Observation On Clinical Effects Of Zishen-Jiangzhuo Decoction On Patients With Chronic Kidney Disease (CKD4 Stage) Of Spleen-kidney Qi-Yin Deficiency With Blood Stasis Complication And Its Effect On FGF23、Klotho Protein

ObjectiveThis study by comparing before and after treatment of clinical symptoms,related clinical indexes,the change of the level of serum fibroblast growth factor(FGF23),the change of the level of serum soluble Klotho protein(s KL)in patients with Spleen-Kidney Qi-Yin deficiency with blood stasis complication of chronic kidney disease(CKD4 stage),objective assessment to explore the clinical curative effect of Zishen-Jiangzhuo decoction,and to explore the effect of Zishen-Jiangzhuo decoction on vascular calcification of chronic kidney disease and its possible mechanism.MethodIn this study,62 patients with chronic kidney disease(CKD4 stage)diagnosed in the people’s Hospital affiliated to Fujian University of traditional Chinese medicine from February 2021 to February 2022 and TCM syndrome differentiation of Spleen-Kidney Qi-Yin deficiency with blood stasis complication were randomly divided into control group(n=31)and treatment group(n=31).The control group was treated with routine western medicine,and the treatment group was treated with Zishen-Jiangzhuo decoction on the basis of the control group.The course of treatment of both groups was 8 weeks.The changes of serum creatinine(Scr),glomerular filtration rate(e GFR),phosphorus(P)、calcium(Ca)、intact parathyroid hormone(i PTH)serum fibroblast growth factor(FGF-23),serum soluble Klotho protein(s KL),abdominal aorta calcification score(AACS)and TCM syndrome scoreswere observed before and after treatment in the two groups,and the correlation between them was statistically analyzed.Result1.There was no significant difference in general data(such as age,sex,etc.),related clinical indexes(Scr、e GFR、P、Ca、i PTH)、FGF23、s KL、AACS and TCM syndrome scores between the two groups before treatment.2.Correlation analysis showed that FGF23 was positively correlated with P,Scr and i PTH,negatively correlated with e GFR and CA,and s KL was negatively correlated with P,Scr and i PTH,correlated correlated with e GFR and CA,3.The levels of Scr in both groups after treatment were lower than those before treatment(P<0.05),and the levels of e GFR in both groups after treatment were higher than those before treatment(P<0.05).The curative effect in the treatment group was better than that in the control group(P<0.05).Scr in both groups decreased after treatment,and e GFR in both groups elevated after treatment(P<0.05).4.After treatment,the P and PTH in the two groups decreased(P<0.05).and the treatment group had better efficacy than the control group(P<0.05).After treatment,the Ca in the two groups showed no significant difference with pre-treatmen(P>0.05).5.After treatment,The levels of s KL in both groups after treatment were higher than those before treatment(P<0.05),and the levels of FGF23 in both groups after treatment were lower than those before treatment(P<0.05).The curative effect in the treatment group was better than that in the control group(P<0.05).but there was no significant difference in the decrease of AACS between the two groups(P>0.05).6.After treatment,the TCM syndrome scores of the two groups were lower than those before treatment(P<0.05),and the curative effect of the treatment group was better than that of the control group(P<0.05).The total effective rate of TCM syndrome of the two groups was 62.07% in the control group and 82.76% in the treatment group.The difference was statistically significant(P<0.05).7.The total effective rate of clinical comprehensive effect of the two groups was 65.51%in the control group and 86.21% in the treatment group,and there was significant difference between the two groups(P<0.05).Conclusion1.Correlation analysis showed that FGF23、s KL was correlated with the degree of renal function damage and the disorders of calcium and phosphorus metabolism,suggesting that reducing FGF23 and increasing s KL can improve renal function,protect kidney function,delay the progression of CKD and treat the vascular calcification in CKD.2.Zishen-Jiangzhuo decoction combined with western medicine routine treatment of Spleen-Kidney Qi-Yin deficiency with blood stasis complication of chronic kidney disease(CKD4 stage)patients with significant therapeutic effect,can better improve the clinical symptoms and signs of patients,and the curative effect is better than the routine treatment of western medicine alone.3.Zishen-Jiangzhuo decoction combined with western routine therapy had better efficacy in increasing s KL and reducing P,FGF23 than only using western routine therapy,suggesting that Zishen-Jiangzhuo decoction plays a certain role in controlling vascular calcification in CKD patients by raising the level of s KL,reducing P,FGF23 and improving the disorders of calcium and phosphorus metabolism.