| Background:IgA nephropathy(immunoglobulin A nephropathy,IgAN)is the most common primary glomerular disease in the world,with a high incidence in Asia,and some patients develop end-stage renal disease(ESRD)within decades of onset.Because the pathogenesis is unknown,modern medicine still focuses on supportive treatment,and specific therapeutic drugs that effectively delay the progression of the disease have not yet come out.The KDIGO guidelines recommend the use of RAS inhibitors and immunosuppressive agents for treatment based on the patient's proteinuria level and renal function status,but the effectiveness and safety of the regimen are controversial.In recent years,many clinical studies have shown that traditional Chinese medicine treatment of IgA nephropathy has certain advantages,which can delay the deterioration of renal function and improve the quality of life of patients.In his decades of clinical practice in the prevention and treatment of nephropathy with integrated Chinese and Western medicine,Chief Physician Liu Yuning put forward the theory of "Triple Burner Damp-Heat Injury to Blood" through long-term research on the etiology,pathogenesis and clinical manifestations of IgA nephropathy,which has been observed in pre-clinical studies.Guiding the effectiveness of kidney disease treatment can provide new ideas for the prevention and treatment of IgA nephropathy by traditional Chinese medicine.Objective:In this study,patients with CKD 2-4 stage diagnosis of IgA nephropathy and TCM syndromes of damp-heat syndrome combined with blood stasis syndrome were used as the research object.On the basis of western medicine supportive treatment,Chinese medicine treatment plan guided by the theory of "triple burnt damp-heat injury and blood" was added.Analyze the changes in renal function status(assessed by blood creatinine,estimated glomerular filtration rate,renal function staging),urinary protein quantitative level and TCM syndrome scores at different time points before and after treatment by statistical analysis of the experimental group and the control group,To evaluate the effectiveness and safety of traditional Chinese medicine treatment programs,and to verify the theory of "Triple Burner Damp Heat Injury Blood".Methods:The outpatient department of the Department of Nephrology of Beijing University of Chinese Medicine Dongzhimen Hospital and Peking University First Hospital was used as the research center,the drug intervention cycle was 6 months,and the start and end time of the study was October 2018-April 2021.Using a non-random,concurrent control method,the patients who meet the criteria for inclusion in this study were divided into an experimental group(n=72)and a control group(n=29).The control group received the western medicine supportive treatment plan,and the experimental group was based on the western medicine supportive treatment plan.The Chinese medicine treatment plan guided by the theory of "Triple Burner Damp-heat Injury Blood" is added above.Comparison of baseline levels,renal function status at the end of 3 months of treatment and 6 months of treatment(assessed by blood creatinine,estimated glomerular filtration rate,renal function staging),urinary protein quantitative level,and TCM syndrome scores between the two groups Changes.Analyze the data through statistical methods to evaluate the effectiveness and safety of traditional Chinese medicine treatment programs.Results:The baseline age of the experimental group(n=72)and the control group(n=29)(41.56±11.62 vs 40.45±11.54 years old),the median Scr(quartile)was 142.5(109.5,235.025)umol/L,174.0(145,227)umol/L,the median(quartile)of eGFR-EPI were 42.3(25.9,66.3)ml/(min·1.73 m~2),37.0(26.7,45.3)ml/(min·1.73 m~2),the median(quartile)of CKD staging is 3(2,4),3(2.3,4),and the median(quartile)of 24hUTP is 1.8(0.9625,3.135),respectively g/d,2.1(0.5,3.6)g/d,the median(quartile)of TCM syndrome scores were 90(82,95.5)points,94(88,98)points,the baseline values of the two groups were compared There was no significant difference(P>0.05).Follow-up to 3 months,the renal function of the experimental group and the control group were improved compared with before,24hUTP,TCM syndrome scores were reduced compared with the previous,the median Scr(quartile)of the two groups were 127.7(96.5,203.5)umol/L,164.8(124.0,238.8)umol/L,the median(quartile)of eGFR-EPI were 49.1(28.0,82.8)ml/(min·1.73 m~2),38.1(24.0,56.7)ml,respectively/(Min·1.73 m~2),the median(quartile)of 24hUTP is 1.5(0.5,2.5)g/d and 1.8(0.4,2.8)g/d,respectively,the median of TCM syndrome integral(quartile)The digits)were 84(80,90)points and 93(88,98)points respectively.There were significant differences in Scr,eGFR-EPI,24hUTP,and TCM syndrome scores between the two groups(P<0.05).Follow-up to 6 months,the renal function of the experimental group improved compared with the previous,24hUTP,TCM syndrome scores were reduced compared with the previous,the renal function of the control group deteriorated compared with the previous,24hUTP decreased compared with the previous,the TCM syndrome scores did not change,the two groups of Scr The quartiles(quartiles)were 134.6(86,218.5)umol/L,179.5(111.6,243.3)umol/L,and the median(quartiles)of eGFR-EPI were 47.9(26.1,88.0).ml/(min·1.73 m~2),32.4(25.0,59.3)ml/(min.1.73 m~2),the median(quartile)of CKD staging is 3(2,4),3(3,4),The medians(quartiles)of 24hUTP were 1.2(0.5,2.3)g/d and 1.2(0.3,2.3)g/d,respectively,and the medians(quartiles)of TCM syndrome scores were 80(76.5).,86)points,94(86,97.5)points,there are significant differences in Scr,eGFR-EPI,and TCM syndrome scores between the two groups(P<0.05),and there is no significant difference in 24hUTP(P>0.05).Conclusion:(1)Treating IgA nephropathy with CKD2-4 stage based on "triple burnt damp heat and blood" can improve its renal function;(2)Treating IgA nephropathy with stage CKD2-4 based on "triple damp heat and blood injury" can reduce proteinuria levels(3)Treating IgA nephropathy CKD2-4 stage based on "three-burner damp heat injury and blood"can improve the TCM syndrome points. |
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