| Objective:This study conducted a retrospective analysis and followup investigation of cases of refractory nephrotic syndrome in children treated by Liu Xiaoying.To explore the characteristics and distribution of children with refractory nephrotic syndrome at various stages,obtaining the tutor's "staged demonstration and treatment" for the treatment of children with refractory nephrotic syndrome and summarize her academic ideas,exploring the clinical efficacy of the tutor's "staged demonstration and treatment" in the treatment of children with refractory nephrotic syndrome and its effect on the quality of life of children.To provide certain theoretical guidance and medication reference for clinical application of traditional Chinese medicine to treat children with refractory nephrotic syndrome.Methods:Part 1:Data mining Collecting cases of refractory nephrotic syndrome in children treated by the tutor from 2009 to 2019,after screening in strict accordance with the inclusion and exclusion criteria,the cases included in the study were recorded using Excel tables to sort out the general information,diagnosis and clinical stage,symptom,syndrome,treatment method,prescriptions,etc.of each patient,so as to establish the original case database.Then,the syndrome types and prescriptions of each diagnosis are summarized by using Excel tables according to clinical stage,so as to build a case staging database,including a database of recurrence and edema,a database of cloudy urine,and a database of remission.The ancient and modern medical case cloud platform(personal version V2.1)was used to statistically analyze the syndrome types included in the case staging database in order to observe the distribution of syndrome characteristics.Perform analysis of Siqi,Wuwei,Guijing,and efficacy on selected Chinese medicines to observe the characteristics of medication properties,Combining frequency analysis,cluster analysis,complex network analysis,and TCM syndrome-drug association analysis to observe the instructor's "segmented treatment" method for the prevention and treatment of various syndrome types in children with refractory nephrotic syndrome at each stage.Part 2:Clinical efficacy study Collect and sort out cases of refractory nephrotic syndrome treated by tutor and other hospital from 2009 to 2019.After screening strictly in accordance with the inclusion and exclusion criteria,historical cohort studies and retrospective analysis were used to sort out,count,and compare relevant observation indicators to evaluate the clinical efficacy and safety of the "staged demonstration and treatment" method for children with refractory nephrotic syndrome,attenuating effect.Part 3:Quality of life survey Refer to the Children's Quality of Life Universal Core Scale(Peds QL4.0)and Kidney Disease Quality of Life Summary Table(KDQOL-SFTM-1.3),and combine the characteristics of children with refractory kidney disease to design a quality of life survey for children with refractory nephrotic syndrome This form is distributed to the mentor outpatient child nephrotic syndrome We Chat consultation management group in the form of a Tencent questionnaire.Parents of children complete the questionnaire through a mobile phone,and then use the Tencent questionnaire background software to collect and collect the questionnaire.Questionnaires that met the inclusion and exclusion criteria were analyzed,the changes in scores of related quality of life items before and after treatment were observed,and the effect of the "staged demonstration and treatment" method on the quality of life of children with refractory nephrotic syndrome was evaluated in a self-contrast manner.Results:1 Data mining1.1 Case collection A total of 203 cases were included in this study,with a total of 1381 consultations.The results of the study showed that in the diagnosis of refractory nephrotic syndrome,the remission period was the most common,followed by the swelling and urinary turbidity,and the recurrence of edema was the least common.1.2 Distribution pattern of syndromes In the distribution of syndrome types,the symptoms of exogenous pathogenic syndrome(39.27%)are most common outside the relapsed edema phase,and the symptoms of dampness, blood stasis(total 5.76%)are relatively rare,and the ex exogenous pathogenic with yang deficiency are most common;In the urinary turbidity phase,the syndrome of insufficiency of kidney qi(50.64%)is the most common,and the damp-heat syndrome(5.96%)is the least common;in the remission phase,the syndrome of spleen and kidney yang deficiency(37.32%)is the most common,the yin-yang deficiency syndrome(3.67%)is the least common.1.3 Rules of medication in recurrent