| Objective: To study and explore the efficacy and safety of Kunxian Capsule in the treatment of CKD(chronic kidney disease).Methods: Prospectively collected from March 2017 to February 2018,First Hospital of China Medical University,Department of Nephrology,inpatient and outpatient patients with a total 115 cases.ARB class based on medication,according to proteinuria,pathology and medication programs,alone or in the original treatment given Kunxian Capsule,observation of 3 to 6 months.Monthly review of blood,liver function,kidney function,urine,urine microglobulin,24 h urinary protein,and record adverse reactions.Before and after treatment comparison.According to 24-hour urinary protein quantitatively divided into 3 groups,each group by pathological type is divided into different subgroups.(1)<3.5g group;(2)3.5g-6g group;(3)> 6g group.(1)Kunxian Capsule monotherapy for newly diagnosed patients,(2),(3)mostly Kun xian Capsules and hormones or other immunosuppressive agents in combination therapy.In addition,8 of 115 patients were enrolled,who previously treated tacrolimus alone for more than 3 months and retrospectively collected their clinical data.Effects were compared with 9 patients alone Kunxian Capsule.Another set of a group of applications Tripterygium more than 3 months for poor results in exchange for use of Kunxian Capsule in 19 patients,a separate analysis of their clinical remission.Results: One case was excluded due to adverse reactions,the remaining 114 cases.(1)Efficacy: Total effective rate: 23 cases achieved complete remission(28.9%)after 1 month of treatment,43 cases achieved partial remission(37.7%),and total effective rate reached 57.9%;40 cases achieved complete remission at 3 months after treatment(35.1 %),36 patients achieved partial remission(36.0%),the total effective rate was 71.1%.The total effective rate of the three groups after treatment was 64.7%,80.0% and 72.7% respectively.Decreased proteinuria level: The urinary protein in 24 hours after treatment decreased by 1.44g(P <0.01),1.59g(P <0.01),1.64g(P <0.01).And after 3 months of treatment than the first month decreased 0.2g(P <0.01).(2)The subgroups: The total effective rate of each pathological type was> 53%,and the best effect was membranous nephropathy.The total effective rates were 69.2%,88.9% and 77.3% respectively in 3 different groups.(3)Urinary red blood cells: 3 months after treatment,urinary red blood cells decreased by 2.25 / HP(P <0.05),1.41 / HPF(P <0.01)and 2.55 / HPF(P <0.01)respectively before treatment.(4)treatment up to 6 months patients: The proteinuria of 24-hour urinary protein in 6 months decreased from the 3rd month,but the difference was not statistically significant(P> 0.05).The total effective rate was 80% in 6 months.(5)Safety: Nephrotoxicity: ? 1 followed MA and IgU decreased significantly(P <0.01)three months after treatment.Creatinine was doubled in only 1 patient,with a rate of 0.87%.Liver toxicity: Serum albumin decreased 3 months after treatment(P <0.01).Liver enzyme doubled in 2 cases,the incidence was 1.74%.Myelosuppression: Blood leukocytes decreased 1.2 * 10 ~ 9 / L(P <0.01),1.15 * 10 ~ 9 / L at the second and third month after treatment(P <0.01),but not lower than the lower limit of 4 * 10 ~ 9 / L.No change in platelet before and after treatment(P> 0.05).Gonadal suppression: the incidence of irregular menstruation 15.38%.Gastrointestinal symptoms: nausea,vomiting 1.74%,diarrhea 1.74%.Other adverse reactions: the incidence of rash 0.87%,the incidence of edema 1.74%.(6)compared with single tacrolimus group: Kunxian Capsule group of 9 patients,the total effective rate was 88.9%.Tacrolimus group of 8 patients,the total effective rate was 25%.the difference was statistically significant(P <0.05).The quantitation of urinary protein in 24 hours after Kunxian capsule treatment decreased 1.078g(P <0.05),1.182g(P <0.05),1.254g(P <0.01).Urinary protein in 24 hours after tacrolimus treatment did not change significantly(P> 0.05).(7)Kunxian capsule for Tripterygium 3 months after the complete remission rate of 15.8%,36.8% partial response rate,the total effective rate of 52.6%.The urinary protein in 24 hours after 3 months of dressing change decreased by 0.851g(P <0.01),0.978g(P <0.01)and 0.990g(P <0.01),respectively.Conclusiong:(1)Kunxian Capsule proteinuria significant effect,rapid onset and the role of stability.(2)Kunxian Capsule for different pathological types of CKD are effective,the best effect on membranous nephropathy.(3)For large amounts of proteinuria,Kunxian Capsules and hormones and other immunosuppressive agents have a synergistic effect.(4)Kunxian Capsule to reduce the role of small and medium amounts of proteinuria is better than tacrolimus.(5)Triptolide ineffective patient application Kunxian capsule can still get good effect.(6)Kunxian Capsule no obvious liver and kidney toxicity,although it can significantly reduce proteinuria,but the role of serum albumin is not obvious,have some reproductive toxicity and gastrointestinal reactions,can be used under monitoring. |
PDF Full Text Request