A Comparative Study Of Kunxian Capsule And Tacrolimus In The Treatment Of Idiopathic Membranous Nephropathy

BackgroundIdiopathic membranous nephropathy(IMN)is a common pathological type of primary nephrotic syndrome.There are many treatments for IMN,including glucocorticoids,biologics,traditional Chinese medicine,cyclophosphamide,tacrolimus,and other immunosuppressants.In general,glucocorticoids alone are not recommended,and immunosuppressive agents should be combined.The choice of immunosuppressive agents,the ideal time to start immunosuppressive therapy,and the patient groups who can actually benefit from immunosuppression are still controversial.Therefore,the best treatment plan for IMN is still being discussed.ObjectiveTo compare the efficacy and safety of Kunxian capsule combined with prednisone and tacrolimus combined with prednisone in the treatment of IMN.MethodsFrom March 2019 to January 2020,60 patients who underwent renal biopsy and clinically confirmed IMN at the Nephrology Hospital of the First Affiliated Hospital of Xinxiang Medical College were selected and randomly divided into two groups,and they were given Kunxian Capsules combined with prednisone(Kunxian capsule group)and tacrolimus combined with prednisone(tacrolimus group).The 24-hour urine protein quantification and serum albumin levels of the two groups of patients before treatment and1,3,6,and 12 months after treatment were recorded,and the total effective rate,complete remission rate and incidence of adverse reactions were compared between the two groups.Results1.A total of 28 patients in the Kunxian capsule group completed the follow-up,and a total of 30 patients in the tacrolimus group completed the follow-up observation.There were no differences in general data and laboratory indicators between the two groups of patients when they were enrolled(P>0.05).2.At 1 month of treatment,the total effective rate(64.3%)of the Kunxian capsule group was higher than that of the tacrolimus group(33.3%)(χ~2=5.557,P<0.05);after 3,6,12 months of treatment,There was no significant difference in the total effective rate between the two groups of patients(χ~2=1.479,0.265,0.251,P>0.05).3.At 1,3,6,and 12 months of treatment,there was no significant difference in the complete remission rate of the two groups of patients(χ~2=1.047,0.259,0.074,0.006,all P>0.05).4.The 24-hour urine protein level of patients in the Kunxian capsule group was lower than before treatment at 1,3,6,and 12 months(P<0.05);at 12 months,the 24-hour urine protein level of patients in the Kunxian capsule group was low At 1 month of treatment(P<0.05).The 24-hour urine protein level of patients in the tacrolimus group was significantly lower than before treatment at 6 and 12 months(P<0.05).At 6 and 12 months,the 24-hour urine protein level of patients in the tacrolimus group was significantly lower Lower than at 1,3 months of treatment(all P<0.05).At the first and third months of treatment,the 24-hour urine protein level of the tacrolimus group was higher than that of the Kunxian capsule group(both P<0.05);at the 6th and 12th month,the 24 h urine protein level of the two groups was different No statistical significance(all P>0.05).5.At 3,6,and 12 months of treatment,the serum albumin level of patients in Kunxian capsule group was higher than before treatment and at 1 month of treatment(P<0.05).At 6and 12 months of treatment,Kunxian capsule group The patient’s serum albumin level was higher than that at 3 months of treatment(all P<0.05).At 1,3,6,and 12 months of treatment,the serum albumin level of patients in the tacrolimus group was higher than before treatment(all P<0.05);at 6 and 12 months of treatment,the serum albumin level of patients in the tacrolimus group was The albumin level was higher than that at 1 and 3months of treatment(all P<0.05).At 1 and 3 months of treatment,the serum albumin level of the tacrolimus group was higher than that of the Kunxian capsule group(P<0.05);at 6and 12 months of treatment,there was no statistical difference in the serum albumin level of the two groups Academic significance(P>0.05).6.The incidence of adverse reactions in the Kunxian capsule group was 21.4%(6/28),the incidence of adverse reactions in the tacrolimus group was 46.7%(14/30),and the incidence of adverse reactions in the Kunxian capsule group was lower than that of tacrolimus group(χ~2=4.083,P<0.05).ConclusionThe effect of Kunxian capsule combined with glucocorticoid in the treatment of IMN is similar to tacrolimus combined with glucocorticoid regimen,with faster onset and better safety,and is one of the effective regimens for the treatment of IMN.