edema phase A total of 191 Chinese medicine prescriptions were included in this issue,and a total of 104 Chinese medicines were used.Frequency analysis showed that the top five frequencies of use were Tuckahoe,Alisma,Cmnamomi Mmulus,Atractylodes,and Poria.The statistics of drug attributes show that the four qi are mostly warm and flat.the five flavors are mainly Gan,Xin and Dan,while the classics are most common in lung,spleen and kidney.According to the classification of drug efficacy,the most beneficial effect is diuretic and hydrating medicine(25.30%),followed by tonic medicine(24.05%)and antihypertensive medicine(18.21%),and the main efficacy is mainly dispel evil(62.49%);Association analysis showed that the most supported drug combination was “Poria cocos-Alisma orientalis ”;combined with cluster analysis,complex networks,syndrome types,and drug association analysis,the commonly used prescriptions in this issue: Yang Deficiency and External Sensation for Wuling San and Ephedra Aconiti Lateralis.Addition and subtraction of Xintang,addition and subtraction of Qi deficiency external sensation for Wulingsan and Ginseng Baidu San,addition and subtraction of yin deficiency external sensation for Wulingsan plus addition and subtraction weirui decoction,and edema syndrome due to Yang deficiency for Wuling San and Zhenwu decoction,and qi deficiency The water-stopping syndrome is the addition and subtraction of Wulingsan and Fangjihuangqi Decoction.The data mining results suggest that the core prescription of this period is Wulingsan.In this phase of treatment,Leeshui swelling is the main treatment method,and syndrome differentiation is supplemented by treatment methods such as relieving the table and tonifying deficiency.1.4 Rules of medication in cloudy urine phase A total of 235 Chinese medicine prescriptions were included in this issue,and a total of 123 Chinese medicines were used.Frequency analysis shows that the top five frequencies of use are Poria,Astragalus,cherokee rose-hip,Gorgon fruit,and Alisma;The statistics of drug attributes show that the four qi are mainly warm and flat,the five flavors are mainly Gan,Xin,and bitter,and the spleen,kidney,and lung are the most common for guijing.According to the classification of drugs by efficacy,tonic medicines(29.90%)are the most,followed by astringent medicines(14.11%),and the main efficacy is equalizing the righting type(47.26%)and eliminating the evil type(43.88%).Drug correlation analysis showed that the most supported drug combination was "Poria-Astragalus";Combining clustering analysis,complex network,syndrome type and medication association analysis,the commonly used prescriptions in this period are: Spleen Deficiency Qi Trapping Syndrome is Buzhong Yiqi Decoction or Juyuan Jian Decoction;Kidney Yin Deficiency Syndrome is the addition and subtraction of Zhibai Dihuang Wan or Qiju Dihuang Pill,and the damp-heat syndrome is Xiehuang San and Sanren Decoction.Although the prescriptions vary depending on the type of syndrome,each type of syndrome is invested with astringent and solid essences such as cherokee rose-hip,Gorgon fruit,etc,indicating that the treatment is to regulate the spleen and kidney,and to astringently solidify.Sperm is the principle of treatment,with the aim of improving proteinuria. 1.5 Rules of medication in remission phase A total of 955 Chinese medicine prescriptions were included in this issue,and a total of 204 Chinese medicines were used.The frequency analysis shows that the top five frequencies of use are Poria,Yam,Moutan bark,Dogwood,Astragalus.Statistics of drug properties show that the four qi are mostly warm and flat,the five flavors are mainly sweet,bitter,and Xin,and the spleen,lung,and kidney are the most common for guijing.According to the classification of drug efficacy,the tonic medicine(39.84%)is the most,followed by the blood circulation and blood stasis medicine(10.45%),and the main efficacy is the righting type(54.66%);Drug correlation analysis showed that the most supported drug combination was " Moutan bark-Fructus Corni";combined with cluster analysis,complex networks,syndrome types,and drug association analysis,the commonly used prescriptions in this issue: Lung and Spleen Qi Syndrome was Shenling Baizhu Sanyu Yupingfeng Powder addition and subtraction,liver and kidney yin deficiency syndrome is Zhibai Dihuang Pill or Qiju Dihuang Pill,spleen and kidney yang syndrome is Shenqi pill addition or subtraction,or Liuwei Dihuang pills with psoralea,Xianling spleen,etc.For Liuwei Dihuang Wan plus Taizishen,Astragalus, etc.,the deficiency of yin and yang is Liuwei Dihuang Wan combined with Sini Decoction.Although the syndromes