| Research objective:To observe the effect of modified Wulingsan on proteinuria,serum albumin,electrolyte,blood lipid,serum aldosterone levels and clinical symptoms of adult primary nephrotic syndrome patients with edema of spleen and kidney yang deficiency type,and to evaluate its clinical efficacy,and to explore the possible mechanism of modified Wulingsan in treating adult primary nephrotic syndrome edema.Research method:From June 2017 to October 2018,64 patients with primary nephrotic syndrome complicated with edema and syndrome differentiation of TCM and spleen and kidney yang deficiency were selected as observation cases in the nephropathy ward and outpatient clinic of garden hill courtyard of Hubei TCM hospital.They were randomly divided into control group and experimental group with 32 cases each.The control group and the experimental group were given basic treatment:low salt,low fat,limited-high-quality-protein-diet,improved-circulation,anti coagulation,diuretic-detumescence,immunosuppression and other symptomatic supportive treatment.On the basis of the control group,the experimental group added and subtractedWulingsan(porcine Ling 15 g,Alisma 10 g,fried Atractylodes macrocephala 10 g,Poria cocos 30 g,cinnamon 10 g,plantain seed15 g,Wang Buhuixing 10 g,Leonurus 15 g,Astragalus 30 g,Xianling Spleen 15 g,Jin Yingzi 15 g,Qinshi 30 g,Guangmuxiang 10 g,Chen Pei 10g)as the decoction of the traditional Chinese medicine in our hospital,once a day,twice a day,warm after 100 ml meal for 8weeks.The 24-hour urine volume,body weight,body mass index,24-hour urinary protein quantification,serum albumin,serum potassium,serum sodium,serum total cholesterol,triglyceride and serum aldosterone levels in the decubitus position at the 0th,4th and 8th weeks were measured before and after treatment,and the scores of clinical symptoms of the two groups were recorded before and after treatment.Research result:1.Comparison of disease efficacy:After treatment,the total effective rate of the control group was 81.25%,and that of the experimental group was 87.50%.There was significant difference between the two groups(P<0.05).The disease efficacy of the experimental group was better than that of the control group.2.Comparison of TCM syndromes:After treatment,the total effective rate of the control group was 75.00%,and that of the experimental group was 93.75%.There was a statistical difference between the two groups(P<0.05).The curative effect of TCM syndromes in the experimental group was better than that in the control group.3.Comparison of TCM clinical symptom scores:After treatment,the symptoms of the control group were improved except for cold limbs,lumbar spine pain,lumbar and knee soreness and feces(P>0.05);the clinical symptoms of the experimental group were improvedsignificantly compared with those before treatment(P<0.01);after treatment,the clinical symptoms of the experimental group were improved compared with those of the control group,especially the symptoms of edema and mental malaise.The improvement was most obvious(P<0.01).4.Comparison of serum aldosterone indicators in recumbent position:After treatment,aldosterone in the control group and the experimental group decreased significantly in the 4th and 8th weeks compared with that before treatment,especially in the 8th week(P<0.01);after treatment,aldosterone in the experimental group had no statistical difference compared with that in the control group(P>0.05),aldosterone in the 8th week was higher than that in the experimental group(P>0.05).The difference was statistically significant(P<0.05).5.Comparison of other biochemical indicators:After treatment,the 24-hour urinary protein and serum potassium in the control group and the experimental group decreased significantly,serum albumin increased significantly,serum total cholesterol did not change significantly,serum sodium and triglyceride in the control group did not change significantly,and serum sodium and triglyceride in the experimental group decreased significantly;after treatment,there was no significant change except serum total cholesterol.In addition,the biochemical indexes of the experimental group were better than those of the control group(P<0.05).6.Comparison of indicators reflecting edema changes:After treatment,the 24-hour urine volume of the control group and the experimental group increased significantly,while the body weight and body mass index decreased significantly;after treatment,theobservation indicators reflecting edema changes of the experimental group were better than those of the control group(P<0.05).There was a difference in the degree of edema between the two groups after treatment(P<0.05).The improvement of edema in the experimental group was better than that in the control group.7.Comparison of safety indicators:After treatment,there was no significant difference in blood routine,liver function,renal function,electrocardiogram and other indicators between the experimental group and the control group(P>0.05).Research conclusion:Adding or subtracting Wulingsan combined with routine western medicine treatment can significantly improve the clinical symptoms of spleen and kidney yang deficiency edema in adult primary nephrotic syndrome.It can reduce edema,increase urine volume,reduce proteinuria,improve lipid metabolism,reduce body weight and body mass index,reduce 24-hour urinary protein quantification and triglyceride,and increase serum albumin.Adding or subtracting Wulingsan can reduce the level of aldosterone in patients' lying position,reduce water and sodium retention and reduce kidney damage.It may be one of the mechanisms of Wulingsan in treating edema in patients with primary nephrotic syndrome,reduce the incidence of hypokalemia,and may have a certain role in regulating electrolyte disturbance.The clinical effect of modified Wulingsan in treating primary nephrotic syndrome edema is definite,and there are no obvious adverse reactions in the use process.It is safe to use medicine and has clinical application value.It is worthy of clinical promotion and further study. |
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