Clinical Observation Of Therapy Of Bushen Yiqi Huayu Decoction On Refractory Nephritic Syndrome

Refractory nephrotic syndrome (RNS) is the primary nephrotic syndromewhich is of no response to or only partly alleviative to the conventionaltreatment with predisone, but relapses frequently (3 times or more in one year,or 2 times or more in half of year), or predisone-dependent. It includes threetypes: steroid-resistant nephrotic syndrome (SR), steroid-dependent nephroticsyndrome (SD) and frequently relapse nephrotic syndrome (FRNS). In ChineseMedicine, it belongs to the diseases such as edema, uroschesis, consumptivedisease, and umbago. RNS occupies 30%-50% or so in the primary nephroticsyndrome, has poor prognosis and tends to lead to the renal failure, so it ismore important to treat RNS. In Western Medicine the doctors think therefractory factor primarily has closely relationship with pathology types. TheRNS has a better prognosis if it comes from the minimal change nephropathyor mesangial proliferative glomerrulonephritis, but the treatment of otherpathology types is tougher. Other refractory factors are mainly the abnormalimmunologic function, hyperlipemia, hypercoagulablility, proteinuria,hypoalbuminemia and infection. In Chinese Medicine, the doctor think therefractory factor is primarily the use of repeated steroid that resulted indysfunction of yin and yang, deficiency of genuine, deficiency of spleen-yangand kidney-yang and blood stasis. In the treatment of RNS, the therapy withsteroid and immuno-suppressant is the main method, which make functionquickly but has lots of adverse reaction. If we only use traditional ChineseMedicine, the effect is slow and slight. In our research, we primarily treat RNSwith Integrated Traditional Chinese Medicine(TCM) and Western Medicine.Objective: To investigate the clinical effect of TCM and Westernmedicine on refractory nephritic syndrome.Methods: 60 cases of refractory nephritic syndrome(RNS) were locatedrandomly into the treatment group(n=30) and the control group(n=30). In thecontrol group, patients were only treated with predisone and cytoxan (CTX).In the treatment group, cases were administered with integrated treatment ofpredisone, cytoxan (CTX) and Chinese herbs. In both groups patients'urinaryprotein, plasma albumin, bloodlipid, renal function, hemorrheology andplatelet aggregation rate were analyzed. Their clinical complete remissionrates, recurrence rates, and adverse reaction were examined. All these datawere analysed with SPSS12.0.Results:1. The complete remission rates is significantly higher in treatment group(50%) compared with those in control group 20% (P<0.01). The total effectiverate is 93.3% in treatment group, while in the control group it is 73.3%(P<0.05).The adverse reaction rate in the treatment group is 53.3%, which is farlower than the 83.3% in the control group (p<0.05).2. In treament group, 24-hour urine protein excretion was decrease from 7.37+ 1.89 g/L to 1.22+2.10. Serum albumin was increased from 22.06+2.66g/L to34.02+5.61 g/L after three months.3. BUN had no differences before and after therapy in these two groups, butScr had significant differences in treatment group and was better than that incontrol group after therapy.4. Hypercoagulablility in both groups were improved obviously before andafter the therapy and the improvement in treatment group was much betterthan that in control group.Conclusions:1. Integrated treatment of TCM and Western medicine can significantlyimprove the clinical effect on RNS.2. In the clinical treatment of RNS, we should pay attention to thefollowing three aspects: Firstly, the initial dose of steroid should be enough,the extenuation should be slow and the maintenance should be long; Secondly,integrate enough cytotoxic drugs; Thirdly, predisone, cytoxan (CTX) andChinese herbs should be cooperated, which not only can improve the clinicaleffect, reduce the recurrence, but also can avoid lots of adverse reaction ofsteroid and immuno-suppressant.3. Integrated treatment of TCM and Western medicine on RNS canimprove renal function, reduce urinary protein, increase plasma albumin, lowerblood lipid and decrease hypercoagulablility.4. Integrated treatment of TCM and Western medicine on RNS can notonly reduce the rebound phenomenon but also increase the sensitivity of bodyto the steroid, improve the immunity, increase the resistibility of body todisease and steady clinical effect.Conclusion analysis:The Integrated treatment of TCM and Western medicine can improve theremission rate, reduce the recurrence rate and adverse reaction effectivelyinRNS. The mechanisms is as follows:1: The Chinese herbs decrease thefeedback inhibition of steroid to hypothalamus-pituitary-adrenocortex axis, sothey can increase the sensitivity of body to the steroid , improve the effect ofsteroid, reduce the remission time and then make better therapeutic effect. 2:The Chinese Medicine reduce the adverse reactions of the steroid andimmuno-suppressant, which ensure the whole period treatment of the steroidand immuno-suppressant and make them play full roles in the treatment. 3:he Chinese Medicine can regulate the immunologic function, accelerate thesynthesis of albumin in the liver, reduce urinary protein and improveimmunologic function. Meanwhile it can increase the resistibility of body to...