are different and the treatment methods are different,the treatment purpose of all core prescriptions is mainly to replenish qi,blood,yin and yang,indicating that the treatment principle of tonifying deficiency is the current principle.2 Clinical efficacy study2.1 Analysis of the effect of "staged demonstration and treatment" on the clinical efficacy of RNS and its attenuation effect.2.1.1 Effect of "staged demonstration and treatment" on the remission rate of urine protein.Urine protein of 31 children in the Western medicine treatment group was relieved after cyclophosphamide shock,22cases(70.97%)were resolved,of which 19 cases(61.29%)were completely relieved,and 6 cases(31.58%)of the complete remission continued to be relieved within 1 year.In the group of integrated traditional Chinese and western medicine,there were 34 cases(94.44%),30 cases(83.33%)and 17 cases(56.67%).The chi-square test showed a significant difference between the two(p <0.05). 2.1.2 Effect of "staged demonstration and treatment" on the edema subsidence time,urine protein negative time.There was no significant difference in urine protein quantification 24 hours before treatment between the two groups of patients(p> 0.05).After treatment,the 19 patients with urine protein turning negative in the Western medicine treatment group had the fastest 10 days and the slowest 87 days,with an average of 28.20 ± 13.14 days,the fastest swelling subsided 7 days,the slowest 25 days,an average of 12.69 ±3.98 days,30 patients with urine protein turned negative in the combination of Chinese and Western medicine treatment group,the fastest 6 days,the slowest 33 days,the average 15.72 ±6.05 days,the fastest edema resolution was 4 days,and the slowest was 16 days,with an average of 8.36 ± 2.99 days.The difference between the two groups was statistically significant(p <0.05).2.1.3 Effect of "staged demonstration and treatment" on Serum Total Protein,Albumin and Total Cholesterol Before treatment,there was no significant difference in serum total protein,albumin,and total cholesterol between the two groups of patients(p> 0.05).After treatment,the above indicators of the two groups of children were improved(p <0.01), but with the Western medicine treatment group Compared with the combination of Chinese and Western medicine treatment group,the improvement was more obvious(p <0.01).2.1.4 Analysis of the toxic effect of the "staged demonstration and treatment" method.During cyclophosphamide shock therapy,14 cases,9 cases,5 cases,and 1 cases of respiratory tract infections,gastrointestinal reactions,bone marrow suppression,and increased transaminase occurred in the Western medicine treatment group.No other side reactions were seen.In the combined treatment group,there were respiratory tract infections,gastrointestinal reactions,bone marrow suppression,7 cases,3 cases,1 case,respectively,and no other side effects such as liver and kidney damage were found..2.2 Effect of "staged demonstration and treatment" method on clinical efficacy of FRNS and SDNS2.2.1 The effect of "staged demonstration and treatment" on the dosage of hormones and immunosuppressive agents Before treatment,there was no significant difference in the dosage of mycophenolate mofetil and hormone between the two groups(p> 0.05).After 1 year of treatment,the dosage of hormone in the group of traditional Chinese and Western medicine was significantly reduced compared with the group of Western medicine.p <0.01).2.2.2 The effect of "staged demonstration and treatment" on relapse and respiratory tract infection in children Within 1 year of treatment,the total number of recurrences of children in the Western medicine treatment group was 58 times,with an average of 1.49 ± 0.84 times,and the total number of recurrences in the combined Chinese and Western medicine treatment group was 49,with an average of 0.67 ± 0.79 times.Sexual difference(p <0.01);the total number of respiratory infections in children in the Western medicine treatment group was 178,with an average of 4.57 ± 1.62 times,and the total number of respiratory infections in the treatment group with integrated Chinese and Western medicine was 176,with an average of 2.43 ± 1.66 times.The difference was statistically significant(p < 0.01).2.3 The effect of "staged demonstration and treatment" on serum Ig G,Ig A,COR(08:00)in children with refractory nephrotic syndrome The serum Ig G,Ig A and COR values of 97 children with refractory nephrotic syndrome included in the study had decreased compared with six months ago(p <0.01).The serum Ig G,Ig A,COR(08:00)increased from the first diagnosis(p <0.01).3 Quality of life survey3.1 Questionnaire Recovery A total