| Currently Chronic Kidney Disease (CKD) is common and difficult to treat。The immune therapy and delay the progress of CKD is commonly used clinicaly. Being able to play a certain effect, but its toxicity obvious, not suitable for long-term administration, and also recur after treatment, is one of the difficulties in clinical treatment. In recent years, immunosuppressive Chinese medicines widely used, but the clinical efficacy of such proprietary Chinese medicines and medical cases are rarely reported in detail.ObjectiveIn this study, clinical observation, about commonly used immunosuppressants such as Tripterygium preparations (eg Tripterygium Queensland cents capsules) and breeze Rattan drugs (eg Zhengqingfengtongning) the efficacy and side effects of drugs safety effective treatment of CKD provide a frame of reference.MethodsLiterature research, clinical research and medical case excerpts, etc. combined, comprehensive analysis of the efficacy and characteristics of these drugs.1. A literature study:literature search, analyzed with immunosuppressive Chinese medicine relevant information, investigate major commonly used in clinical medicine: Tripterygium preparations, capsules and Queensland cents Zhengqingfengtongning so its pharmacology, efficacy, side effects clinical application and experimental research, analyzes its therapeutic efficacy and adverse reactions of CKD, literature studies provide the basis for clinical use of these drugs.2. Clinical Research:A retrospective analysis was collected from March2012to October2013Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Nephrology single center in Shenzhen, in a study of63CKD patients treated with Tripterygium, Queensland cents capsules or Zhengqingfengtongning, clinical syndromes, laboratory biochemical indicators, side effects of statistical analysis of the efficacy and adverse reactions were observed.3. Medical Case Study:Some medical records taken from Professor Li Shunmin, typical cases with combined application of proprietary Chinese medicine and immunosuppressant modulating, as the clinical efficacy of the other supplementary basis. Results1. Literature study found(1) Queensland cents capsules in the treatment of nephrotic syndrome, nephritis lupus nephritis (LN) can significantly improve clinical symptoms, reduce proteinuria, even for hormone therapy plus cyclophosphamide method of LN patients, application of Kun Xian capsule combined with tacrolimus have a significant effect, remission rate of64%, less adverse reactions; experimental findings:Kun Xian Capsule can reduce doxorubicin induced nephrotic syndrome in rats24h urine protein, elevated serum total cholesterol and reduce glomerular pathological damage.(2) Use of Zhengqingfengtongning with benazepril and losartan or combined with hormone can reduce patients with IgA nephropathy24h urinary protein excretion and urinary albumin levels; in addition Zhengqingfengtongning would rather pass down the expression level of the kidneys of diabetic nephropathy ET patients with renal protective effect. The auxiliary corticosteroids and cyclophosphamide (CTX) can reduce idiopathic focal segmental glomerular sclerosis patients24h urinary protein, elevated serum albumin and creatinine clearance. Experimental studies have found:Zhengqingfengtongning non-specific immunity, humoral and cellular immunity were inhibited.(3) Tripterygium treatment of nephrotic syndrome is widely used clinically, IgA nephropathy, diabetic nephropathy, nephritis disease, chronic renal failure, etc., lower urinary protein, improve kidney disease prognosis and shorten the duration and reduce recurrence combined with TCM obtain better efficacy. The main side effects of Tripterygium is gonadal toxicity, gastrointestinal symptoms and blood system, skin and mucous membranes, modulating with Traditional Chinese Medicine, all adverse reactions disappeared after discontinuation and efficacy more pronounced.2. Clinical study found(1) In this study, one and a half of years of clinical observation:patients taking Kun Xian Capsule for three months, the total efficiency of69.8%can be achieved, can effectively reduce proteinuria and slow down the progression of chronic kidney disease. At early stage, patient taking Kun Xian Capsule rarely occurs on gastrointestinal disorders, skin allergies, herpes zoster, abnormal liver function, menstrual disorders or amenorrhea and other adverse reactions. From the results of long-term follow-up study:women of childbearing age taking Kun Xian capsules, menstrual disorders or amenorrhea occurred was still high (approximately31.8%), clinically application of Bushenyijing medicine does not reduce reproductive toxicity Kunming Hill Begonia.(2) For taking Zhengqingfengtongning of proteinuria in patients with chronic kidney disease for three months was observed and found that clinical effective rate of63.3%, adverse reactions are upper abdominal discomfort and rash, no liver dysfunction noted.3. Medical case study found(1) Kun Xian Capsule treatment of chronic glomerulonephritis:Hao Moumou, chronic nephritis patients, duration of2years, did not undergo biopsy, combination of Kun Xian capsule and Chinese Medicine, clearing heat Differential Treatment, proteinuria rapidly reduce, no adverse reactions. Nephritis medical record:Ao Moumou, pathology clearly as nephritis (focal proliferative, ISKD type:Ⅲ a), hormone therapy, after the addition of Queensland cents capsules and chinese medicine, spleen and kidney. Yiqiyangyin, clearing heat treatment, urine protein was negative, skin purpura without recurrence, no significant side effects.(2) Application of Tripterygium glycosides with Chinese medicine treatment of IgA nephropathy typical cases:Yuan Moumou, IgA nephropathy sclerosis type (over50%) of severe pathology, and has served Bailing Capsule hormone therapy for five years, the disease poorly controlled. Chinese medicine Qi Yin, clearing heat subtraction method combined double dose Tripterygium and shellfish that reducing Plymouth tablets in the treatment patients urine protein; decrease creatinine gradually declined and remained at around120umol/L, no significant hepatic dysfunction noted.(3) Application of Zhengqingfengtongning with Chinese medicine treatment of chronic nephritis typical cases:patients Shi Moumou, proteinuria associated with high blood pressure, about155/110mmHg, qi and yin, clearing heat subtraction method, in combination with low dose hormones, ACEI class of antihypertensive drugs and Zhengqingfengtongning oral sustained-release tablets, can effectively control the urine protein and blood pressure, reverse kidney disease progression process, with no obvious patient discomfort, and liver function showed no abnormality.ConelusionSummarized the above three studies a lot of literature support immunosuppressive medicine such as Kun Xian Capsule, Zhengqingfengtongning, Tripterygium preparations, can significantly improve proteinuria of man and experimental animal, delay the progression of CKD. The molecular mechanisms involved in various aspects including renal pathology, coagulation, immune system and MRL/lpr serum metabolism indicators have different effects in mice.Clinical cases observed:Kun Xian Capsule with Zhengqingfengtongning can effectively alleviate proteinuria and protect renal function Kun Xian Capsule total efficiency with69.8%can be achieved, early Kun few cents rarely gastrointestinals, skin allergy, demage of reproductive function and other adverse reactions, but after prolonged use, menstrual disorders or amenorrhea occurs in approximately31.8%high level. Medical case studies summarized double Dose of experimental Kun Xian capsules, Zhengqingfengtongning and Tripterygium with Chinese medicine modulating treatment of chronic kidney disease, induction appreciate these drugs can effectively relieve proteinuria and protect renal function, even patients with severe refractory condition may still have some effect, and fewer side effects, low recurrence rate, safe and effective. |
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