加味参芪地黄汤联合沙库巴曲缬沙坦治疗慢性心肾综合征的疗效及对血清GDF-15、Gal-3水平的影响OA

Objective To observe the therapeutic effect of Modified Shenqi Dihuang Decoction combined with Sacubitril Valsartan in treating patients with chronic cardiorenal syndrome(CRS)and to assess its impact on serum levels of galectin-3(Gal-3)and growth differentiation factor 15(GDF-15).Methods Using a random number table method,120 patients with chronic CRS manifesting as qi-yin deficiency with blood stasis and water retention syndrome,admitted to Shaanxi Traditional Chinese Medicine Hospital from January 2024 to January 2025,were randomly divided into a western medicine group and a traditional Chinese medicine(TCM)group,with 60 cases in each group.On the basis of conventional foundational treatment,the western medicine group was treated with Sacubitril Valsartan,while the TCM group was treated with Modified Shenqi Dihuang Decoction combined with Sacubitril Valsartan.The treatment duration for both groups was 12 weeks.Changes in TCM syndrome scores,echocardiographic parameters,cardiac and renal function indicators,and markers related to inflammatory response and oxidative stress were observed before and after treatment in both groups,and the clinical efficacy was evaluated.Results(1)Regarding dropouts,during the treatment period,1 case dropped out from the western medicine group and 2 cases from the TCM group,resulting in a total of 117 patients included in the efficacy analysis(59 in the western medicine group,58 in the TCM group).(2)In terms of efficacy,after 12 weeks of treatment,the total effective rate was 93.10%(54/58)in the TCM group and 83.05%(49/59)in the western medicine group;intergroup comparison(by rank sum test)showed that the efficacy of the TCM group was significantly superior to that of the western medicine group(P＜0.05).(3)Regarding TCM syndrome scores,after treatment,the scores in both groups were significantly decreased compared to before treatment(P＜0.01),and the reduction in the TCM group was significantly greater than that in the western medicine group(P＜0.01).(4)Concerning echocardiography,after treatment,left ventricular ejection fraction(LVEF)and stroke volume(SV)were significantly increased in both groups compared to before treatment(P＜0.05),while left ventricular end-diastolic diameter(LVEDD)and renal resistive index(RRI)were significantly decreased(P＜0.05).The increases in LVEF and SV,as well as the decreases in LVEDD and RRI,were significantly greater in the TCM group compared to the western medicine group(P＜0.05 or P＜0.01).(5)Regarding cardiac and renal function indicators,after treatment,serum levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),serum creatinine(Scr),blood urea nitrogen(BUN),and cystatin C(Cys-C)were significantly decreased in both groups compared to before treatment(P＜0.05),and these reductions were significantly greater in the TCM group than in the western medicine group(P＜0.05 or P＜0.01).(6)Regarding inflammation-related markers,after treatment,serum levels of soluble suppression of tumorigenicity 2(sST2),Gal-3,and GDF-15 were significantly decreased in both groups compared to before treatment(P＜0.05),and the reductions were significantly greater in the TCM group than in the western medicine group(P＜0.01).(7)Regarding oxidative stress indicators,after treatment,serum malondialdehyde(MDA)level was significantly decreased(P＜0.05)and serum superoxide dismutase(SOD)level was significantly increased(P＜0.05)in both groups compared to before treatment.The reduction in MDA and the increase in SOD were significantly greater in the TCM group than in the western medicine group(P＜0.01).Conclusion The combination of Modified Shenqi Dihuang Decoction and Sacubitril Valsartan demonstrates definitive efficacy in treating patients with chronic CRS manifesting as qi-yin deficiency with blood stasis and water retention syndrome.It can significantly improve cardiac and renal function,and effectively reduce serum levels of inflammatory markers such as GDF-15 and Gal-3,as well as oxidative stress indicators.