of 170 questionnaires were distributed to 170 people through the We Chat group,and 154 questionnaires were recovered.48 incomplete and non-compliant cases were excluded,and 106 questionnaires were effectively recovered with a recovery rate of approximately 90.59% and an effective recovery rate of approximately 62.35%.3.2 "staged demonstration and treatment" on the total score of quality of life of children with refractory nephrotic syndrome The total quality of life scores of the patients included in the study were 85.06 ± 9.78 before the treatment of “staged demonstration and treatment” and 94.51 ± 6.92 after the treatment.There was a statistically significant difference between the two(p <0.01).3.3 "staged demonstration and treatment" on the physiological field of children with refractory nephrotic syndrome The total score in the physiological field of the patients included in the study was 33.64 ± 4.11 before the treatment of “staged demonstration and treatment” and 37.81 ± 2.74 after the treatment.The difference between the two was statistically significant(p <0.01),except for “learning ability The scores of the two items of "/ Achievement" and "height increase" were not significantly improved compared with those before treatment(p> 0.05),and the scores of the remaining 9 items were significantly improved compared with those before treatment(p <0.01).3.4 "staged demonstration and treatment" on the psychological field of children with refractory nephrotic syndrome The total score in the psychological field of the patients included in the study was 20.89 ± 3.61 before the“staged demonstration and treatment” and 23.19 ± 2.90 after the treatment.The difference between the two was statistically significant(p <0.01).All 6 items were significantly improved after treatment(p <0.05 or p <0.01).3.5 Impact of "staged demonstration and treatment" on the field of social relations in children with refractory nephrotic syndromeConclusion:1.The distribution of data mining patterns suggests that yang deficiency is the main source of the development and development of refractory nephrotic syndrome in children,and contracting external evil is the main cause of recurrence of refractory nephrotic syndrome in children.Water overflow is the main cause of edema after recurrence.2.According to the rules of data mining and drug administration,Liu Xiaoying used the principle of hydration and swelling for the treatment of relapsed edema in children with refractory nephrotic syndrome and the rapid elimination of edema for the treatment purpose,The academic thoughts in this issue can be summarized as " treating water first".In the period of Cloudy urine,the spleen and kidney are treated,and astringent solid essence is collected as the treatment principle,and proteinuria is relieved as the therapeutic purpose.The academic thoughts in this issue can be summarized as "open source,reduce flow,and cure turbidity".In the period of remission,Taking the principle of tonifying deficiency as the treatment principle and the purpose of restoring righteousness to reduce recurrence,the academic thoughts in this issue can be summarized as "benefiting deficiency and omission,treating deficiency as the foundation".At the same time,promoting blood circulation and removing blood stasis should be used throughout the treatment of this disease. 3.For children with SRNS,the "staged demonstration and treatment" method can effectively improve the proteinuria remission rate and maintain the remission rate,accelerate proteinuria to overcast and edema,and improve the serum total protein,albumin and total cholesterol levels..4.For children with FRNS and SDNS,the "staged demonstration and treatment" method can effectively reduce the risk of disease recurrence,while reducing the dosage of hormones and immunosuppressants.5."staged demonstration and treatment" method for children with refractory nephrotic syndrome not only has good safety in itself,but also can effectively reduce the incidence of side effects such as respiratory infections,gastrointestinal reactions,and elevated transaminase caused by western medicine.6."staged demonstration and treatment" can improve humoral immune function and adrenal function in children with refractory nephrotic syndrome,which may be partly related to the mechanism that can reduce the risk of relapse of refractory nephrotic syndrome.7."staged demonstration and treatment" can improve the overall quality of life of children with refractory nephrotic syndrome by improving relevant factors in the physical,psychological and social relations of children with refractory nephrotic syndrome. |
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