| Purpose:1.To study the distribution of TCM Syndrome Types and proteinuria stratification in patients with elderly primary nephrotic syndrome(EPNS),and to explore the correlation between TCM syndrome types,different proteinuria stratification and clinical indicators,so as to provide theoretical basis for promoting the treatment of EPNS with integrated traditional Chinese and Western medicine.2.To observe the clinical efficacy and safety of Yiqi Huoxue Decoction in the treatment of EPNS,in order to improve the efficacy of EPNS,improve the symptoms of patients and expand the treatment methods.Methods:1.Patients who were diagnosed with EPNS would be collected when they met the inclusion criteria from January 2016 to December 2019.The basic information of patients and TCM syndrome types,laboratory indicators and therapeutic schedule were collected,and TCM syndrome types were classified according to asthenia syndrome of the primary and sthenia syndrome of the secondary.24hUTP was divided into three groups according to ≤ 4g/24h,4～8g/24h and≥8g/24h in order to analyze the correlation between TCM Syndrome Types,proteinuria stratification and clinical indicators,evaluating the treatment effect with before and after self control study and comparison between groups.2.30 cases of EPNS with Qi deficiency and blood stasis were divided into control group and therapy group by random grouping method,patients were treated with basic treatment of western medicine while Yiqi Huoxue Decoction was added in the treatment of therapy group.Collect the efficacy indexes of the two groups before treatment,4 weeks,12 weeks and 24 weeks in order to identify differences.Results:1.Retrospective analysis1.1 72 patients with EPNS were included in the study in actuality,these patients aged 65～69 was the most,accounting for 44.4%while the average age of onset was 70.85±5.19 years.The course of disease ranged from 10 days to 36 years while 1 to 2 years for the most,with a median of 1 year.Membranous nephropathy was the most common type in 35 cases of renal biopsy pathology,accounting for 68.6%.Among the types of disease,33 cases were primary,22 cases were recurrent,and 17 cases were unresponsive after treatment for 6 months or more.50 times of complications and adverse reactions occurred during the treatment.The complications were found in 32 cases,followed by infection(61%),deep vein thrombosis(22%)and acute kidney injury(17%),while adverse events were followed by abnormal liver function(38%),infection(31%),steroid diabetes(22%)and serum creatinine increased from normal to abnormal after teartment(9%).1.2 Proteinuria stratification and clinical:Tripterygium wilfordii used singlely was the most selected therapeutic schedule,and there was therapeutic effect varies among different therapeutic schedules(P<0.05).The number of people whose UTP among 4～8g/24h was the most,accounting for 40.3%,29.2%of them were less than 4g/24h,and 30.5%of them were more than 8g/24h.There were significant differences on clincal effective rate,TC and TG among different proteinuria stratifications.There was no statistical difference in ALB and renal function among all proteinuria stratifications.Treatment lead to statistical difference in ALB level among different proteinuria stratifications(P<0.05)which in contrast to the result in renal function(P>0.05).Similar clinical effects were also observed in indicators,such as UTP,urinary protein characterization and ALB(P<0.05).Proteinuria stratification was significantly correlated with urinary protein characterization and TC(P<0.01),but not with ALB,TC,renal function and CKD stage(P>0.05).The renal function of patients with chronic renal insufficiency got worse during treatment along with higher BUA level(P<0.05),while the change of BUN had no statistical difference(P>0.05).1.3 TCM syndrome type and clinical parameters:Qi deficiency syndrome with blood stasis syndrome is the most common combination among EPNS patients.There was statistic difference in proteinuria stratification among different deficiency syndromes(P<0.05).The level of UTP was the highest in the spleen kidney yang deficiency syndrome while on the contrary in the spleen kidney qi deficiency syndrome(P<0.01).The level of the ALB was the highest in spleen kidney qi deficiency syndrome and the lowest in lung kidney qi deficiency syndrome(P<0.01).The results considered that different types of deficiency syndrome had similar distribution in renal function,hemoglobin and TG.The level of Scr usually had a discrepant spread among these syndromes for the highest in the damp turbid syndrome while in the other hand,it changed into the lowest in blood stasis syndrome.and there were differences between damp turbid syndrome and other syndrome types(P<0.05).Wide difference was confirmed in the specific value of TC between damp heat syndrome and damp turbid syndrome,the one before the two was the highest,the other one is the opposite(P<0.01).There was no significant difference in proteinuria stratification,BUN,BUA,hemoglobin and TG among the syndrome types of standard excess(P>0.05).2.Prospective efficacy observation:13 cases of each group were followed up regularly through the observation period.The two groups had a similar level in UTP before treatment(P>0.05).Compared with basic level,the therapy group showed a significant remission in each followed-up period while the other group only occurred the same effect in 24 weeks.However,the two groups projected similar therapeutic effects at 4,12weeks after statistics process,and the therapy group showed better in 24weeks under the circumstances.Compared with before treatment,ALB was significantly increased in the two groups at 4,12 and 24 weeks of treatment(P<0.01),and the curative effect was similar(P>0.05).The therapeutic effect of TC occurred since the middle stage in therapy group while the other group occurred later,within similar curative effect(P>0.05).The laboratory data seemed that different therapeutic schedule had no exact curative effect on TG(P>0.05)during the study,and renal function had no suffer compared with the basic line.The therapy group did better than the control group in reducing D-Dimer(P<0.05).The two groups all improved EPNS patients’ life quality in varying degrees with considerations of several standards such as TCM syndrome total score,quality of life score,in which the therapy group always had a better score than the other group.Conclusion:1.The majority of EPNS are male among these 72 patients,the course of disease varies greatly,the clinical symptoms are mild and severe,the main pathological type of kidney is membranous nephropathy in this group,high incidence rate of complications and adverse reactions,often combined with a variety of basic diseases,medication prone to liver and kidney function damage.2.There were differences in the curative effect among different proteinuria stratification.Proteinuria stratification was significantly correlated with urinary protein and TG,but not with ALB,renal function,TC and CKD stage based on the available study.3.Occurrence and progress of the diaease usually contribute to Qi deficiency syndrome combine with blood stasis syndrome,the most common combination among EPNS patients.Considering the deficiency syndromes in this study,the level of UTP in the kidney qi deficiency was the leastest while spleen and kidney yang deficiency on the contrary,the other one syndrome in the middle.A similar trend could be seen in the decrease of ALB,while these syndromes reversed their positions.Considering the standard excess syndromes,Scr showed a increasing trend from Blood stasis syndrome to dampness turbidity syndrome,the other two syndromes in between.Highest level of TC preferred to be distinguished to the dampness heat syndrome while the least always together with the dampness turbidity syndrome,and the others fall in between.4.Compared two groups of laboratory indicators and criterions of therapeutical effect,Yiqi Huoxue Decoction showed several superiorities in early stage,including significantly relieving clinical symptoms,promoting quality of life in EPNS patients.It also has unique advantages in improving clinical efficacy,reducing proteinuria,maintaining renal function within a normal range,alleviating hypercoagulable state,without apparent adverse reactions occurred during the period of observation,so it’s worthy continuous study and promoting. |
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