A Pre- And Post-control Study Of CKD2-5 Stage IgA Nephropathy In The Treatment Of CKD2-5 Stage IgA Nephropathy Which Is Invalid Under The Guidance Of Five Methods

Objective:IgA nephropathy is a common glomerulonephritis with a total incidence of at least 2.5 cases per 100,000 people,but the long-term prognosis is poor,with 25%of patients developing chronic renal failure after 20 years.IgAN is the predominant primary glomerulonephritis in China,accounting for about 43.5%,the first place in primary glomerular disease.The exact pathogenesis of IgAN has not been clarified,and there is no unified treatment plan.RAS system blockers are used to reduce proteinuria,but some patients have high blood pressure after taking it.Patients treated with RAS drugs for more than 6 months(including 6 months),and/or have been treated with hormones and immunosuppressants,but the 24-hour protein quantification is still greater than 0.5g,Or serum creatinine is higher than the baseline value,the glomerular filtration rate is<90ml(min.1.73 m2),indicating that RAS has a poor effect on these patients.For these patients we call them"ineffective Western medicine treatment".There are few clinical studies on the effects,pathological types,and immunofluorescence characteristics of such patients.In clinical practice,my instructor uses "the five methods" to treat these kind of chronic patients using"warming,supporting,supplementing,clearing,promoting blood circulation,removing phlegm and detoxifying,truncation method,grasping the independent method,expelling wind" are usefull.We are now further observing the efficacy and pathological characteristics of these patients under the guidance of the "Five Methods" in order to provide clinical basis for the treatment of IgAN CKD 2-5.Method:A study using a small sample of the real world before and after itself.The cases originated from 60 patients with primary IgAN CKD 2-5 from September 2016 to January 2020 who were treated in my tutor's clinic at Dongzhimen Hospital.Under the guidance of the "five methods",differentiation of traditional Chinese medicine treatment.Observe 24 urine protein(UTP),serum creatinine(Scr),glomerular filtration rate(eGFR),albumin(ALB),uric acid(UA),urea nitrogen(BUN),hemoglobin(HGB),and valleys at each follow-up point.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood potassium(K).Observations were performed 6 months before treatment and at each follow-up point(-6 months,-3 months,-1 months,and 0 months before treatment,and 1 month,3 months,and 6 months after treatment).Observe the pathological type characteristics and immunofluorescence characteristics of patients,and observe the effect.Result:(1)Compared with-6 months,Scr has an increasing trend in-3 months,Scr has increased in-1,0 months and-6 months,the difference is significant(P<0.05)And there is a continuous upward trend.Multiple comparisons indicate that there is also a statistically significant difference in Scr in each observation period(P<0.05).Compared with before the addition of traditional Chinese medicine,Scr decreased at 1 month,3 months and 6 months after treatment with Chinese medicine,the difference was statistically significant(P<0.05),and showed a continuous downward trend.Multiple comparisons suggested that each observation period There was also a statistically significant difference in Scr(P<0.05).(2)Compared with-6 months,eGFR in-3 months showed a downward trend,eGFR in-1,0 months and-6 months all decreased,the difference was statistically significant(P<0.05)And there is a continuous downward trend,multiple comparisons suggest that the eGFR of each observation period is also statistically different(P<0.05).Compared with before the addition of Chinese medicine.eGFR increased at 1 month.3 months,and 6 months after treatment with Chinese medicine,and the difference was statistically significant(P<0.05),and it continued to increase.Multiple comparisons suggested that each observation period There was also a statistically significant difference in eGFR(P<0.05).(3)Compared with-6 months,24h UTP decreased in-3 months,-1 month,and 0 months,the difference was statistically significant(P<0.05),and there was a continuous downward trend.Multiple comparisons suggested that each There was also a statistical difference in 24hUTP during the observation period(P<0.05).Compared with before the addition of Chinese medicine.24hUTP at 1 month after Chinese medicine treatment had a downward trend,and 24hUTP at 3 months and 6 months after Chinese medicine treatment had a decrease compared with before treatment,the difference was statistically significant(P<0.05).And there is a continuous downward trend,multiple comparisons suggest that there is a statistical difference in 24hUTP in each observation period(P<0.05).(4)There was no significant difference in ALB,UA,BUN before Chinese medicine treatment(P>0.05),and there was no statistical difference in multiple comparisons(P>0.05).After treatment with Chinese medicine,ALB showed an upward trend.Compared with before treatment,there was a statistically significant difference at 6 months after treatment(P<0.05).There was no significant difference in UA and BUN after Chinese medicine treatment(P>0.05),and there was no statistical difference in multiple comparisons(P>0.05).(5)There was no statistical difference in the changes of HGB,AST,ALT,and K before the treatment of traditional Chinese medicine(P>0.05),and there was no statistical difference in multiple comparisons(P>0.05).The changes of HGB,ALT,and K after Chinese medicine treatment were not statistically different(P>0.05),and multiple comparisons were not statistically different(P>0.05).The AST in the 3rd and 6th months after Chinese medicine treatment was higher than that before treatment,and there was a statistical difference(P<0.05),but both were within the normal range.(6)Among the patients in this group,36 cases were markedly effective,8 cases were effective,8 cases were stable,and 6 cases were ineffective.The effective rate is 62%,the effective rate is 13.7%,the smooth rate is 13.7%,the inefficient rate is 10.3%,and the total effective rate is 89.6%.(7)In the effective group,the pathological type was mainly FPGN,and the effective rate of FPGN was higher than other pathological types.IgA+IgM deposition is the main immunoglobulin.and the efficiency of IgA+IgM is higher than other immune deposition types.Complement deposition is mainly C3 deposition,of which C3 and Clq deposition are more effective than other complement deposition types.The effective group with renal interstitial vascular disease accounted for 88.46%.and the effective rate was 93.8%Conclusion:(1)The majority of the 58 patients were young and middle-aged men,and the onset was most often caused by respiratory infections.(2)The pathological types of 58 patients were mainly focal hyperplasia and proliferative sclerosis.The main deposition forms of immunoglobulin were co-deposition of IgA and IgM.The complement deposition was mainly C3.Nearly half of the patients have renal interstitial vascular disease.(3)Co-deposits of immunoglobulins IgA and IgM Chinese medicine treatment under the guidance of this program is better.(4)Complementary deposition of individuals with C3 deposition alone.The Chinese medicine treatment effect is better under the guidance of this program.(5)Patients with IgAN with renal interstitial vascular disease have better treatment with traditional Chinese medicine under the guidance of this program.(6)Using the "Five Methods" under the guidance of Fuxie theory to treat patients with IgAN CKD2-5 who are ineffective or ineffective with standardized Western medicine,can significantly reduce the serum creatinine and improve the glomerular filtration rate within a certain period,Reduce urine protein,thereby delaying the progression of these patients to end-stage renal disease.