Clinical Study Of Fuzhengxiaozhuo Decoction Combined With Irbesartan On The Treatment Of Proteinuria Of Qi-yin Deficiency And Damp Turbidity Stasis Resistance Type Induced By Apatinib

Objective1.To investigate the incidence of apatinib in proteinuria and its effect on 24 hUPr,UACR,creatinine,urea nitrogen,creatinine clearance,Podocalyxin(PCX).2.To explore the clinical effect and mechanism of fuzheng xiaozhuo decoction combined with irbesartan in the treatment of apatinib caused by qi-yin deficiency and damp turbidity stasis resistance typeproteinuria.Method Clinical study ?: 30 patients who met the inclusion criteria and were admitted to the oncology and digestive departments of our hospital from October 2016 to April 2017 were selected and compared with the changes in urine routine urine protein,24 hUPr and ACR,and the changes in PCX,BUN,Scr and eGFR before treatment,2 weeks after treatment and 4 weeks after treatment.Clinical study ?: from May 2017 to December 2018,67 patients who were admitted to the oncology department and digestive department of anhui university of traditional Chinese medicine for inpatient and outpatient treatment and met the inclusion criteria were randomly divided into the treatment group and the control group,including 34 cases in the treatment group and 33 cases in the control group.A total of 3 cases fell off during the study,and 32 cases in the final treatment group and 32 cases in the control group.The treatment group and the control group were given irbesartan orally,and the treatment group was given fuzheng decoction plus or minus on the basis of the control group.The changes of urine routine urine protein,24 hUPr,ACR,PCX,TCM syndrome score and KPS score before and after treatment were observed in the two groups,and the efficacy of the two groups was evaluated.ResultsClinical study I1.Influence on urinary protein: the incidence of proteinuria at 2 weeks and 4 weeks after treatment was 26.66% and 43.33%,respectively.The difference of 24 UPr and ACR at 2 weeks before treatment and 4 weeks before treatment was statistically significant(P<0.01).2.Effect on PCX podocyte marker protein: plasma PCX was compared between 4weeks before and after treatment,and the paired t-test showed that P<0.01,with statistically significant difference.3.Influence on renal function: paired t-test of BUN,Scr and eGFR showed that P>0.05 in all patients before and 4 weeks after treatment,and the difference was not statistically significant.Clinical study ?1.Qualitative changes of urinary protein: qualitative comparison of urinary protein before and after treatment in each group showed statistical significance(P<0.05),and qualitative comparison of urinary protein in the treatment group and the control group showed statistical significance(P<0.05).2.24 changes in UPr and ACR: the differences of 24 UPr and ACR levels before and after treatment in each group were statistically significant(P<0.01)by paired t-test,while the differences of 24 UPr and ACR levels in the treatment group and the control group were statistically significant(P<0.05)by t-test of two independent samples after treatment.3.PCX changes: the differences in PCX levels before and after treatment in each group were statistically significant by paired t-test(P<0.01),while the differences in PCX levels after treatment in the treatment group and the control group were statistically significant by t-test of two independent samples(P<0.01).4.Comparison of efficacy of proteinuria: the effective rates of the treatment group and the control group were 87.50% and 71.87%,respectively,and the difference was statistically significant(P<0.05)by Wilcoxon test.5.Comparison of TCM syndrome efficacy and integral points: the total effective rates of the control group and the treatment group were 87.50% and 68.75%,respectively,and the difference was statistically significant(P<0.05)by Wilcoxon test.Paired t-test showed statistically significant differences in TCM syndrome score levels before and after treatment in each group(P<0.01),while t-test of two independent samples showed statistically significant differences in TCM syndrome score levels after treatment in the treatment group and the control group(P<0.01).6.Comparison of KPS efficacy and scores: Wilcoxon test showed no significant difference in KPS score between the two groups(P>0.05).Wilcoxon test showed no statistically significant difference in KPS scores before and after treatment in each group(P>0.05),while t test of two independent samples showed no statistically significant difference in KPS scores after treatment in the treatment group and the control group(P>0.05).7.Evaluation of tumor efficacy: the DCR of tumor evaluation in the treatment group and the control group were 62.50% and 56.25%,respectively.Wilcoxon test showed no significant difference(P>0.05).Conclusion1.PCX,24 hUPr and UACR levels of patients taking apatinib were significantly higher than those before treatment,indicating that proteinuria was one of the adverse reactions of apatinib,and glomerular podocyte injury may be involved in the occurrence of apatinib-induced proteinuria.2.Fuzhengxioahzuo decoction combined with irbesartan can reduce the urine protein of patients with apatinib proteinuria caused by qi-yin deficiency and damp turbidity stasis resistance type,which provides the basis for the clinical treatment of albuminuria caused by antivascular targeted drugs with traditional Chinese medicine.