| The part?:Analysis of prognostic risk factors for IgA nephropathyObjective:To analyze the risk factors related to the risk of poor prognosis of IgA nephropathyMethods:IgA nephropathy patients diagnosed by renal biopsy in Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences were selected.By collecting clinical data,laboratory indicators,pathological indicators,TCM syndromes and their elements during follow-up,the initial Scr was increased from baseline Times or the initial eGFR decreased by more than 50%compared with baseline,or entered the ESRD phase or died as a joint endpoint event indicator,with the joint endpoint event as the dependent variable,and each clinical,pathological,TCM syndrome and its elements as independent variables,through Cox Regression survival analysis to determine the predictive value of risk factors and calculate the cumulative renal survival rate by Kaplan-meier survival curve.Results:A total of 226 patients with IgA nephropathy were enrolled in this study.The results showed that in general data,the baseline systolic blood pressure and mean arterial pressure of patients in the end point group were higher than those in the end point group(P<0.05),and the end event group was mainly distributed in CKD3-4.In terms of laboratory indicators,the 24h urine protein quantitation,Scr,blood uric acid,urea nitrogen,and triglyceride levels of patients in the end-point event group were higher than those in the end-point event-free group,and eGFR,serum albumin,total serum protein,and hemoglobin levels were lower than There was no end event group(P<0.05).In terms of pathological indicators,the Oxford classification MEST-T score and MEST-C score were higher in the end-event group(P<0.05).In terms of TCM syndromes and its elements,the proportion of fatigue,edema,chills,and nausea is higher than that in the group without end point(P<0.05),and the proportion of spleen and kidney yang deficiency is significantly higher than that in the group without end point(41.6%vs6.9%,P<0.05).In the treatment of Chinese and Western medicine,the patients in the Chinese medicine group with an end-event group were significantly lower than those without an end-point group(16.7%vs 63.4%,P<0.05);the proportion of taking Bailing capsules and Huangkui capsules was higher than those without an end-point group(58.3%vs46.5%,62.5%vs39.1%,P<0.05),the proportion of taking nephritis rehabilitation tablets was lower than that of the end point group(29.2%vs68.8%,P<0.05).By incorporating the above single factor analysis results into Cox multivariate regression analysis results,TA-MAP,24h urine protein quantification,TA-UP,Scr,New Oxford pathological classification T score,New Oxford pathological classification C score,fatigue are closely related to the occurrence of joint endpoint events and are independent risk factors for poor renal prognosis.Conclusion:TA-MAP,24h urinary protein quantification,TA-UP,Scr,New Oxford pathological classification T score,New Oxford pathological classification C score,fatigue,and chills are closely related to the occurrence of the joint endpoint event,and are Independent risk factors for poor renal prognosis.Among them,compared with the initial Chinese medicine treatment,the risk of combined end point events of Chinese medicine combined with hormone and(or)immunosuppressive therapy will not be reduced.The partll:Clinical Observation of Yiqi Heluo Recipe in Intervening Risk Factors of IgA Nephropathy Patients with Deficiency of Qi and YinObjective:To observe the improvement of total effective rate and clinical remission rate of Yiqi Heluo Recipe on IgA nephropathy patients with Qi-yin deficiency syndrome,TCM syndrome score,TCM syndrome score,and to preliminary discuss the intervention of Yiqi Heluo Recipe Clinical efficacy of risk factors for IgA nephropathy.Methods:Thirty patients with Qi-yin deficiency syndrome and IgA nephropathy diagnosed by renal puncture biopsy in the outpatient department of the Nephrology Department of Xiyuan Hospital,Chinese Academy of Chinese Medical Sciences were selected,and on the basis of conventional treatment,Yiqi and Luoluo basic prescriptions were added to the disease.Oral,one dose per day,taken twice a day for breakfast and dinner.The course of treatment was 24 weeks,followed up for 24 weeks,and a total of 48 weeks of observation.By observing the clinical indicators,TCM syndrome scores,TCM