Effects of Yishenjiangzhuo granules on immunity and bone metabolism in patients with stage 3-4 chronic kidney disease

OBJECTIVE:To determine the effects of Yishenjiangzhuo granules(YJG)on bone metabolism and to explore the changes in levels of bone Gla protein(BGP),tartrate-resistant acid phosphatase(TRAP),as well as their relationships with levels of B cells,regulatory T cells(Treg)and interleukin(IL)-17 in patients with stage 3-4 chronic kidney disease(CKD)before and after treatment.METHODS:Fifty-three stage 3-4 CKD patients were divided randomly into two groups:YJG treatment and control.Peripheral blood was taken from two groups of CKD patients and 21 healthy subjects in the normal group.The parameters determined were the levels of CD4+,CD19+,CD19+CD69+,CD19+AV,Treg(CD4+CD25+CD127lo),BGP,TRAP,IL-17,calcium,phosphate,blood urea nitrogen,serum creatinine(SCr),hemoglobin(Hb)in peripheral blood,and urinary creatinine.Calcium-phosphate products and endogenous creatinine clearance rate(CCr)were calculated according to standard protocols.RESULTS:In YJG and control groups,SCr levels were lowered(P<0.01)after treatment,whereas CCr(P<0.05)as well as Hb and albumin levels(P<0.01)were increased.The changes in levels of CCr and SCr in the YJG group were more significant.After treatment,CD19+CD69+and Treg levels in the two groups varied(P<0.01)compared with those of the normal group;the level of CD19+increased but the levels of CD4+and CD19+AV decreased(P<0.01)in both groups.Compared with the control group,the changes of CD19+and CD19+AV in the YJG group were more apparent(P<0.05).Compared with the normal group,levels of IL-17 in both groups increased significantly(P<0.01),and the difference in the control group was more significant(P<0.05).After treatment,the TRAP level increased(P<0.05),but the difference in BGP level(P>0.05)was not significant.CONCLUSION:In stage 3-4 CKD patients,B cells and IL-17 participated in the induction of osteoclast activation.YJG could also elevate the level of B cells and decrease their apoptosis,but showed no significant effects on active B cells,IL-17 or osteoclast activity.