The Meta-analysis Of Treating Primary Nephrotic Syndrome By Chinese Medcine Combined With Glucocorticoid And The Study Of Medication Rule Of Professor Zhang Zongli For Treating Primary Nephrotic Syndrome

Objective: In this study,Meta-analysis was used to systematically evaluate the clinical efficacy of traditional Chinese medicine combined with glucocorticoid in the treatment of Primary Nephrotic Syndrome(PNS);to analyzes the medication rule of Professor Zhang Zongli in the treatment of Primary Nephrotic Syndrome and summarizes the clinical treatment experience and theoretical thinking based on the method of data mining.Methods:1.All clinical randomized controlled trials published from December 31,2009 to December 31,2019 about the clinical efficacy of traditional Chinese medicine combined with glucocorticoid in the treatment of Primary Nephrotic Syndrome were retrieved and filtered from Wanfang Database,CNKI,VIP,CBM,Pubmed,Embase,The Cochrane Library.Then the selected data were evaluated by the Cochrane risk bias assessment tool and analyzed statistically according to the software Review Manager 5.3.2.After collecting and screening,this retrospective study included 58 clinically effective cases of Professor Zhang Zongli in treating Primary Nephrotic Syndrome,with 222 consultations.By using Microsoft Excel 2010 to establish a database with medical records and "Traditional Chinese Medicine Support System V2.5" for data mining to obtain the result of medicine flavors statistics,the frequency of medicine use,cluster analysis and association rule analysis.Results:1.A total of 25 studies were included in this study,including 2060 adult patients with Primary Nephrotic Syndrome.The results of the meta-analysis showed that:(1)the clinical effectiveness: RR = 1.27,95% CI [1.22,1.33],Z = 10.61,P <0.00001;(2)24-hour urine protein:(1)age≥41 years old: MD =-0.95,95% CI [-1.04,-0.87],z = 23.30,P < 0.00001;(2)age<41 years old: MD =-0.84,95% CI [-0.88,-0.79],z = 35.48,P < 0.00001;(3)age all unknown: MD =-1.07,95% CI [-1.15,-0.99],z = 26.18,P < 0.00001;(3)albumin: MD=4.99,95%CI[4.43,5.55],Z=17.45,P<0.00001;(4)Triglycerides: MD=-0.77,95%CI[-0.84,-0.70],Z=22.08,P<0.00001;(5)Bad Response rate: RR = 0.54,95% CI [0.44,0.66],Z = 5.87,P<0.00001.2.A total of 222 Chinese medicine prescriptions were included in this study,involving126 kinds of Chinese medicines.The frequency of medcine use was 2776 times,and the highest frequency of use was Huangqi;35 kinds of traditional Chinese medicines were used more than 20 times which accounts for 85% of the total frequency;Cold medicines were the most commonly used,accounting for 59.3% of the total frequency,followed by warm medicines;in the statistics of the five kinds of medcines,sweet and bitter medicines were used the most frequently;and the medcines in liver,lung,spleen,stomach,heart and kidney were used the most frequently;according to the medcine classification,the medcines with the function of promoting diuresis and dampness,tonifying deficiency were highly used,account-ing for 57.4% of the total frequency.Set the "number of support" to 88 to get 12 kinds of Chinese medicines and 28 rules.The correlation coefficient was set to 8 and the punishment degree was set to 2.,then based on the complex system entropy cluster analysis,18 drug core combinations and 9 new prescriptions were obtained.Conclusion:1.Traditional Chinese medicine combined with glucocorticoid is better than conventional western medicine alone in improving clinical efficacy,reducing proteinuria,increasing albumin,reducing blood lipids and adverse reactions in the treatment of adult Primary Nephrotic Syndrome,which indicates that using traditional Chinese medicine has a positive effect and is worthy of further exploration,but due to the low quality of the included studies,the conclusion needs more high-quality and reliable multi-center,large-sample randomized controlled trials to be confirmed.2.The disease is mostly characterized by the mixture of the deficiency and excess.The pathogenesis is mainly due to deficiency of lung,spleen,kidney and the excess of water,dampness,heat,and stasis.so when treating this disease,Professor Zhang Zongli thinks highly of strengthening the body resistance to eliminate pathogenic factors and pays attention to the use of tonic drugs to strengthen the foundation,Qi regulating drugs,blood activating drugs to remove blood stasis and other dialectical applications,which reflect the selection of Professor Zhang Zongli The characteristics of differentiation and treatment of cold and warm medicine,tonic and purgative drugs,and the same treatment of specimen.This study provides a reliable reference for the clinical diagnosis and treatment of nephrotic syndrome,and an effectiveexploration for the summary and inheritance of Professor Zhang Zongli’s academic thought of nephrosis in traditional Chinese medicine.