Yiqi Huoxue Clinical Observation And Water Treatment Of Idiopathic Membranous Nephropathy And Sign Of Urinary Podocyte Proteins (pcx)

Idiopathic membranous nephropathy (IMN) is one of common pathological pattern of primary glomerular disease, and its morbidity is just behind IgA nephritis. The pathogenesis of IMN is because of the thickened basement membrane that resulted from immune complex deposition in the glomerular capillary loop, it can active complement and destroy the podocyte lead to the damage of glomerular filtration membrane, and then lead to massive proteinuria. Podocalyxin (PCX) is a biomarker of the podocyte, when the podocyte is injured the PCX also will be delivered into urine. Treatment with several immunosuppressive agents has shown beneficial effect on the course of this disease, but long-term use will cause immune tolerance, infection. So finding another better way for treatment is the trend. TCM shows a satisfactory effect in treating IMN, especially in reducing the recurrence and the complication incidence. Under the guidance of the classical theory of TCM and clinical practice, supervisor further concluded that this disease mainly due to the disorders of Qi,Xue and Shui, i.e Qi deficiency, blood stasis and water stagnation.Coah also pointed out that the treatment of IMN is Yiqi Huoxue Lishui. This study which is based on former work continues to study the effect of this treatment on IMN, and to observe the affection of the podocalyxin.Objectives1. Analyse the effect of Yiqi Huoxue Lishui method on treating IMN prospectively.2. Observe the effect of the podocalyxin after Yiqi Huoxue Lishi treatment.Methods1. Selecting42IMN patients with the syndrome of Qi deficiency, blood stasis and water stagnation,42cases were divided into two groups by using IMN risk stratification method. One is low-risk group A (treated by Qi Xue Shui IMN prescriptions) and the other is high-risk group B (treated by Qi Xue Shui IMN prescriptions combined with immunosuppressant), each group contains21cases. Observe the pre and post TCM symptom integral, clinical effect,24hUpo and other laboratory index that relative, and compared the therapeutic effect during before and after treatment.2. Selecting42IMN patients treated by Yiqi Huoxue Lishui theory, and observing the pre and post level of PCX in two groups. Results1. The clinical efficacy of Yiqi Huoxue Lishui treatment on IMN(1) The whole curative effect:①TCM symptom integral:The total effective rate in the course of3months and6months is54.8%and83.3%respectively(p<0.05);②General clinical effect:The total effective rate in the course of3months and6months is47.6%and73.8%respectively(p<0.05);③24hupro:the level of6months is lower than3months(p<0.05). It proves that the method of Yiqi Huoxue Lishui can improve TCM symptom integral, general clinical effect and24hupro, and the longer course of treatment take the improvement is more obvious.(2) Analysis by two groups①TCM symptom integral:The total effective rate of group A in the course of3months and6months is57.1%and90.5%respectively(p<0.05), the total effective rate of group B in the course of3months and6months is42.9%and81.0%respectively(P<0.05). It shows that no matter in low-risk or high-risk group of IMN the method of Yiqi Huoxue Lishui is effective, and with the course of treatment extend the effect will become more obvious.②General clinical effect:The total effective rate of group A in the course of3months and6months is38.1%and85.7%respectively(P<0.05), the total effective rate of group B in the course of3months and6months is33.3%and61.9%respectively(P>0.05),the effects in3months and longer duration were obvious in low-risk group, the high have no change between3months and6months.③24hUpo:The level of24hupro of two groups both decrease after treatment (P<0.05), it proves that the method of Yiqi Huoxue Lishui can both reduce the level of low-risk and high-risk IMN.④Safety index:After treatment, the level of eGFR of group A increase (P<0.05), the level of TBIL of group B increase (P<0.05). Others of both two groups have no change after treatment (P>0.05).It shows that the method of Yiqi Huoxue Lishui can improve the renal function of low-risk IMN.⑤Other index:After treatment, the levelof ALB of group A both increase (P<0.05), and the level of CHO and LDL decrease (P<0.05). The level of ALB of group B increased (P<0.05), the level of CHO, TG and LDL have no change(P>0.05). This shows that the method of Yiqi Huoxue Lishui can increase the level of ALB in both two groups, also it can improve hemorrheologic of group A.2. The effect of Yiqi Huoxue Lishui treatment of IMN on PCX(1) After treatment, the level of PCX of two groups both increased (P<0.05), the level of24hUpro of twos groups both decreased (P<0.05). It shows that the method of Yiqi Huoxue Lishui in treating can reduce the excretion of urine protein and elevate the content of PCX in urine.(2) Analysing the relative between PCX and24hUpro, the result shows that there is correlation between them.Conclusions1The method of Yiqi Huoxue Lishui has a significant clinical effect on IMN, and from the treatment observation, we get that patients with long course of treatment can improved more obviously.2The method of Yiqi Huoxue Lishui can can improve hemorrheologic and renal function of low-risk IMN.3. Yiqi Huoxue Lishui method has a certain function in reducing podocyte injure of IMN.