syndrome scores,total effective rate and clinical remission rate improvement of Yiqi Heluo Recipe on patients with IgA nephropathy of Qi-yin deficiency syndrome,the intervention of Yiqi Heluo Recipe in IgA nephropathy was preliminarily discussed The clinical efficacy of risk factorsResults:1.In terms of clinical indicators,compared with before treatment,the 24-hour urine protein quantification level of IgA nephropathy patients at 24 weeks and 48 weeks of treatment decreased,and the 24-hour urine protein quantification level of IgA nephropathy patients at 48 weeks was lower than that at 24 weeks of treatment(P<0.05);IgA nephropathy in patients with 48 weeks of treatment compared with before treatment,urine red blood cell count and IgA level decreased.2.The improvement of TCM syndrome scores,compared with before treatment,the scores of TCM main symptoms and total symptoms of IgA nephropathy patients who were treated for 24 weeks and 48 weeks were reduced.Among them,the total symptom scores of IgA nephropathy patients treated for 48 weeks were higher than those after treatment.The 24-week integral level was lower(P<0.05).3.In terms of the overall effectiveness of TCM syndrome points improvement,the total effective patients with IgA nephropathy after 24 weeks of treatment were 18 patients(60%),and the patients with IgA nephropathy after 48 weeks of treatment were generally effective For 25 patients(83.3%),the overall effective rate of improvement of TCM syndrome scores in patients with IgA nephropathy after 48 weeks of treatment was higher than 24 weeks(P<0.05).4.In terms of clinical remission rate,the total remission rate at 24 weeks of treatment reached 56.7%.After 48 weeks of treatment,the total remission rate reached 80%.Conclusion:Yiqi Heluo Recipe can reduce the 24h urine protein level and urine red blood cell level of patients with IgA nephropathy,improve the TCM syndrome score,control risk factors,and delay the progression of the disease.The part ?:To explore the mechanism of Yiqi Heluo Recipe in the treatment of IgA nephropathy based on T/B cell immune balanceObjective:To observe whether Yiqi Heluo Recipe can reduce the influence of abnormal glycosylated IgAl by regulating the changes of peripheral blood BAFF level,T cell subpopulation ratio and cytokine level in patients with IgA nephropathy,and explore Yiqi Heluo recipe for IgA The mechanism of action of nephropathy.Methods:In the second study,30 cases of IgA nephropathy patients with Qi and Yin deficiency syndromes were intervened by Yiqi Heluo Recipe,and 10 healthy subjects were matched in the same period.Collect peripheral venous blood of patients with IgA nephropathy before and after treatment and healthy subjects,extract peripheral blood mononuclear cells,apply fluorescence staining of flow specimen and detect the ratio of Th1,Th2,Th17,Treg cells,and detect the low glucose in peripheral blood by ELISA Based on the level of IgAl,BAFF and the levels of cytokines IL-4,IL-6,IL-17,explore the mechanism of Yiqi Heluo Recipe in the treatment of IgA nephropathyResults:1.Compared with HC group,peripheral blood Gd-IgA1 level in IgA nephropathy group increased(P<0.05),and peripheral blood BAFF level increased(P<0.05).After 24 weeks and 48 weeks of treatment,Gd-IgAl levels in peripheral blood decreased(P<0.05),BAFF levels decreased P<0.05).In the peripheral blood T cell subsets,compared with the HC group,patients with IgA nephropathy had higher levels of Th2,Th17,Th2/Treg,and Th17/Treg in their peripheral blood,and lower Treg(P<0.05).After 24 weeks and 48 weeks of treatment,the ratio of Th2 cells,Th17 cells,Th2/Treg and Th17/Treg in peripheral blood decreased compared with before treatment,and the ratio of Treg cells increased before treatment(P<0.05).In terms of cytokines,compared with the HC group,the levels of IL-4,IL-6,and IL-17 in the IgA nephropathy group increased(P<0.05),and the peripheral blood IL-4,IL6,IL after 24 weeks and 48 weeks of treatment-17 was significantly lower than before treatment(P<0.05).2.In terms of the correlation between peripheral blood Gd-IgAl levels,the increase in peripheral blood Gd-IgAl levels in patients with IgA nephropathy was significantly correlated with 24h urine protein and IgA levels;it was significantly correlated with peripheral blood BAFF levels;and peripheral blood Th2,Th17 and Th17/Treg were positively correlated,and negatively