aims to observe the effect of Jiawei Liuwei Dihuang Decoction on the level of OPG and RANKL in the stage 3-4 CKD patients with deficiency of spleen and kidney and dampness poisoning syndrome.Through which to clarify the clinical efficacy and mechanism of Jiawei Liuwei Dihuang Decoction for the treatment of CKD-MBD with stage3-4 CKD.Methods: Seventy-eight patients with clear diagnosis of stage 3-4 CKD were choosed from the Department of Nephrology of Ruikang Hospital of Guangxi University of Traditional Chinese Medicine from December 2018 to December 2019.According to the inclusion criteria,78 patients were randomly divided into two groups(39 cases in the treatment group and 39 cases in the control group).The control group was given low-salt,low-fat,high-quality low-protein diet and other general treatments with corresponding symptomatic treatments such as correction of anemia and disturbance of calcium and phosphorus metabolism.On the basis of the control group,the treatment group was given Jiawei Liuwei Dihuang Decoction one dose twice daily.The course of treatment in both groups was 8 weeks.Statistical analysis and efficacy evaluation were given through observation and comparison of TCM symptom scores,24-hour urine protein(24h UTP),serum calcium(Ca),phosphorus(P),and immunoreactive parathyroid hormone(i PTH),serum creatinine(Scr),Urea nitrogen(BUN),estimated glomerular filtration rate(e GFR),Alkaline Phosphate(ALP),OPG,RANKL as well as changes in safety indicators.Results:1.The comparison of general data: In the treatment group,20 males and 19 females were included,and between an age of 31 and 70 years,mean age was(54.92 ± 12.99)years old,a course of the treatment group was 1 to 13 years,and an average course of which was(5.25 ± 2.16)years.In the control group,23 males and 16 females were included,and between an age of that was 32 to 72 years,mean age was(50.17 ± 11.43)years old,a course of the treatment group was 1 to 10 years,and an average course of which was(5.43± 2.68)years.There were no statistically significant differences in the age,gender,and disease duration between the two groups of patients(P> 0.05).2.The comparison of curative effect:(1)Comparison of curative effect of traditional Chinese medicine syndrome: The total effective rate of the treatment group is 87.17%,and the total effective rate of the control group is66.67%,The therapeutic effect of the treatment group was better than that of the control group,and the difference was statistically significance(P<0.05).The total scores of TCM syndromes in both groups were lower than before,but the treatment group was significantly better than the control group(P<0.05).(2)The curative effect of symptoms of traditional Chinese medicine: In the treatment group,symptoms such as lack of food,waist and knee weakness,fatigue,nausea and vomiting,and limb weightiness were 84.61%,82.05%,87.17%,82.05%,and 84.61%,The symptomatic effect is more prominent(P<0.05).(3)Clinical efficacy comparison: the total effective rate in the treatment group was 89.74%,and the total effective rate in the control group was 64.10%,The total effective rate of the treatment group was higher thanthose of the control group(P<0.05).(4)Comparison of renal function efficacy:The effective rate in the treatment group was 89.74%,and the effective rate in the control group was 82.05%,the difference was statistically significant(P<0.05).3.The comparison of laboratory indicators: The comparison between the treatment group and the control group after treatment was statistically significant in increasing e GFR,decreasing Scr,BUN,and 24 h UTP(P<0.05).After treatment,Ca increased with in the two groups,and i PTH,P,and ALP decreased significantly,the difference was statistically significant(P <0.05).After treatment,the serum OPG level increased significantly compared with before treatment,and the serum RANKL level decreased significantly before treatment.Compared with the two groups,the treatment group was improved significantly,the difference was statistically significant(P <0.05).4.The spearman correlation analysis: OPG,RANKL and Ca,P,SCr,BUN,ALP have no correlation(P>0.05),OPG,RANKL and e GFR are negatively correlated,OPG,RANKL and i PTH are positively correlated(r> 0,P<0.05).5.The safety indicators: The blood routine(HGB,WBC,PLT)and liver function(ALT,AST,ALB)were statistically analyzed,and there was no statistical significance before and after administration(P>0.05).During the entire treatment process,no adverse reactions occurred,indicating good safety.Conclusion:1.Jiawei Liuwei Dihuang Decoction can significantly improve the symptoms of patients with stage 3-4 CKD deficiency of spleen and kidney and dampness poisoning syndrome,and reduce the levels of urea nitrogen and serum creatinine.It is suggested that Jiawei Liuwei Dihuang Decoction can delay the progression of kidney disease.2.Jiawei Liuwei Dihuang Decoction can reduce i PTH levels,increase bloodcalcium levels,reduce blood phosphorus levels,correct calcium and phosphorus metabolism disorders,suggesting that Jiawei Liuwei Dihuang Decoction can effectively control secondary hyperparathyroidism and improve CKD-MBD.3.Jia Wei Liuwei Dihuang Decoction can decrease serum RANKL level and increase OPG,suggesting that the mechanism of Jiawei Liuwei Dihuang Decoction in treating CKD-MBD may be related to lower serum RANKL and increase OPG.