Clinic Observation Of Treating Primariy Membranous Nephropathy Patients With Shenluotong And Effect To The Function Of Endotheliocyte

Objective: Primariy membranous nephropathy is one of pathology types about adult nephrotic syndrome, general age of membranous nephropathy is 40~50 years old. The place of primariy membranous nephropathy has decreased to number 2 in some reports. The pathology characteristic includes: immune complex deposit in the endepidermis of the glomerular base- ment membrane,and capillary basement membrane diffusely thicken;the clinical manifestation is nephrotic syndrome and albuminuria without complaint.The disease incidence of the disease higher,the pathological changes is chronic and pro- gressive,some patiengts make advancement terminal stage kidney failure after many years.Excitatory autacoid and cyto- toxic drug have bad curative effect and major adverse reaction. For the recent years,conbined treatment of traditional Chinese medicine and western medicine is better,and can decrease effectually adverse reaction of excitatory autacoid and immuno- depressant. Professor Zhaoyuyong by clinical observation for many years applicates collateral disease theory to described Chinese medical pathomechanism of primariy membranous nephropathy.He thinks pathogenetic condition of primariy membranous nephropathy is difficult to recover and course of disease is long.Long disease must be deficiency.The prolonged disease affect collaterals.Kidney collateral stasis is basic path- ogenesis of primariy membranous nephropathy.He uses the method of increasing pneuma, invigorating the kidney and invigorating the spleen,dispersing blood stasis and dredging collateral.In the foundation of determine the treatment based on differentiation of symptoms and signs,he creates shenluotong (including:huangqi,danshen,chuanxiong,dilong,wushaoshe,jiangcan,chandui,guiban,fuling,chaoshanyao and so on) which is pre- dominant on clinic therapeutic effect.We treat primariy mem- branous nephropathy with the shenluotong,which is a funda- mental prescription in the treating.We will observe clinic curative effect; and observe changes of t-PA PAI-1 and ET-1, to investigate the mechanism about protecting the function of endotheliocyte and improving blood clotting millimicro- dissolving systemic.It will supply valid method and research way for Chinese medicine treatment of primariy membranous nephropathy.Methoths: We choosed 72 patients of primariy mem- branous nephropathy who were in Hebei Provinsial TCM Hospital and Hebei Medical University traditional chinese medical college out-patient department.We divided them into 2 groups randomly and comparable. 36 cases were in the treated group,36 cases in the control group. There were not significant difference in two groups. The treated group and the control group accepted same treatment of the foundation (including general treatment and symptomatic treatment).In the foundation, the treated group was treated by shenluotong,the control group was given Piperazine Ferulate Tablets.The treatment course is3 months.We observe urinconvention,24 hours urine protein,plasmaalbumin,trigly- ceride,total cholesterol,low density lipoprotein,fibrinogen,blood viscosity and clinic symptom.Second part of investigate,we added normal healthy group including 30 cases to give normal diet.We observe the changes of t-PA PAI-1 and ET-1 in the three groups.Results:1 The total effective rate of the treated group was 83.33% and 61.11% in the control group. There was significant difference in both group(P<0.05).2 The curative effect of symptom had significant difference after treatment in two groups,and the treated group surpassed the control group.3 In the treat group clinic symptom integral had significant deviation comparing before treatment(P<0.01).After treat- ment,compared with the control group,clinic symptom had significant deviation in the treated group(P<0.05).4 In differentiation of symptoms and signs for classification of syndrome, the percentage of deficiency of kidney and spleen was highest, and the curative effect of hepatic and renal yin deficiency was worst.To follow light and heavy press in path- ology,the total effective rate of primariy membranous neph- ropathy inⅠstage was 90.47% and 73.33% inⅡstage.Com- paring the treated group and the control group,there was significant deviation(P<0.05).5 After the treatment,compared with the control group,Urine protein and haematuria and blood fat of the treated group was significantly decreased(P<0.05),plasma-albumin was signifi- cantly increased(P<0.05).6 After the treatment,compared with the control group, fibrinogen and blood viscosity of the treated group was signi- ficantly decreased(P<0.05).The indicatrix of fibrinogen and blood viscosity had significant deviation comparing before treatment in the treat group(P<0.01).7 T-PA (ng/ml) of the normal healthy group was 8.62±1.10, PAI-1(ng/ml) was 24.14±4.52,ET-1 (pg/ml) was 40.56±8.93; The treated group,before the treatment:4.16±0.81,34.12±4.13, 69.63±6.13;after the treatment:6.11±1.02,25.70±4.16,41.52±3.36.The control group,before the treatment:4.20±0.84,35.63±3.28,71.75±4.44;after the treatment:5.35±0.71,30.24±3.57, 53.17±6.05.Before the treatment,compared with the normal healthy group, the levels of PAI-1 and ET-1 of the treated group was significantly increased (P<0.01,P<0.01), and the levels of t-PA of the treated group was significantly decreased(P<0.01). After the treatment, compared with the control group,the levels of PAI-1 decreased in the treated group(P<0.05),t-PA increas-ed(P<0.05),ET-1 decreased(P< 0.01).The treated group was much better than the control group.Conclusion:1 Using the method of dispersing blood stasis and dredging collateral treated primariy membranous nephropathy,and shenluotong can significantly decrease clinic symptom integral and improve clinic symptom.The shenluotong group was much better than the control group.2 Shenluotong can decrease urine protein,blood fat,fibrinogen and blood viscosity, and increase plasma-albumin.3 Shenluotong can decrease the levels of PAI-1 and ET-1 of primariy membranous nephropathy(Ⅰstage andⅡstage), and increase the levels of t-PA to protect the function of endotheliocyte and improving blood clotting millimicro- dissolving systemic.It will supply better method for treating of primariy membranous nephropathy.