| IgA nephropathy(IgAN)is a chronic glomerulonephritis caused by abnormal deposition of immunoglobulin A in the mesangial region and capillary loop.It is A common primary glomerulonephritis in China.IgAN is mainly affected by young and middle-aged people,with the peak age of onset ranging from 20 to 40 years old.About 20%to 30%of patients enter end stage renal disease(ESRD)within 10 to 20 years after onset,which causes a huge burden on the society and the family.At present,IgAN uses The Oxford pathological classification as the prognostic factor,and T lesion(renal tubular atrophy/interstitial fibrosis)is the strongest prognostic indicator.Acute tubulointerstitial nephropathy(ATIN)is a kind of clinicopathological syndrome characterized by multi-etiological infiltration and edema of inflammatory cells in renal interstitial,damage of renal tubule and renal insufficiency.At present,the clinicopathological manifestations of IgAN with ATIN account for about 5%?9%of primary IgAN,and these patients often suffer from rapid decline of renal function.Currently,there are few studies on this pathological type,which cannot provide clinical treatment and prognosis information.IgAN with ATIN performance to some extent for acute kidney injury(acute kidney injury,AKI),the characteristics of always tutor found the settlement in the study of shaoyang and the sanjiao method can improve the clinical curative effect,improve the patient's clinical symptoms,so formed on the basis of immune adjustment joint yiqi huoxue,pass through the method of syndrome differentiation based on ideas.This study to the gate of hospital patients with IgA nephropathy long-term follow-up database as the foundation,immunomodulatory therapy were retrospectively analyzed in combination with method of yiqi huoxue,pass through IgAN and ATIN treatment effect,and compared with clinical research has been published,aims at providing a method of yiqihuoxue and tongli sanjiao,pass through treatment IgAN and ATIN provide clinical evidence of integrated traditional Chinese and western medicine treatment,provide experimental basis for further clinical control experiment.Research purpose:To investigate and evaluate the efficacy and safety of yiqihuoxue and tongli sanjiao combined with immunoregulation in the treatment of IgAN with ATIN.Research methods:At the hospital of Guanganmen on January 1,2007 to January 1,2019,513 cases of IgAN database as the foundation,to screen renal biopsy of 41 patients with IgAN and ATIN(8.0%),conform to the standards in 36 cases,review of general situation,clinical manifestation,patients with basic diseases,laboratory examination,pathological data and follow-up data,etc,using their own before and after treatment comparison,analysis and treatment for 6 months,12 months in patients with Scr,BUN,propagated,UTP,eGFR index,the method of yiqi huoxue,tongli sanjiao immunomod-ulatory therapy IgAN merger ATIN curative effect analysis.Research results:1.Renal function index(1)Hypertension is common clinically,and grade 3 hypertension accounts for 59%of the total population.There was no oliguria or anuria.30.56%of the patients had gross hematuria and 69.4%had nocturia for more than 2 times.Clinically,75%of the patients had proteinuria<3.5g/d,high serum creatinine level,and 80.5%had CKD3 or higher..(2)Hypertension is common clinically,with grade 3 hypertension accounting for 59%of the total population;There was no oliguria or anuria,gross hematuria was 30.56%,and 69.4%patients had nocturia for more than 2 times.Clinically,75%of the patients had proteinuria<3.5g/d,high serum creatinine level,and 80.5%had CKD3 or higher.(3)Infection is the main cause of IgAN associated with ATIN,and respiratory tract infection is the most common,accounting for 19.4%.Drugs,pregnancy and so on are also its inducing factors.(4)The time from abnormal urine test to renal puncture lasted from 4 days to 7 years,accounting for 47.2%in 3 months.2.Laboratory indicators(1)After 6 months of treatment,serum creatinine Scr(158.07±68.96 vS 187.12±78.67)and urinary protein quantitative UTP[1.84(1.03,2.89)vs 2.47(1.67,3.49)]were decreased,P<0.01,and the difference was statistically significant.Albumin ALB(41.22±4.99 vs 37.75±6.44)and estimated glomerular filtration rate(eGFR)(52.20±23.23 vs 42.68±18.78)were increased,P<0.01,with statistically significant difference.Blood urea nitrogen BUN(9.17±3.48 vs 9.38±3.17)was decreased,but P>0.05 was not statistically significant.(2)After 12 months of treatment,serum creatinine Scr(145.26±62.44 vs 187.12±78.67)and urinary protein quantitative UTP[1.54(0.84,2.41)vs 2.47(1.67,3.49)]were decreased,P<0.01,with statistically significant differences,compared with baseline.Albumin ALB(42.25±5.04 vs 37.75±6.44)and estimated glomerular filtration rate eGFR(57.47±24.97 vs 42.68±18.78)were increased,P<0.01,with statistically significant difference.Blood urea nitrogen BUN(8.41 ±3.07 vs 9.38±3.17)was decreased,but P>0.05 was not statistically significant.(3)After 12 months of treatment,8 cases(22.2%)returned to normal Serum creatinine level,23 cases(63.9%)decreased Serum creatinine from baseline,and 5 cases(13.9%)increased Serum creatinine from baseline(no more than 35%increase).3.Efficacy evaluation of TCM symptoms and main symptoms(1)After the yiqihuoxue,tongli trijiao combined with immunosuppressive therapy,the TCM symptoms of 36 patients were significantly relieved compared with the previous treatment,Z=-5.243,P<0.01,showing a significant statistical difference.Among the symptoms of fatigue,shortness of breath,lazy speech,lumbar and knee soreness,little sodium,nocturia.(2)According to the efficacy evaluation of TCM symptoms,there was 1 case of obvious effect(syndrome score reduced ?70%);34 cases were effective(syndrome integral reduction?30%).The total effective rate was 94.44%in 2 cases with invalid syndrome score(reduced by less than 30%).4.Adverse reactionsBy the end of the 12 months of treatment,no adverse reactions had occurred in TCM combined with immunosuppressive therapy.In the follow-up,the total follow-up time was 12?93 months,with a median of 18.0(12.0,38.2)months,and a total of 1 adverse event occurred,namely infection.5.Clinical endpoint eventsBy the end of 12 months of treatment,there were no clinical endpoints such as CKD5,renal replacement therapy or death.By The observation of December 2019,the median 18.0(12.0,38.2)months,there were 3 cases(8.33%)of clinical endpoint events,including 1 case of CKD5 and 2 cases of dialysis.6.Conclusion:(1)Yiqihuoxue,tongli sanjiao combined with immunoregulation treatment of IgAN with ATIN can significantly reduce proteinuria,stabilize or improve renal function;(2)Traditional Chinese medicines related to invigorating Yiqihuoxue and Tongli sanjiao can significantly improve patients' clinical symptoms,and may have no obvious side effects.However,their therapeutic effect on the disease remains to be confirmed by new clinical studies. |
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