| ObjectivePrimary chronic glomerularnephritis (CGN) is the leading cause of end-stage renal disease (ESRD), which is insidious during onset and hard to be cured. Currently, western medicine treatment of CGN has been researched systematically, however, Chinese medicine treatment researches were still scattered, especially in long-term prognosis field. Meanwhile, there was no systematic and comprehensive research of chronic disease management on the influence on CGN prognosis. Therefore, this research is going to analyze data collection and collation of CGN cases from nephrology department of Guangdong Provincial Hospital of Chinese Medicine in the past five years. We observed the changing situation of proteinuria and estimating glomerular filtration rate(eGFR) to analyze various influence factors, in order to provide a reference for clinical practice and further research.MethodsThe subjects were those CGN patients with proteinuria and eGFR^ 30ml/(min · 1.73m2) who regularly consulted in nephrology department of Guangdong Provincial Hospital of Chinese Medicine from 2010 to 2014, under the age of 14-80. Those participants whose clinical data was incomplete or follow-up period was less than six months were excluded. Information on demographic data, disease characteristic, laboratory indexes, Chinese and western medicine treatments, chronic disease management of TCM was collected. The SPSS 17.0 software was utilized to process statistical analysis. Firstly, the participants were divided into two groups based on whether their proteinuria turned negative or not, and the various influence factors were compared between two groups to find out whether there was statistical significance. Then, we used multivariate logistic regression to analyze independent influence factors of proteinuria prognosis, by regarding the remission situation of proteinuria as dependent variable, and the statistically significant index in the above analysis as independent variable. Afterwards, we considered the decline of 30% eGFR or accepted renal replacement therapy as end event. The whole above factors were statistically processed by COX regression model to analyse independent influence factors of eGFR changing on CGN patients.ResultsThis research included 216 CGN patients who were followed up for 119 (65.75,175.50) weeks. Focus on the curative effect of proteinuria,75 cases were in complete remission, and 49 cases were in half remission. A statistically significant difference(P<0.001) in curative effect of proteinuria exists among follow-up 6 months,1 year,2 years,3 years and 4 years. Besides, the complete remission rate of the second follow-up year is highest. We divided participants into two groups based on whether their proteinuria turned negative or not. And used the single factor analysis and Logistic regression analysis method to analyze the factors influencing the curative effect of proteinuria. The results showed that, shenyankangfu tablet (OR=3.009.95%CI 1.077,8.405), chronic disease management of TCM(OR=2.607. 95%CI 1.044,6.509), baseline of serum creatinine (OR=0.974.95%CI 0.958, 0.989) and serum albumin (OR=0.930.95%CI 0.883,0.979) were independent influence factors of proteinuria complete remission. A total of 20 patients occurred endpoint events (eGFR drop by 30% or accepted renal replacing treatment). The endpoint event rate in 6th months,1st year,2nd years,3rd years and 4th years was 5‰,15‰,74‰,154‰ and 214‰. By single factor and multiple factors COX regression method, this research analyzed the influential factors of endpoint events. The results showed that chronic disease management of TCM (OR=0.307.95%CI 0.110,0.860) is an independent protective factor to slow down the progression of CGN. Meanwhile, systolic pressure (OR=1.024.95%CI 0.999,1.049) may be a risk factor for CGN patients to turn into endpoint event.ConclusionSince the clinical manifestation of CGN is various, controlling proteinuria was regarded as an evaluated standard of clinical curative effect. It was found that the treatment effect of proteinuria is good in our centre. Besides, shenyankangfu tablet, chronic disease management of TCM, baseline of serum creatinine and serum albumin levels were independent influence factors of proteinuria complete remission. Shenyankangfu tablet is made of clinical prescription of traditional Chinese medicine which can supplement qi and nourish yin, as well as strengthen spleen and nourish kidney. The characteristic of curative effect was corresponding to the distribution of Chinese medicine syndrome of included patients. This may be a primary reason of shenyankangfu tablet to become an independent influence factor. What’s more, It also prompted that Chinese medicines have important effect on CGN proteinuria treatment. The increase of serum creatinine was relative to persistent proteinuria and kidney damage, so that it became risk factor of proteinuria complete remission. Patients with lower serum albumin may get more attention from health care staff, which might lead to a better therapeutic effect. In our centre, chronic disease management of TCM is long-term effective communication and education from health care staff to patients. We tried to improve patients’ adherence and awareness of CGN. In the same time, we guided them to accept Chinese medicine style diet and exercise to decrease risk factors of disease and improve treatment effect. The conclusion showed that chronic disease management of TCM is an independent protective factor in proteinuria remission and endpoint events. So we suggest that chronic disease management of TCM should become an important part of CGN regular treatment. However, there still are some limitations of this research. The larger sample and longer follow-up period RCTs are needed to prove this conclusion. |
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