correlated with Treg cell percentage and Th1/Th2(P<0.05);positively correlated with peripheral blood IL-4,IL-6 and IL-17(P<0.05).3.In terms of the correlation between peripheral blood BAFF,BAFF levels are positively correlated with peripheral blood Th2,Th17.Th17/Treg,and negatively correlated with Treg cell percentage and Th1/Th2(P<0.05);BAFF levels are correlated with peripheral blood IL-4,IL-6 and IL-17 were positively correlated(P<0.05).4.In terms of the correlation between peripheral blood T cell subsets,the proportion of Th2 cells was negatively correlated with 24 h urine protein quantification,Scr,TC levels(r=-0.394,p=0.036;r=-0.312,p=0.013;r=-0.382,p=0.038);Th17 cell ratio was negatively correlated with ALB level(r=-0.317,p=0.018),positively correlated with IgA level(r=0.385,p=0.026);Treg was negatively correlated with BUN level Correlation(r=-0.463,p=0.015);Thl/Th2 is negatively correlated with Scr level(r=-0.365,p=0.011);positively correlated with TC level(r=0.396,p=0.007);Thl/Treg Positively correlated with eGFR level(r=0.352,p=0.037);Th2/Treg negatively correlated with eGFR level(r=-0.337,p=0.040);Th17/Treg positively correlated with 24-hour urine protein quantification(r=0.385,P=0.029),negatively correlated with ALB levels(r=-0.376,p=0.031);Th2,Thl/Th2 were positively correlated with IL-4 and IL-6,Th17,Th17/Treg were positively correlated with IL-17(P<0.05).5.Regarding the correlation of peripheral blood cytokines,IL-4,IL-6,IL-17 were positively correlated with 24h urine protein quantification;IL-4,IL-17 were negatively correlated with eGFR(P<0.05).Results:1.In terms of clinical indicators,compared with before treatment,the 24-hour urine protein quantitative levels of IgA nephropathy patients at 24 weeks and 48 weeks of treatment decreased,and the 24-hour urine protein quantitative levels of IgA nephropathy patients at 48 weeks of treatment were lower than those at 24 weeks of treatment.(P<0.05);The urinary red blood cell count,IgA and C3 levels of patients with IgA nephropathy treated for 48 weeks were lower than before treatment,and the IgA/C3 levels of patients with IgA nephropathy treated for 24 weeks and 48 weeks were lower than before treatment.IgA/C3 levels in patients with IgA nephropathy treated for 48 weeks were lower than those at 24 weeks(P<0.05).2.The improvement of TCM syndrome scores,compared with before treatment,the scores of TCM main symptoms and total symptoms of IgA nephropathy patients who were treated for 24 weeks and 48 weeks were reduced.Among them,the total symptom scores of IgA nephropathy patients treated for 48 weeks were higher than those after treatment The 24-week integral level was lower(P<0.05).3.In terms of the overall effectiveness of TCM syndrome points improvement,the total effective patients with IgA nephropathy after 24 weeks of treatment were 18 patients(60%),and the patients with IgA nephropathy after 48 weeks of treatment were generally effective For 25 patients(83.3%),the overall effective rate of improvement of TCM syndrome scores in patients with IgA nephropathy after 48 weeks of treatment was higher than 24 weeks(P<0.05).4.In terms of clinical remission rate,the total remission rate at 24 weeks of treatment reached 56.7%.After 48 weeks of treatment,the total remission rate reached 80%.5.In terms of mechanism,the levels of Gd-IgA1 in peripheral blood decreased after 24 and 48 weeks of treatment(P<0.05),and the level of BAFF decreased P<0.05);the ratio of Th2 cells,Th17 cells,Th2/Treg,Th17/Treg in peripheral blood Compared with before treatment,the proportion of Treg cells was higher than before treatment(P<0.05);peripheral blood IL-4,IL6,IL-17 were significantly lower than before treatment(P<0.05).Conclusion:1.Patients with IgA nephropathy have an imbalance of T/B cell immunity,which is mainly manifested in the increase of peripheral blood BAFF level,the imbalance of the proportion of T cell subsets and the secretion of cytokines.2.The level of Gd-IgA1 is higher in patients with IgA nephropathy,which is significantly correlated with 24h urine protein quantification,BAFF level,T cell subset ratio and the level of cytokine secreted.3.Yiqi Heluo Recipe can significantly reduce the level of Gd-IgA1 in patients with IgA nephropathy,and its mechanism may be related to the reduction of peripheral blood BAFF level and the improvement of T cell immune balance. |
PDF Full Text Request