| Objective: Membranous nephropathy is a common cause of the nephritic syndrome in adult patients.It’s characteristic change is immune complexes deposition under epithelial cells with diffuse thickening of basement membrane.It can be divided into idiopathic membranous nephropathy(IMN)and secondary membranous nephropathy(SMN).Recently,the prevalence of IMN in primary glomerulonephritis disease has significantly increased among the world.The disease affects patients of all ages and ethnic and racial groups but is more common in men than in women(sex ratio=2:1),with the peak incidence in individuals aged 30~50 years.60~80%of patients with IMN present with nephrotic syndrome;the remainder present with asymptomatic proteinuria.Long term mass proteinuria can lead to progressive decline in renal function in patients with renal disease,and even gradually develop into end-stage renal disease.The treatment includes non immunosuppressive therapy and immunosuppressive therapy.The use of angiotensin-converting enzyme inhibitors(ACEI)or angiotensin II receptor blockers(ARB)to reduce proteinuria and control blood pressure,correct the disorder of lipid metabolism;there are many choices of immunosuppressive agents,including corticosteroids combined with cytotoxic agents,such as alkylating agents,calcineurin inhibitors or mycophenolate mofetil etc,but the side effects of hormone and immunosuppressant brings cannot be underestimated.A large number of clinical practice in recent years show that traditional Chinese medicine on the basis of syndrome differentiation combined with individual cases compelling results have been reported recently to relieve clinical symptoms,reduce side effects and complications and protect renal function.Professor Tan according to the "Prolonged illness enters into venation" theory and the disease path length,easy to repeat,the tongue is dull teeth marks,pulse astringent and other characteristics,he suggested that the key to IMN pathogenesis is spleen and kidney deficiency Syndrome,Blood stagnation in kidney meridian.This topic uses the method of invigorating the kidney and invigorating the spleen,dispersing blood stasis and dredging collateral.To analyze the clinical curative effect of invigorating the kidney and invigorating the spleen,dispersing blood stasis and dredging collateral on the treatment of idiopathic membranous nephropathy based on the changes of laboratory indexes and clinical symptoms scores of patients before and after treatment,the clinical curative effect evaluation of the drug,in order to play the advantages and characteristics of traditional Chinese medicine,to provide reference and basis for the treatment of this disease combination of traditional Chinese medicine.Methoths: A total of 80 patients with idiopathic membranous nephropathy were enrolled in this study.All of them were from September2014 to September 2016 in Hebei Provincial Hospital of traditional Chinese medicine outpatients and inpatients(54:26).All subjects were randomly divided into experimental group(n=40)and control group(n=40).There was no significant difference between the experimental group and the control group before the treatment,and the two groups of patients were given the same basic treatment.The control group given prednisone acetate tablets,follow the "starting dose should be enough to reduce the drug to be slow,long course of treatment" principle.Starting dose of 0.8~1mg/(kg·d),morning dayton clothing,after 8 weeks the regular reduction,minus 5 mg per week,until reduced to 30mg;thereafter every 2 weeks by 5mg,reduced to 20mg;thereafter every 4 weeks Reduced by 5mg,reduced to 10 mg,maintain oral;oral cyclophosphamide(CTX)50mg bid,CTX total dose of 6~9g.The rats in the experimental group were treated with Yishen Tongluo Decoction at the same time one dose per day,in addition to medicines same as what the control group took.The two groups were both treated for 3 months.Levels of 24 hurinary total protein(24h-UTP),serum total protein(TP),serum albumin(ALB),triglyceride(TG),cholesterol(TC),type I plasminogen activator inhibitor(PAI-1),endothelin 1(ET-1),fibrinogen(FIB)and other laboratory indicators were examined respectively before and after treatment.The data were analyzed by SPSS19.0 statistical software,P<0.05 difference was statistically significant,P<0.01 was statistically significant.To analyze the clinical curative effect of invigorating the kidney and invigorating the spleen,dispersing blood stasis and dredging collateral on the treatment of idiopathic membranous nephropathy.Results:1 Compared with the two groups,the total effective rate of the experimental group was 92.30% and 80.56% in the control group.There was significant difference between the two groups(P<0.05).2 The efficacy of TCM clinical symptom: the experimental group average symptoms before treatment was 43.93+6.56 points,while average symptoms after treatment was 15.08+4.08 points,there was significant difference(P<0.05).The control group average symptoms before treatment was43.27+7.28 points,while average symptoms after treatment was 20.54+3.23 points,there was significant difference(P<0.05).There was significant difference between the experimental group and the control group after the treatment(P<0.05).3 The curative effect of symptom had significant difference after treatment in two groups(P<0.05).the total effective rate of the experimental group was 87.18%,the control group was 77.78%,the experimental group was better than the control group.4 Compared with the control group,the symptom scores of the two groups were better than the control group.In the experimental group,anorexia,curative effect of the six aspects of waist and knee pain,diarrhea,listlessness,scaly skin,frequent micturition is significant,the difference was statistically significant(P<0.05).5 The experimental group was superior to the control group in reducing24 h proteinuria and the effect was improved with the treatment time.There was significant difference(P<0.05).The experimental group was superior to the control group in improving plasma protein(TP,ALB)and lowering blood lipids(TC,TG),which was statistically significant(P<0.05).6 The experimental group was better than the control group in the improvement of coagulation index(PAI-1,ET-1,FIB),There was a significant difference between the two groups after treatment(P<0.05).Conclusion:1 The treatment of Yishen Tongluo decoction for idiopathic membranous nephropathy can significantly improve clinical symptoms,reduce the clinical symptoms score,the role of the clinical symptoms improved significantly better than the control group.2 The treatment of Yishen Tongluo decoction for idiopathic membranous nephropathy could reduce proteinuria,increase plasma protein,reduce blood fat,improve coagulation function.3 The treatment of Yishen Tongluo decoction for idiopathic membranous nephropathy can maintain the stability of liver and kidney function with good safety. |
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